Insight April 2020 by Prime Creative Media

INSIGHT APR

2020

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

OF CORONAVIRUS

Ophthalmic companies begin ramping up production after supply chain slow down.

MAKING MYOPIA A BUSINESS SUCCESS What should a practice consider before incorporating myopia management?

81012378_Gen8 Trade publication cover_Insight_v01.indd 1 SUPPLIERS VIGILANT

New

DECIPHERING THE EYECARE CODE

4/3/20 10:29 am

Big data is poised to shape future eyecare models and policy in Australia.

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INSIGHT APR

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

OPHTHALMIC SUPPLIERS EXERCISE VIGILANCE AMID CORONAVIRUS SUPPLY CHAIN DISRUPTION

The vast majority of ophthalmic manufacturers and suppliers in Australia have expressed confidence in their contingency plans and stock availability to continue supplying goods to the sector, following a disruptive trading period stemming from the coronavirus pandemic. The global outbreak, which coincided with the Chinese New Year holiday period in late January, prompted the Chinese Government to suspend production in factories across the country, including optical manufacturing hubs such as Wenzhou and Guangzhou. Several weeks later, as Chinese health officials secured a firmer grip on the virus, factory workers were allowed to return to work and begin increasing production to full

manufactured in China. All three Chinese factories the company has dealings with have since resumed production, but were still not fully operational at the time of print.

capacity. Outbreaks have since surfaced in Italy, South Korea and Iran, placing pressure on other parts of the international trading community. Organisers of the Milan eyewear trade show Mido postponed the event until July, while the O-Show, scheduled for Sydney on 16-17 May, has been cancelled due to the pandemic.

Lisa Wymond, of Eyes Right Optical, with stock that recently arrived from Europe.

At the time of writing, a selection of Australian ophthalmic manufacturers and distributors contacted by Insight reported disruption due to the outbreak, but remained confident they had enough stock to outlast the delayed arrival of goods.

however the next three to six months could be more uncertain. Businesses that work on a stock indent model could face a more immediate problem, with some not having had access to their suppliers’ inventories for six weeks.

Industry figures have said larger suppliers, particularly in the frames segment, will have available stock from the Christmas holidays,

Mr John Van Staveren, of Victorian-based eyewear company VS Eyewear, said his company’s entire four-brand portfolio is

“Our production time is normally three months, but now we are being told it could go to four or five months," Van Staveren said. "One particular model that was supposed to be delivered early April has already been pushed out to May, so we’re just going to have to deal with the delay. “In the meantime, we’ve got plenty of stock. We are an importer of our own brands and manufacture and import in bulk.” Ophthalmic equipment and lens maker Zeiss also has continued page 6

OPHTHALMOLOGY TRAINING UNDER SPOTLIGHT In terms of how to raise concerns about patient safety, 58% of ophthalmology trainees rated the quality of their training as 'good' or 'excellent', which was below the 75% national average.

Ophthalmology trainees have indicated a high rate of satisfaction with their Vocational Training Program, according to the results of Australia’s first Medical Training Survey, but safe working hours remain an issue for the broader health sector. Commenting on the findings, RANZCO stated that ophthalmology trainees rated their position at or above national response averages in a number of areas, including recommending their current training position to other doctors, as well as their workplace as a place to train. The results of the inaugural 2019 survey provide a snapshot of medical training in Australia from

the perspective of trainee doctors in order to identify strengths and potential issues. According to RANZCO, the survey also identified areas where its training can continue to improve. In particular, ophthalmology trainees rated the quality of their orientation at 52%, compared with the national response average of 71%.

According to its statement, RANZCO is working towards addressing concerns highlighted in the survey through a curriculum redesign project. It is also using feedback provided by the Australian Medical Council through its accreditation process. “RANZCO is committed to working with other medical colleges, jurisdictions and both state and federal health departments to address the continued page 6

TOOLS, TRAINING, TIME: THE PILLARS TO MYOPIA CARE With an expanding patient group, effective interventions and a strong research-base, the conditions are ripe for optometrists to make myopia management a serious part of their practice. page 25

Like you, when the day comes to an end, we’re still on call

Issues pay no respect to working hours. You might be on the way home, but that doesn’t necessarily mean that your work is over. It’s the same for us. Our client service centre operates 24/7. It doesn’t matter what time of day or night it is. It doesn’t matter where you are. We’ll ensure that your call is handled by a highly trained team member and that local resources are mobilised and monitored to find a solution for you. Day in, day out. We’re here to help. Visit us at boqspecialist.com.au or speak to your local finance specialist on 1300 131 141.

UPFRONT Just as Insight went to print, ODMA cancelled this year's O-Show, scheduled for Sydney between 16–17 May, due to the coronavirus. In a statement, the association said it reviewed alternatives, including rescheduling. However, with no end date to the government’s ban on gatherings of 500-plus people, it was deemed too difficult to make a further commitment that may have far reaching financial implications. "The cancellation has come at a cost with venue, contractors and

WEIRD

organisers already partially paid and other amounts due. We will continue to work with our suppliers to minimise the exposure. We will be refunding exhibitors from [17 March]," the statement said. IN OTHER NEWS, Optometry Australia has released an occupational optometry/ safety eyewear guide to help eyecare professionals prevent patient injuries in the workplace. The 2020 Occupational Optometry Guide includes information on the prevention of occupational eye injuries, vision assessments, eye protection products, Australian vision and eye-protection standards and screening protocols. It also advises about eye

safety consultations and how to conduct workplace screenings. The 28-page booklet is an updated version of an earlier guide. FINALLY, Centre for Eye Health (CFEH) and Guide Dogs NSW/ACT are launching a collaborative new hub in Parramatta called The Cameron Centre. The CFEH will be offering the same diagnostic and management services currently available at its other locations, but will be adding a new full-scope low vision service. Referrals for these services will open in early 2020. Additionally, CFEH is joining the C-Eye-C program and will be involved in the assessment of non-urgent referrals to Westmead Hospital.

insightnews.com.au Published by:

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

STAT

christine.clancy@primecreative.com.au

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

An ophthalmologist extracted three parasitic worms from a man’s eye after his dog unwittingly infected him. The 54-year-old Chinese man complained of conjunctivitis, tear over-secretion and sharp pain. When he was examined, he was found to be hosting Thelazia callipaeda roundworms, commonly found in dogs and cats.

Clinical & Technical Editor Lewis Williams PhD Journalist Rhiannon Bowman rhiannon.bowman@primecreative.com. au

Business Development Manager Alex Mackelden alex.mackelden@primecreative.com.au

WONDERFUL

A blind Crown prosecutor was among a group of students who attended classes in a bid to become a certified scuba diver. Mr Jason Mitschele, of Canada, took to the water as part of an initiative offering courses for visually impaired people that want to try new activities. Next year, Mitschele will be climbing Mt Kilimanjaro. n

Client Success Manager Justine Nardone justine.nardone@primecreative.com.au

Design Production Manager Michelle Weston

MYOPIA MANAGEMENT In a recent survey of Australian optometrists, more than 50% of said they would ‘always’ or ‘mostly’ prescribe single‐vision distance spectacles for myopia. Full report page 25.

Graphic Design Jo De Bono

WHAT’S ON

Complete calendar page 49

WACKY

Some Japanese companies have told spectacle-wearing female employees to remove their eyewear, sparking debate. The firms reportedly imposed the ban for various reasons, including the claim it gave shop assistants a “cold impression”. Ms Kumiko Nemoto, a professor of sociology at Kyoto University, told the BBC the outdated policies were discriminatory.

THIS MONTH

michelle.weston@primecreative.com.au

Art Director Blake Storey

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AVC 2020

O-SHOW

APR 4-5, GOLD COAST

CANCELLED

This year’s Australian Vision Convention is still going ahead, but will now be delivered through an online, livestream format.

Sheduled to take place in Sydney on 16-17 May, ODMA has cancelled the event due to the coronavirus pandemic.

infoqld@optometryqldnt.org.au

marketing@odma.com.au

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INSIGHT April 2020 5

NEWS

CONTINGENCY PLANS TO COMBAT SHORTAGES continued from page 3

manufacturing operations in China. The company is aware that further restrictions to airfreight could lead to limited availability of raw materials, chemicals for lens manufacturing or longer delivery times between its labs, distribution points and markets. “I am happy to report that our supply of lenses, Zeiss wipes and Zeiss equipment is not affected by the virus,” a Zeiss Australia and New Zealand spokesperson told Insight. The spokesperson said that the company’s Chinese employees have returned from a prolonged New Year holidays and are “ramping up to full manufacturing capacity”. “Production had been reduced due to the holidays and to give the team time to prepare for anti-coronavirus activities. [We are] happy to report that all employees are safely back to work and production [is running] as planned,” she said. “We are fully focused on our customer service and satisfaction – making sure that every single order still gets shipped

in place, which means that so far we are not expecting any shortages,” the company’s ANZ professional services director Mr Tim Thurn said.

as fast as possible by avoiding and minimising any impact on our delivery capabilities through activation of global contingency measures, including alternative supply routing from our other Zeiss manufacturing sites. "We have plans in place to change the supply routing of lenses if needed but will advise our customers upfront.”

"ESSILOR AUSTRALIA HAS ALWAYS HAD A STRONG SUPPLY CHAIN AND OPERATIONS HAVE CONFIRMED THAT IT REMAINS ROBUST"

Luxottica, the world’s largest frame maker, confirmed its manufacturing sites are all operational. Its Chinese staff were reported to be resuming work at a good pace. The company expects production flow to normalise in the short-term due to the flexibility of its supply chain and TIM THURN, stock availability. In Italy, including its Milan operations, Luxottica restricted travel between company offices and other locations. Lens companies Hoya Australia, Rodenstock Australia, Essilor Australia and CR Surfacing Laboratories all reported no supply chain issues. “Essilor Australia has always had a strong supply chain and operations have confirmed that it remains robust with back-up sites with contingencies

ESSILOR AUSTRALIA

Mr Tim McCann, general manager of Rodenstock Australia, said: “Our factories and supply chain are not in affected areas and we also have contingency supply, so at this stage it is not an issue. Of course, things can change and we are monitoring closely.” Vertically integrated optical chain Specsavers had no impact on its supply chain. It would continue to work with its global supply partners daily to look at the short, medium and long-term planning horizons across all product categories to ensure it has contingency plans in place to maintain supply. Eyes Right Optical managing director Mr Mark Wymond said the company carries stock in Australia. As a result of the outbreak, it ordered more stock than it typically would and has placed reserve orders of stock in the European factories. “This will cover us now and well into the future,” he said. n

EXCESSIVE WORK HOURS PROBLEMATIC FOR TRAINEES “This is particularly worrying given the clear recent Australian research showing that doctors in training who work more than 55 hours each week have double the risk of developing mental health problems and suicidal ideation.”

continued from page 3

issues identified in the survey,” a college statement said. “This will ensure that we not only deliver solutions that benefit ophthalmology trainees, but also contribute to improving the quality of training across the entire Australian medical workforce.”

Bartone said the survey also shows the pressure that trainees continue to work under, with half of all trainees who completed the survey considering their workload ‘heavy’ or ‘very heavy’.

WORKING HOURS UNDER SPOTLIGHT Dr Tony Bartone, president of the Australian Medical Association (AMA), echoed the sentiments of RANZCO, saying the survey “revealed that most trainees rated the quality of their training and clinical supervision very highly, and would also recommend their current training post”.

identify key areas for improvement.

Bartone said the AMA had lobbied for the survey for many years to measure the performance of the nation’s medical training system and

“Safe working hours are still an issue for the profession, with one in eight trainees working at least 60 hours on average per week,” Bartone said.

INSIGHT April 2020

He said AMA’s advocacy has been justified, with the survey indicating many trainees are still unacceptably experiencing excessive hours, heavy workload, bullying, harassment, or discrimination.

“One in five doctors in training felt they had personally experienced bullying, harassment, and/or discrimination in their workplace in the last 12 months.” Half of the doctors in training surveyed reported they are concerned about their future career, which Bartone said reflects ongoing concerns about a known shortfall in vocational places and the lack of employment opportunities once a college fellowship is obtained in some specialty areas. n

NEWS

LIONS OUTBACK TO OPEN NEW NORTH WEST CLINIC A former backpacker accommodation is being transformed into a new eye health clinic in Broome, featuring three resident ophthalmologists available for 24-hour emergency support to service the north west of Western Australia. In what will be the first clinic established by Lions Outback Vision outside of the Perth metropolitan region, the facility will become the organisation’s north west base, providing access to ophthalmology and telehealth clinics, seminar rooms and community diabetic health education. Dr Angus Turner, McCusker Director of Lions Outback Vision, part of the Lions Eye Institute, said the venture was conceived five years ago to improve the capacity of outreach services and meet the changing needs of eye treatments, particularly diabetic retinopathy, which requires monthly injections. The new centre, known as the North West Hub, will feature three ophthalmologists residing in Broome who are available for around-the-clock emergency eye health support, a significant change from the earlier fly-in fly-out service model. “It is important that we are able to offer specialist eye health care to the regions so residents have the same access to services as those in the metropolitan area. People don’t need the added burden of travel and being away from family when requring specialist treatment,” Turner said. “Until the introduction of the North West Hub there was no resident ophthalmologist north of Geraldton. “In 2016, 83.6% of clinicians in Australia were located in a major city. The north west demographics require 3.3 full-time ophthalmologists. To provide this with current outreach models from Perth would cost $10 million annually.” The clinic will be based in a former backpacker accommodation in a property donated by Hawaiian and Wen Giving Foundation. Local building company Indent will complete the refurbishment, which has been supported by Christine and Kerry Stokes, Australian Capital Equity, The Fred Hollows Foundation and the Australian Federal Government. It is anticipated that the first phase of building will be complete later this year. “Having three ophthalmologists based

Dr Angus Turner with the Broome team and families outside the soon to be refurbished building. Image: Lions Outback Vision.

in Broome not only increases frequency and reach of services, it also allows for more effective treatments as well as closing the equity gap in accessing eye health services in the Kimberley and Pilbara regions,” Turner said. “Resident ophthalmologists in Broome also offers 24-hour emergency eye health support for patients who would have previously been flown to Perth and also enables on-call telehealth support for remote practitioners across the region.” For the past three years, Turner has been committed to making the clinic a reality by developing service delivery and financial models before attending hundreds of meetings and talking with a wide range of stakeholders across the Kimberley and Pilbara. This included public hospitals, Aboriginal Medical Services, Medical Health Forums, allied health workers, community support groups, patients, local MPs, Aboriginal Elders and other health professionals to determine if the centre and specialist resident ophthalmologists would add value to north west residents. “With an overwhelmingly positive response we then turned our attention to working with interested parties to identify where and how we could generate the funds to make it happen,” Turner said. “The whole team is really excited to be part of the Broome community and we are looking forward to being able to provide services from the hub once refurbishment is complete." In the meantime, the team will continue to travel across the north west communities with a team of eye health professionals with the aim of improving eye health in the outback. n

IN BRIEF n “HAVING THREE OPHTHALMOLOGISTS BASED IN BROOME NOT ONLY INCREASES FREQUENCY AND REACH OF SERVICES, IT ALSO ALLOWS FOR MORE EFFECTIVE TREATMENTS” ANGUS TURNER, LIONS OUTBACK VISION

INSIGHT APPOINTMENT

Experienced vision science journalist Ms Rhiannon Bowman has joined Insight, bringing nearly a decade of experience in ophthalmic publishing. Bowman joined Optometry Australia in 2011 as assistant editor for its newspaper Australian Optometry. She went on to become communications manager, developing and delivering member communications across multiple digital channels and building the organisation’s social media presence. She took a break from the profession after having a daughter in 2018 and has subsequently returned to the sector with Insight.

BUSHFIRE HELP

The team from CR Surfacing Laboratories left the comfort of their optical laboratory for the charred landscapes of rural Victoria as part of efforts to aid the bushfire recovery. Over the course of a weekend in February, 13 staff members from the Melbourne company helped tear down 3.3km of damaged fencing and rebuilt 500m of new fencing in its place in Bruthen. The project was arranged through Blaze Aid, a volunteer-based organisation that coordinates work in rural Australia following natural disasters.

PACIFIC EYECARE

A new study investigating the availability, use and comfort of ophthalmic equipment and medications in Papua New Guinea and the Pacific Islands has found that, overall, trained mid-level eyecare workers are well equipped. The research, which serves as an indicator of the state of eyecare in the Pacific, found access is “excellent” for refraction equipment, while ocular assessment equipment is “widely available”. More than 70% also had access to topical diagnostic medications.

GENE EDITING

Editas Medicine and Allergan announced the gene-editing therapy CRISPR has been used inside a person’s body for the first time. Editas’ flagship drug candidate EDIT-101 was used to treat the first Leber congenital amaurosis (LCA) patient in the US as part of the Brilliance clinical trial at Oregon Health & Science University Casey Eye Institute. The trial will assess the safety, tolerability, and efficacy of the therapy in about 18 patients with LCA.

INSIGHT April 2020 7

NEWS

MULTI-MILLION DOLLAR AUSSIE PROJECT TO CUT OPTOMETRY FALSE-POSITIVE RATE Australian agencies are collaborating with technology firm Big Picture Medical in a $12 million project to develop an AI-assisted platform that could reduce inappropriate patient management at the primary point-of-care.

"A UNIQUE FEATURE OF THIS PROJECT IS THAT THE PLATFORM WILL COMBINE PATIENT DATA SUCH AS AGE AND OTHER RISK FACTORS WITH THE SCANS"

Led by Big Picture, the venture will involve intellectual property from Sydney and Adelaide-based research institutions that will be integrated into the company’s platform that combines artificial intelligence (AI), data analytics and decision support algorithms to drive better patient outcomes. If successful, Professor Fiona Stapleton, one of the lead project researchers, said the collaboration would provide optometrists with a platform that could analyse multiple eye scans, as well as medical history data with significantly improved diagnostic accuracy. Big Picture was recently awarded a $2.9 million government grant for the project under the Cooperative Research Centre Project Grants program, which supports short-term collaborative research projects. The collaboration will also involve the University of Adelaide’s Australian Institute of Machine Learning, Brien Holden Vision Institute (BHVI), Menicon Australia and the University of New South Wales (UNSW), comprising its School of Optometry and Vision Science, Centre for Eye Health (CFEH) and School of Computer Science and Engineering. CFEH director Professor Michael Kalloniatis told Insight that Big Picture, which is based in both Sydney and London, has an AI-powered software platform that “structures and liberates medical dark data” to improve patient outcomes. In eye health, the platform has already linked primary eyecare practitioners to other practitioners such as GPs, as well as hospital ophthalmology departments. The company had expressed a desire to incorporate AI into the platform to help the referring practitioner correctly manage patients with eye disease. “Most AI systems only consider raw clinical images – a unique feature of this project is that the platform will combine patient data such as age and other risk factors with the scans and provide a

INSIGHT April 2020

PROF MICHAEL KALLONIATIS

superior algorithm to help guide primary care clinicians in patient management,” Kalloniatis said. “The key point is that this will guide optometrists, it will not make decisions for them.” In Australia, misdiagnosis can be relatively common in optometry, leading to poor patient outcomes and unproductivity for limited specialist services. This results in an estimated $74 million per annum in avoidable costs for the Australian health system. Kalloniatis said Big Picture had previously worked with Moorfields Eye Hospital in London to examine referrals to hospital ophthalmology departments, which showed high false-positive rates – 37% in the National Health Service (NHS) – for optometric referrals. “The average number of visits in cases of false-positive referrals is around 2.2, which reflects wasted public clinical resources. Big Picture’s platform significantly reduced the false-positive rates – effectively halving it – but there are still too many inappropriate referrals,” he said. “The expectation is that the AI-assisted platform will further reduce unnecessary referrals and improve patient outcomes and also improve communications between all health care providers.” According to Kalloniatis, the NHS has parallels to Australia, which could translate into a similar reduction in falsepositive referrals currently experienced on public hospital waiting lists. Researchers and industry peak bodies,

including RANZCO and Optometry Australia, have identified AI as a way to improve the accuracy of diagnosis and lead to better patient outcomes. As such, they predict it will play a major role in future eyecare. To be useful in practice, AI systems need to be trained to consider and analyse broad patient data including multiple images, vision tests and historical clinical data. WHAT EACH ENTITY BRINGS • Big Picture is the lead commercial partner with an AI powered software platform that structures and liberates medical dark data to transform patient outcomes, facilitates commercial insights and changes the delivery of healthcare for the benefit of all. • The UNSW’s School of Optometry and Vision Science and CFEH have the clinical expertise, as well as being in a position to test the AI algorithms in a practical setting. • The UNSW’s School of Computer Science and Engineering and University of Adelaide’s Australian Institute of Machine Learning have the expertise in AI algorithm development. • BHVI has access to remote and international communities to test the program's effectiveness. • Menicon has a history of working with the UNSW’s School of Optometry and Vision Science and has relationships with eyecare practitioners internationally. • Previously, Big Picture and CFEH have teamed up in a number of small projects and the School of Optometry and Vision Science has collaborated with Menicon, providing expertise in eyecare. n

Advance your career At Specsavers, we’re committed to helping you reach your potential. Our professional development programs and resources – including local opthalmology-led education evenings, our new MyCPD Portal, and our clinical conferences – are all designed to support your clinical decision making, improve your diagnostic skills and build your professional networks. Whether you’re looking for your first job, looking for new opportunities or ready to get on the pathway to partnership, at Specsavers you’re only limited by the scale of your own ambition. Go to spectrum-anz.com or contact us: Partnership enquiries: Maria Savva +61 401 353 587 Optometry recruitment enquiries: Marie Stewart +61 408 084 134 or Madeline Curran +61 437 840 749

NEWS

MYOPIA MANAGEMENT: SPECTACLES MOST COMMON APPROACH FOR AUSTRALIAN OPTOMETRISTS Australia’s first myopia management survey has revealed single‐vision distance spectacles are the mainstay of myopia correction in school‐aged children, despite awareness among practitioners of the potential effectiveness of other interventions. The survey of 239 Australian optometrists aimed to investigate their knowledge and understanding of myopia, as well as their self‐reported clinical practices in terms of diagnosis and management of childhood myopia. Optometry Australia members and optometrists Dr Amanda Douglass, Associate Professor Peter Keller and Dr Laura Downie, from the University of Melbourne Department of Optometry and Vision Science, and Centre for Eye Research Australia ophthalmologist Professor Mingguang He authored the survey, which was sent to Optometry Australia members in 2016. In one of the starkest findings, it was revealed the most common approach to management were single‐vision distance (full correction) spectacles. More than 50% of respondents indicated they would ‘always’ or ‘mostly’ prescribe this modality, with it being less likely in respondents with an interest in myopia and in independent practice.

This is despite most optometrists identifying orthokeratology, low‐dose (0.01%) topical atropine and soft peripheral defocus contact lenses as three potentially more effective therapeutic interventions for modifying childhood myopia progression. “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,” the study concluded. “Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best‐ available research evidence.” In other findings, almost half of practitioners considered progressive addition spectacles to be more efficacious than single‐vision distance spectacles for reducing childhood

"OPTOMETRISTS APPEAR AWARE OF EMERGING EVIDENCE, BUT ARE NOT ROUTINELY ADOPTING MEASURES THAT HAVE NOT YET RECEIVED REGULATORY APPROVAL" MYOPIA SURVEY AUTHORS

myopia progression. This is despite the totality of the evidence suggesting that any potential clinical benefits are modest. About 20% of respondents considered the need to purchase additional clinical equipment as an ‘important’ or ‘very important’ barrier to myopia management, although this response was less likely if the practitioner had an interest in myopia or was an independent. The study also examined the criteria for ceasing treatments. Responses varied considerably, both with respect to patient age – with most respondents selecting either 21 or 25 years – and the time period of refractive stability – with 58% selecting the absence of myopia progression for at least 24 months. “This spread of ages suggests there is uncertainty regarding the appropriate age for ceasing an intervention to assure refractive stability,” the authors said. The survey also found that, relative to a single‐vision distance full‐correction, practitioners considered orthokeratology (85.4%), low‐dose topical atropine (54.4%) and soft defocus contact lenses (40.6%) as the most effective modalities. The minimum absolute degree of refractive error most practitioners considered necessary to prescribe for a child was −0.50D. n

EYE DROPS ADDED TO PBS FOR INDIGENOUS PATIENTS Prednefrin Forte eye drops can now be prescribed to Aboriginal and Torres Strait Islanders under the Pharmaceutical Benefits Scheme (PBS) for certain cases of severe eye inflammation. The National Aboriginal Community Controlled Health Organisation (NACCHO) led a successful submission to the Pharmaceutical Benefits Advisory Committee (PBAC) to expand the drug’s listing on the PBS for treatment of postoperative eye-inflammation for patients who identify as Indigenous. The decision came into effect on 1 March. Announcing the decision, NACCHO stated the expanded listing will translate into a greater range and better affordability of anti-inflammatory eye

INSIGHT April 2020

drops for Aboriginal and Torres Strait Islander people. Prednefrin Forte (prednisolone and phenylephrine eye drops) is a medication used to treat eye inflammation and swelling that ophthalmologists often prescribe as first-line therapy after cataract surgery. The NACCHO worked with a range of stakeholders on the PBAC submission, including the manufacturer Allergan. Dr Dawn Casey, deputy CEO of NACCHO, said: “This successful collaboration with experts and industry is important to NACCHO as access to the right medication and the best medical treatment for Aboriginal and Torres Strait

Islander peoples, is our top priority. In order to close the gap in health rates and experiences, more actions like this in the right direction must be made.” The treatment has been previously listed on the PBS for uveitis and corneal grafts. Prednisolone was among the top 10 PBS drugs by prescription count by optometrists in 2015, according to Optometry Australia. Vision 2020 Australia CEO Ms Judith Abbott added: "We welcome this change to current drug scheduling, which will enable Aboriginal and Torres Strait Islander people to access a broader and more affordable range of eye medications, when they are needed.” n

THE FREEDOM OPTOMETRIST â&#x20AC;&#x201C; COFFS HARBOUR

Coffs Harbour offers a never-ending array of natural and adventure activities, magnificent beach and bush walks, scenic drives, world class events, and stylish cafes, restaurants and bars. From Harbour to Hinterland, Coffs Harbour has it all. At OPSM we are about innovation. We use the most cutting-edge products and technologies, and collaborate with an amazing collective of knowledgeable and experienced optical professionals. As a leading eye care and eyewear retailer, we have been looking after the eyes of Australians and New Zealanders for over 80 years We currently have an amazing opportunity for a new graduate or experienced optometrist to join our amazing team. This role would suit a practitioner with a special interest in ocular pathology and the practice is well equipped with an OCT, Optos Daytona, Medmont VF, retinal camera, Auto-refractor, NCT, I-Care and Pachymeter. At OPSM we can offer you an opportunity to make a real difference in the way people see the world. You will be able to access many opportunities for continuing professional development through financially supported industry training, peer learning communities and product training. An attractive salary and relocation package is available for the right candidate as well as a generous product allowance for you to enjoy wearing our premium brands and other benefits too. You will also have the opportunity to join our mission to help the world see by participating in the OneSight outreach program. TO APPLY PLEASE CONTACT: BRENDAN PHILP brendan.philp@luxottica.com.au or call 0418 845 197

OPSM.COM.AU/CAREERS JOIN OUR COMMUNITY ON LINKEDIN

NEWS

PRESBYOPIA: NEW CLINICAL DATA REVEALS BENEFITS OF MULTIFOCAL ASX-listed contact lens manufacturer Visioneering Technologies (VTI) has been encouraged by new clinical data examining the performance of its soft multifocal contact lens in ‘mature presbyopes’. QEI's Dr Brendan Cronin (from left) with Avedro’s Ms Grace Lytle, QEI's Dr David Gunn and Mr TC Kok, also from Avedro, who helped with the installation.

QEI CLINIC UNVEILS NEW CROSS-LINKING TECHNOLOGY FOR CORNEAL PROCEDURE The Queensland Eye Institute (QEI) has become the first clinic in Australia to offer a new topography-guided corneal collagen cross-linking treatment for keratoconus. The clinic’s Dr Brendan Cronin and Dr David Gunn are now the country's only ophthalmologists who can perform the procedure with the Avedro Mosaic machine, which is being touted as a major advancement in the field of cross-linking diseased corneas. According to QEI, corneal collagen cross-linking is the main form of treatment for keratoconus. Using ultraviolet light and riboflavin, it enhances the chemical bonds between the layers of the cornea to increase strength. Traditionally, cross-linking systems have only been able to strengthen corneas. However, this new technology also improves the cornea’s shape. The Avedro Mosaic machine is the only cross-linking machine that can deliver extra energy to the more distorted parts of the cornea and subsequently regularise a patient’s cornea and their vision. It uses advanced iris recognition technology to correctly identify a patient, their pupil and track the movements of the eye. “The potential benefits of being able to improve the shape of the cornea at the same time as stopping progression is very appealing,” Gunn told Insight. “The machine has improved in terms of its abilities as well as development of protocols for treatment. This technology is a great step forward for patients with keratoconus as it offers customised treatments for what is a very variable disease.” As of 4 February, the clinic had treated approximately 50 patients with the device with a wide variety of disease severity. n

INSIGHT April 2020

At the recent Global Specialty Lens Symposium in Las Vegas, the US-based company revealed findings of a study that assessed the effectiveness of the NaturalVue Multifocal 1 Day lens in patients over the age of 55 with an add power of +1.75 or greater. According to the company, of the 59 patients in the study, 71% had add powers of +1.75 or higher. This subgroup, which are considered a more challenging group to satisfy clinically, seemed to perform “extremely well” with the lens. Specifically, the study demonstrated this group of patients had vision at every distance that was comparable to best corrected spectacle acuity. “These patients reported that they could meet 85% of their daily needs with the NaturalVue lens alone, such as without the use of readers. Also, near vision was significantly better with the NaturalVue Multifocal versus their previous correction,” VTI reported, according to Business Wire.

NaturalVue corrects presbyopia and myopia.

NaturalVue is locally distributed by Contact Lens Centre Australia and is also approved for myopia control in Australia. It uses a centre-distance, extended depth of focus design and relies on the visual cortex to suppress the high amount of plus in the lens, creating a virtual aperture that provides clear vision at all distances. Other key highlights of the clinical update included; stereo acuity was virtually the same as best corrected spectacle vision (BCSV); near vision was subjectively rated statistically significantly better than BCSV; NaturalVue was within two letters of BCSV, at the intermediate distance; and range of clear vision was 60% better with NaturalVue. Near work was also statistically significantly better in all three categories. n

FIRST HUMAN TRIAL TO EXAMINE ROLE OF VITAMIN B3 IN GLAUCOMA A world-first clinical trial in Australia is investigating whether vitamin B3 could help protect nerve cells against damage in glaucoma patients. The highly-anticipated Centre for Eye Research Australia (CERA) study is examining the effect of daily, high doses of the vitamin in addition to typical treatments that lower eye pressure, with the findings expected to be released this year. Current therapies aim to lower pressure rather than protecting or repairing cell damage. Earlier pre-clinical research in the US has shown that vitamin B3 could prevent optic nerve degeneration. The CERA research is the first time this approach has been trialled in humans. Researcher Dr Flora Hui is leading the trial initiated by former CERA managing director Professor Jonathan Crowston, which is being continued in partnership with him.

Researcher Dr Flora Hui is leading the trial to determine if high dose vitamin B3 could be used to support existing glaucoma therapies.

“Our research has investigated if there is a way to protect nerve cells from further damage in glaucoma and also whether this treatment can support sick nerve cells to help them work better,’’ Hui said. “Our study hopes to confirm that vitamin B3 can protect nerve cells from dying, in a similar way that adding oil to a faulty car engine can still allow it to run more smoothly.” n

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NEWS

AUSTRALIAN CONTACT LENS MANUFACTURER PENS LONG-TERM DEAL WITH CHINESE MEDICAL FIRM Capricornia Contact Lens is set to take its specialty products to the Chinese market after signing a 10-year distribution deal with a major pharmaceutical and medical equipment distributer. The Brisbane-based manufacturer and distributor of prescription contact lenses announced the agreement with Shenzhen Relin Medicine via the Australian Trade and Investment Commission (Austrade). Capricornia won the contract over other manufactures and suppliers from the US, Japan, and Europe. The deal is expected to bring the company’s Epicon scleral lens design to the Chinese market to satisfy an unmet need for the treatment of keratoconus and other eye disorders. The Australian firm, which only comprises 20 staff, also has a range of lens designs for orthokeratology and irregular corneas. It manufactures custom soft and rigid gas-permeable lenses using state-of-the-art computercontrolled lathes. Mr Xintao Xia is the general manager of Shenzhen Relin Medicine, which is located in Shenzhen, southeast China. The company distributes medicines and medical equipment to more than 3000 hospitals and medical clinics for several medical fields, including ophthalmology.

Capricornia Contact Lens has landed a distribution deal with Shenzhen Relin Medicine.

"THERE IS HUGE SCOPE FOR US TO MAKE A POSITIVE IMPACT IN THE TREATMENT OF EYE DISORDERS THROUGHOUT CHINA" TONY CAPITANO, CAPRICORNIA

“There are currently no satisfactory solutions to keratoconus at the middle and late stages in China and to ametropia after keratoplasty,” Xia said.

been manufactured since the mid-1990s. The Epicon A lens design is said to exhibit excellent lens centration with minimal lens movement and an appropriate scleral landing zone for the Asian eye. Quadrant specific options are also available as required. It is indicated for irregular corneas, keratoconus, pellucid marginal degeneration, post-surgical, corneal scarring and therapeutic for ocular surface disease. “There is huge scope for us to make a positive impact in the treatment of eye disorders throughout China through our current advanced processes for lens manufacture but also by combining our research capability,” Capitano said.

“We had been looking for the right partners across the globe to help resolve these clinical pain points. With the assistance of leading ophthalmic experts in China and colleagues from Austrade, we were connected to Capricornia, a professional company in the field of contact lens with a history of 35 years.

“Large diameter scleral lenses are relatively new to China and at Capricornia we have a long history and huge experience in this specialty lens sector.”

“Capricornia's sclera lens solved the issue perfectly. As Capricornia is also looking to develop in Asia and bring their premium products to China, we happily reached a consensus on cooperation.”

Following the announcement, Capitano said more work would be required, including obtaining the relevant regulatory approvals and understanding China’s hospital and eye clinic environments.

Mr Tony Capitano, managing director of Capricornia, said the deal was built on the company’s Epicon design, which has

“It’s a great first step and important for the future growth and continued internationalisation of Capricornia. n

ELLEX REFOCUSES BUSINESS AS CEO STEPS DOWN Further leadership changes have occurred at Ellex Medical Lasers with the resignation of its interim CEO, as the company prepares to offload its lasers and ultrasound business to target higher growth ophthalmic segments. Ms Maria Maieli, who was appointed interim CEO of the ASX-listed Adelaide firm last July, resigned from her post on 18 February effective immediately in order to spend more time with her family. Maieli was appointed to the position when experienced global health executive Mr Gerard Wallace suddenly stepped down after three and a half months in the role. She has since overseen a crucial period for the company, including the proposed sale

INSIGHT April 2020

shareholders vote to approve it at a meeting this month, with Ellex viewing the sale as an opportunity to monetise a low growth market segment.

of Ellex’s laser and ultrasound business to French company Lumibird Group for $100 million. “On behalf of Ellex we wish Maria all the best into the future and thank her for her service over a number of years at Ellex, including as chief financial officer, company secretary and more recently as interim CEO during this very important time for the company,” Ellex executive chairman Mr Victor Previn said. Previn will assume management responsibilities with the company’s vice president of global operations Mr Keith Byrne until the completion of the pending Lumibird transaction. That deal will be finalised if

Maria Maieli, Ellex

Previn said the sale of the laser and ultrasound business, which accounted for as much as 80% of total revenue last year, would significantly reduce the revenue base for Ellex. However, he said the company would be bank debt-free, with a less complex and streamlined business model, comprising its iTrack minimally invasive glaucoma device and its Retinal Rejuvenation Therapy laser 2RT therapy for intermediate age-related macular degeneration. n

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NEWS

PROMINENT MEDICAL DEVICE INDUSTRY FIGURE JOINS AUSTRALIAN OCT MANUFACTURER CYLITE at the market introduction stage – and help direct the future commercialisation phase globally – did not emerge often.

Melbourne-based OCT company Cylite has appointed accomplished medical device industry figure Ms Kylee Hall to its executive team as it prepares to bring its new system to market. Hall, who is now the company’s vice president of sales and marketing, will play a crucial role for Cylite over the next five years as it seeks regulatory approval for its hyperparallel optical coherence tomography (HP-OCT) system in Europe and Australia. The Australian-made OCT instrument is said to differ from competing models by offering industry-leading A-scan speeds. It also captures volume data to provide accurate analytics for corneal and refractive specialists. A key feature of the fourth generation platform is its ability to overcome eyemotion limitations during scanning, often the Achilles heel of current devices developed by other manufacturers. Hall, a medical device industry expert, brings more than 13 years of senior leadership in sales, marketing and corporate management and 20 years' experience in the local ophthalmic sector. She was previously a surgical business manager for Device Technologies and the medical division manager for Zeiss,

Cylite's HP-OCT offers leading A-scan speeds.

responsible for overall management of the Australian and New Zealand medical business group. “I am delighted to welcome Kylee to the Cylite executive team,” Cylite CEO Dr Steve Frisken said. “I am confident that her breadth of experience in the medical industry in both surgical and diagnostic instruments will play a key role in driving our entry into the diagnostic market. “Kylee’s in-depth knowledge of the ophthalmic diagnostics business will significantly strengthen our team as we launch our fourth generation OCT system, HP-OCT, into the market.” Cylite is currently focused on pursuing European regulatory approval. If successful, it will then make a submission to the Therapeutic Goods Administration. Hall said opportunities to join a company

"SOMETIMES YOU HAVE TO APPROACH A CHALLENGE WITH A DIFFERENT MINDSET TO SUCCEED, AND THIS IS EXACTLY WHAT THEY HAVE DONE" KYLEE HALL, CYLITE

“It is even more rare for this to be with an Australian start-up in the ophthalmic diagnostic field.” she said. “I have tremendous respect for the founding team, who have incorporated photonics knowledge from the telecommunications industry into the medical technology field. “They have developed an impressive piece of diagnostic ophthalmic equipment that solves so many of the issues faced with current offerings. Sometimes you have to approach a challenge with a different mindset to succeed, and this is exactly what they have done.” Founded in 2013, Cylite is backed by four experienced scientists drawn from the fields of photonics, optics, instrumentation, and software development. Frisken is a 25-year veteran of the photonics industry and the holder of more than 30 patents. The company’s chief technology officer is his brother Mr Grant Frisken. Others involved in the project have backgrounds in telecommunications and photonics, while Dr Simon Poole, who has more than 37 years of experience in academia and photonics, is Cylite’s co-founder and the project’s customer-facing front man. n

SPECSAVERS CELEBRATES 400-STORE MILESTONE visual field facilities and nine dispense points, making it easier than ever for customers in the Sydney CBD to access optometry services.”

Specsavers has opened its 400th store across Australia and New Zealand, in a major milestone for the optical chain since its arrival to the local ophthalmic market 12 years ago. Specsavers Chifley Square in Sydney is now the newest store within the Specsavers network, taking the total number of Australian stores to 345, with 55 locations open in New Zealand. The store, which hosted an official ribbon cutting ceremony, is owned and operated by Ms Sasha Kempen, Mr Gregory Braude and Ms Greeshma Patel. The trio also own and operate the company’s Sydney Central and Sydney MetCentre stores.

INSIGHT April 2020

The Sydney Chifley Square store was offically opened on 5 March.

“The new Sydney Chifley Square store is a fantastic addition to our store network,” a company spokesperson said. “With significant room for expansion, it initially features two optical test rooms, dedicated space for OCT and

Coinciding with the 400-store milestone, Specsavers noted the success of its joint venture partnership model, which “has transformed the fortunes of hundreds of the optometrists and optical dispensers” and provided opportunities to become business partners in their own business. Across both countries, its store partners employ more than 6000 staff with each store generating an average of 16 current jobs. The Specsavers support offices in Port Melbourne and Auckland, with its local field-teams, employ a further 550plus team members. n

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NEWS

FRED HOLLOWS WARNS CHARITIES FACE CHALLENGING YEAR AHEAD

AUSSIE CORNEAL ENGINEERING RESEARCH EARNS MAJOR BACKING A Melbourne researcher has received a major funding boost to progress development of a tissue-engineered corneal endothelium for transplant, which could help overcome a global shortage of cornea donations in future. Dr Karl Brown, from the Centre for Eye Research Australia’s (CERA) Corneal Research Unit, recently secured DHB Foundation funding that will cover a fouryear research fellowship. The project, which will trial growing corneal endothelia in the lab using the patient’s own cells, could eliminate the need for donated corneas in transplant surgery and prevent transplant rejection from occurring in some patients. According to CERA, cells of the corneal endothelium – a fine layer at the back of the cornea – help pump fluids out of the cornea and maintain transparency. When these cells fail because of ageing, trauma or disease – the cornea swells and becomes cloudy, leading to vision loss and blindness. Brown is working closely with CERA’s principal investigator corneal research Associate Professor Mark Daniell to engineer the new approach. In recent years they have collaborated with colleagues from the University of Melbourne to develop a hydrogel film which helps prevent damage to fragile donor corneal endothelium during transplant surgery. The next phase of research builds on this technology by adding donor cells to the gel film to grow new corneal tissue. The technology could also enable cells from one donor to be grown into many transplants to help people in countries where there are major shortages of donor tissue. “Eventually, the use of stem cell technology and tissue engineering could eliminate the need for donors to treat corneal endothelial disease allowing the treatment of millions of people worldwide currently blind because of a global shortage of donor corneas,” Brown said. In future, the researchers will also investigate whether corneal endothelial cells grown from induced pluripotent stem cells can be incorporated into the engineered corneal endothelium. n

INSIGHT April 2020

"WHAT WE CAN’T YET QUANTIFY IS THE IMPACT OF THINGS LIKE THE BUSHFIRES, THE CORONAVIRUS AND THE WEAKENING AUSTRALIAN ECONOMY"

The Fred Hollows Foundation is warning 2020 could be one of the toughest years in recent memory for Australian charities due to a combination of the coronavirus, a weakening economy and an outpouring of support for the bushfire crisis.

IAN WISHART, FRED HOLLOWS

Wishart hoped the bushfire tragedy would unlock a trend of charitable giving where people considered other causes to support in the year ahead.

The organisation’s CEO Mr Ian Wishart has acknowledged a difficult few months for Australians, culminating in unprecedented levels of support for bushfire causes.

However, he is concerned this year could be one of the toughest “in a long time” for all Australian charities because of the natural disaster and other uncontrollable factors. “What we can’t yet quantify is the impact of things like the bushfires, the coronavirus and the weakening Australian economy. This is no doubt a major concern for Australian charities, including ours,” he said. “The reality for charities in Australia is that for a number of years, regardless of what they do on the ground, they have seen numbers of traditional donors getting older and not being able to give at the

Image: Michael Amendolia/Fred Hollows

same levels. That, combined with the tough economic environment, has seen a decline in charitable giving.” Wishart added: “There’s been an enormous outpouring of support – more than $500 million – and it’s amazing to see Australians banding together to help communities recover and rebuild. “We have seen similar displays of incredible generosity in other terrible disasters, like the Indian Ocean Tsunami, when the Australian public got behind massive fundraising appeals. "What we saw then was sustained giving, where the Australian people supported the devastating tragedy but also continued to give to other important causes. “Australians will do what they can and we thank our amazing supporters for their incredible ongoing generosity.” n

GEORGE & MATILDA ENCOURAGES STAFF TO SUPPORT BUSHFIRE TOWNS George & Matilda Eyecare (GME) has created a new initiative to support communities affected by the 2020 bushfires by incentivising staff to get out and visit impacted regions. After an initial assistance package consisting of complimentary eyewear and eyecare to people directly affected by the bushfires, the network has now announced a long-term campaign. “While it’s hard to fathom, the reality is that once the TV cameras stop, our minds turn to other topics and other events and unfortunately the needs of these communities become less visible," GME CEO Mr Chris Beer said. "Local businesses, tourism and accommodation providers are all already experiencing a huge downturn – even if

they are in an area not directly affected by the fire." To counter this situation, GME has announced that all of its team members will be provided an additional day of annual leave this year, provided they use it to visit a region affected by the fires and spend some money to help the local community. n

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Please review Product Information before prescribing available from https://sunophthalmology.com.au/pi or Sun Pharma by calling 1800 726 229 CEQUATM ciclosporin 900 microgram/mL eye drops ampoule. Indications: Increases tear production in patients with moderate to severe keratoconjunctivitis sicca (dry eye) where prior use of artificial tears has not been sufficient. Contraindications: Hypersensitivity to the active substance or excipients. Active or suspected ocular or peri-ocular infection, malignancies or premalignant conditions Precautions: Potential for eye injury and contamination: avoided by not touching the eye or other surfaces with the ampoule tip. Contact Lenses: remove contact lenses prior and reinsert 15 minutes after administration. Careful monitoring of patients with severe keratitis is recommended. Infections: resolve existing or suspected ocular or peri-ocular infections before initiating treatment and if an infection occurs during treatment, withhold temporarily until infection resolves. Effects on the immune system: may affect host defenses against local infections and malignancies so regular examination of the eye(s) is recommended, e.g. at least every 6 months, when used for long periods. Paediatric use: safety and efficacy is not established below the age of 18. Pregnancy: Category C Adverse effects: Very Common and Common: instillation site pain, conjunctival hyperemia and punctate keratitis. Dosage and administration: one drop twice daily (approximately 12 hours apart) into the affected eye(s). Response to treatment should be reassessed at least every 6 months. Can be used concomitantly with artificial tears, with a 15-minute interval between products. Storage: Store below 25Â°C. Do not freeze. Store the ampoules in the original foil pouch. Protect from light. Date of preparation: February 2020. 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. Sun Pharma ANZ Pty Ltd ABN 17 110 871 826, Macquarie Park NSW 2113 Ph: 1800 726 229. Fax: +61 2 8008 1613. Med Info: 1800 726 229 Adverse events may be reported to Sun Pharma by either email: adverse.events.aus@sunpharma.com or phone: 1800 726 229. Date of preparation: March 2020. CEQ03/2020ad1 Reference: 1. CEQUAâ&#x201E;˘ Product Information. 2020 Feb, 2020; Available from: Sun Pharma by calling 1800 726 229.

NEWS

LACK OF FUNDING FOR NON-CLINICAL SUPPORT REVEALED IN INDIGENOUS EYE HEALTH REVIEW "THE AVAILABILITY OF NON-CLINICAL SUPPORT IS ASSOCIATED WITH INCREASED PATIENT ATTENDANCE AT EYECARE SERVICES"

A new Indigenous eye health study has recommended greater financial backing for non-clinical support providers, a critical factor linked to improved patient appointment attendance. Published in the Medical Journal of Australia in February, the review also found that while non-clinical support services are vital for ensuring access to preventive, primary and tertiary eyecare for Indigenous patients, the capacity to provide such services is currently limited. The authors of the work titled: Non‐ clinical eye care support for Aboriginal and Torres Strait Islander Australians: a systematic review, analysed data from 27 publications. They identified five areas of non-clinical support for Indigenous eye health, including coordination of eyecare, integrating and linking services, cultural support, health promotion, and social and emotional support. Lead author Dr Aryati Yashadhana, from the University of New South Wales (UNSW), said clinical services are central to improving preventive measures and reducing disease prevalence, but nonclinical support services can improve access and uptake of care. The study recommended greater financial investment for key providers of non-clinical support, especially eye

health coordinators, community-based liaison officers, and family members and carers. They can play a role in reducing anxiety about new diagnoses, interpret biomedical information and enable cultural safety for Indigenous patients. The authors noted the limited availability of personnel to fulfil the linguistic and cultural needs of Indigenous patients had resulted in burnout among a declining number of Aboriginal Health Workers who act as both family or community members and clinicians. “We found that the availability of non-clinical support is associated with increased patient attendance at eyecare services, higher visual acuity examination and cataract surgery rates, broader eye health knowledge, and greater cultural responsivity,” Yashadhana said. “Another key finding was the prominent role of eye health coordinators

ARYATI YASHADHANA, UNSW

in providing these types of nonclinical support. However, eye health coordinators are often employed parttime, which may be attributable to the complex funding arrangements for eye health coordination.” Professor Hugh Taylor, founder of the Indigenous Eye Health Unit at the University of Melbourne, said expansion of non-clinical support services is crucial if Australia is to meet its 2020 deadline to close the eye health disparity between Indigenous Australians and the broader population. It will also be vital to meet a 2025 target to eliminate avoidable blindness within the Indigenous population. Taylor said the issue could be drastically improved overnight if the government committed extra funding for the Integrated Team Care program, increasing case management capacity. “The last time I checked the government provided funding to support about 20,000 people with chronic disease, but our estimates show there are probably 70,000 people with diabetes who will all need some case management. They all need an eye exam each year, and someone needs to help them get that, so that program needs to be expanded dramatically to meet the need," he said. n

CARE MODEL IMPROVES LIVES OF AGED-CARE RESIDENTS A novel eyecare model has been shown to improve near vision and the emotional well-being of visually impaired Australians in residential care, prompting calls for further studies to evaluate the program’s financial viability. The model was investigated in the research paper titled: A Randomized Controlled Trial of the Effectiveness of the Residential Ocular Care (ROC) Model, which also demonstrated improved perceived burden of vision-related symptoms for people living in residential care facilities with vision impairment. The NHMRC-funded randomised controlled trial, published in the British Journal of Ophthalmology, was conducted in 38 Australian aged-care

INSIGHT April 2020

facilities involving 178 visually impaired people living in residential care. The residents, 65.7% women, aged in their 80s, were randomly grouped into ROC or usual care pathways. The ROC group comprised a tailored and comprehensive on-site eye examination and care rehabilitation pathway, while usual care participants were given a referral to an external eyecare provider. Analysis of the findings showed the ROC model was effective in improving clinical visual outcomes, specifically near vision, as well as subjective quality of vision and emotional well-being for residents living in residential care facilities in Australia.

According to the study’s principal investigator and senior author Professor Ecosse Lamoureux, director of the population health and ocular epidemiology platform at the Singapore Eye Research Institute and Adjunct Professorial Fellow at The University of Melbourne, vision impairment and blindness affect almost 13% of Australians aged over 80. “There are no standardised vision screening and intervention programs to identify and treat individuals with vision impairment in the Australian residential care population. To address this, our group developed a novel model of personalised eyecare, for residential care facilities in Australia," he said. n

NEWS

TRANSITIONS REINVENTS PHOTOCHROMIC SYSTEM Transitions Optical has responded to consumer demand for a photochromic lens that features faster fade back without compromising lens darkness, with the launch of its next-generation Transitions Signature lenses. Available 1 April, Transitions Signature GEN 8 lenses have been developed on the back of surveys with more than 76,000 glasses wearers and 4,000 eyecare professionals over five years to determine the key attributes for a photochromic lens. The new lens design – available across seven lens colours – features a reinvented photochromic system and comes six years after the launch of the previous Transitions Signature VII lenses Transitions Optical Asia Pacific general manager Mr Stuart Cannon said: “[Our] research revealed wearers want a complete and balanced photochromic lens. Transitions Signature VII wearers were also asked which performance attribute they want improved, the definitive feedback was faster fade back without compromising lens

Transitions Signature GEN 8 lenses are faster and darker than previous models.

“THE BREAKTHROUGH OF TRANSITIONS SIGNATURE GEN 8 LENS TECHNOLOGY IS WE’VE IMPROVED BOTH SPEED AND DARKNESS WITHOUT ANY COMPROMISE”

“For example, if you improve speed then darkness is likely to be compromised.

STUART CANNON, TRANSITIONS

The ultra-agile dyes were developed with expertise gained from designing more than 6,000 photochromic dyes since the 1990s.

“The breakthrough of Transitions Signature GEN 8 lens technology is we’ve improved both speed and darkness without any compromise through a fully reinvented photochromic system, including a reinvented matrix and photochromic dyes.” The new lens is the result of five years of research and development involving more than 100 people, according to the company.

darkness. The new Transitions Signature GEN 8 lens is up to three minutes faster to fade back and 30% faster to activate. Not only are the lenses faster, they are even darker than previous generations.”

“These innovative, new ultra-agile dyes result in improved responsiveness, improved darkness, increased stability and consistency in performance across all colours, and increased longevity of the performance,” the company stated.

According to Cannon, one of they key challenges with photochromic technology is if one attribute is improved, then another will be compromised.

Transitions Signature GEN 8 lenses are available this month in a range of seven lens colours – sapphire, amethyst, emerald, amber, graphite green, brown and grey. n

Got Your Eyes On A New Adventure? Your chance to see Australia while earning a great salary. As part of our commitment to support independent Optometry across the country, George & Matilda Eyecare are searching for a team of optometrists with a passion for eyecare and a sense of adventure. If you have two or more years of experience and are therapeutically endorsed, this could be the opportunity of a lifetime. Package includes generous salary, benefits, bonuses, travel and accommodation. To find out more, email our team: opportunities@georgeandmatilda.com.au

NEWS

LATEST OPTOVUE OCT DEVICE ARRIVES IN AUSTRALIA BOC Instruments has introduced Optovue’s latest optical coherence tomography (OCT) machine to the Australian market, combining numerous ophthalmic diagnostic functions into a single device The Sydney-based distributor is now offering the new Solix OCT device, which is said to feature new capabilities, visualisations and applications for practitioners to identify and manage multiple pathologies from the front of the eye to the back. BOC has been the exclusive distributor of Optovue products since it was founded in 2007 and will begin importing the new model, officially launched in January, once it has local demand. “All optometrists and ophthalmologists can benefit from the Solix, it is a highend premium OCT system with superior specifications and combines several ophthalmic diagnostic products/functions in a single device,” BOC national sales executive Mr Robin Lanesman said. Optovue, which pioneered OCTAngiography (OCT-A), has produced Solix following 27 years of OCT development. The system delivers high quality images of retinal structures with the 16mm-wide x 6mm-deep FullRange retina scan, allowing for confident diagnosis and

Optovue’s new Solix OCT device combines several ophthalmic diagnostic products and functions.

management of retinal pathologies – even in highly myopic patients.

"ALL OPTOMETRISTS AND OPHTHALMOLOGISTS CAN BENEFIT FROM THE SOLIX, IT IS A HIGHEND PREMIUM OCT SYSTEM WITH SUPERIOR SPECIFICATIONS" ROBIN LANESMAN, BOC INSTRUMENTS

According to the company, FullRange anterior segment imaging captures the entire anterior chamber in a single scan, with 18mm-wide scans for comprehensive assessment of cataract patients and refractive surgery candidates. Glaucoma analytics also combine structural and 3D AngioDisc Analysis and Trend reports.

Corneal Layer Map, fundus and external eye photography, as well as imaging of the meibomian gland structure.” Solix also features ultra-fast SD technology with Tracking and Motion Correction Technology (MCT), Multivolume merging and 3D Projection Artifact Removal (PAR), producing OCT and OCT-A images with “unprecedented image resolution and clarity”. Further, QuadMontage combines four 9mm x 9mm AngioVue scans for widefield visualisation of the peripheral retina, and 3D vessel rendering enables real-life visualisation of retinal vasculature and vascular connectivity. Lanesman said BOC provides full support, service and education/training for the entire range of Optovue OCT models. BOC has sold several hundred Optovue OCTs, including the RTVue, Avanti XR, iVue, iScan and iFusion. n

“Solix delivers multiple tools for disease management that improves throughput and enables superior patient care,” a company statement said. “[This] includes wide-field anterior and posterior OCT, non-invasive 3D OCT-Angiography with AngioAnalytics, quantification of epithelial, stromal and total corneal thickness with the 10mm

The system delivers high quality images of retinal structures.

SAFILO BRINGS DAVID BECKHAM RANGE TO LOCAL MARKET Safilo has officially launched the new David Beckham Eyewear collection in Australia, bringing a new range of sunglass and optical offerings to the premium male segment. Beckham, a former English footballer and global celebrity, has signed a 10-year licence agreement with the Italy-based eyewear manufacturer and distributor, with the partnership recently unveiling its first Spring-Summer ’20 range comprising 23 sunglass styles and 19 optical designs. Safilo showcased the new range at a series of exclusive launch events in Sydney, Melbourne, Perth and Brisbane. According to the company, the collection focuses on mainstream

INSIGHT April 2020

within its portfolio for a male-centric, mainstream product that is considered both premium and affordable.

shapes, designed to offer instant mass appeal. They aim to deliver a premium product at competitive prices, ranging between $280 to $470. “Many of the styles also feature either polarised, mineral or photochromatic lenses to give added clarity for the wearer. They are lightweight and comfortable yet feature a unique sprinkling of British gentleman style,” a Safilo spokesperson told Insight. “The line is understated, sleek and elegant, styles to be worn from morning till night and in different occasions, from casual to formal events.” For Safilo, which has traditionally focused on female luxury segment, the new range helps plug a distinct gap

A 10-year agreement with Beckham, the creator and face of the brand, allows time for the brand and partnership to take root. The range comprises 23 sunglass styles and 19 optical designs.

“A 10-year license agreement is not so typical within the eyewear industry. [This] is a significant period, so we have time to build the brand in a controlled and sustainable way in order to guarantee the longevity of the collection in the future,” the spokesperson said. Accordng to Safilo, the collection is divided into two distinct groups – one with a casual and timeless English attitude and the second one with a more glamourous and aspirational spirit. n

NEWS

NOVEL DRY EYE TREATMENT NOW TGA-APPROVED Australian drug regulators have approved a novel aqueous, nanomicellar ciclosporin solution that a leading ophthalmologist believes could fulfil an unmet clinical need for dry eye patients who don’t respond to typical treatments. Cequa (ciclosporin 900 microgram/ mL) is now the first Therapeutic Goods Administration (TGA)-approved calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with moderate-to-severe dry eye, where prior use of artificial tears has not been sufficient. The therapy is locally distributed by global pharmaceutical company Sun Pharma, whose Australia and New Zealand business markets a portfolio of branded dermatology products and a range of oral and specialty generics. According to Sun Pharma, Cequa inhibits T-cell activation and inflammatory cytokine production, reducing the underlying inflammation

associated with dry eye disease. The solution also has a novel delivery system utilising nanomicellar technology to encapsulate the hydrophobic ciclosporin in a small hydrophilic particle. It improves the bioavailability and physicochemical stability of the formulation, which may enhance delivery of ciclosporin to ocular tissue. Further, the Cequa formulation allows for a solution with more than a 10-fold increase in the aqueous solubility of ciclosporin. Ciclosporin was the first agent used in the treatment of dry eye to address the pathogenesis of the disease. The TGA’s approval is based on two randomised, vehicle-controlled clinical studies, OTX-101- 2014-0016 and OTX101-2016-001, in which it demonstrated clinically and statistically significant improvements in tear production and ocular surface integrity in affected patients over 12 weeks. Significant improvements were also

observed for corneal staining from day 28 and for conjunctival staining from day 56 in the OTX-101-2016-001 study, relative to vehicle.

Cequa is an aqueous, nanomicellar ciclosporin solution.

Ophthalmologist Associate Professor Colin Chan, from the from Vision Eye Institute in Sydney, said an additional dry eye treatment will be welcomed by clinicians and patients alike. He said one in five dry eye patients are dissatisfied with their overall treatment due to lack of symptom relief, the time taken to relieve symptoms, and the associated side-effects. Although artificial tears are a mainstay of disease management they do not target the underlying pathophysiology of the disease. “The TGA’s approval of this novel treatment with improved solubility and tissue bioavailability, helps to fulfil a clinically unmet need for dry eye therapies especially for patients who don’t respond to previous therapies,” Chan said. n

NEWS COMPANY

NOVARTIS AMD DRUG BEOVU SECURES EUROPEAN APPROVAL

COMMISSION PROBES ESSILORLUXOTTICAGRANDVISION ACQUISITION EssilorLuxottica has reaffirmed its goal to complete the acquisition of optical retail giant GrandVision within the next 18 months, following the announcement of a new investigation by the European competition watchdog. On 6 February, the European Commission commenced an investigation into the proposed merger of EssilorLuxottica, the world’s largest supplier of ophthalmic lenses and eyewear, and GrandVision, Europe’s largest optical retail chain. If approved, the deal, valued by financial analysts to be worth €7.2 billion (AU$11.6 billion), will see EssilorLuxottica drastically increase its footprint by more than 7,200 stores and 37,000 employees across 40 countries. The commission is concerned the merger may reduce competition for the wholesale supply of ophthalmic lenses and eyewear, as well as for the retail supply of optical products. GrandVision is described as a global eyewear retailer that operates some of the largest optical chains throughout Europe such as GrandOptical and Pearle. EssilorLuxottica sells its products to optical retailers, including GrandVision, which resell them to final consumers. European Commission executive vicepresident Ms Margrethe Vestager, who is in charge of competition policy, said the investigation would be conducted with consumers in mind. “In this consolidating market, we need to carefully assess whether the proposed merger would lead to higher prices or reduced choices for consumers when they visit their local optician,” she said. EssilorLuxottica and GrandVision acknowledged the European Commission’s review in a statement. So far, the transaction has been unconditionally cleared by the US, Russia and Colombia, and it is currently under review in Brazil, Chile, Mexico and Turkey. “The parties are confident that Phase II will be completed in a timely manner and will closely cooperate with the European Commission to fully demonstrate the rationale of the proposed acquisition and the benefits that it will bring to customers, consumers and all the eyewear industry players,” the joint statement said. n

INSIGHT April 2020

“CURRENTLY, WET AMD PATIENTS, WHO ARE OFTEN OLDER, CAN FACE SIGNIFICANT CHALLENGES IN MANAGING THEIR DISEASE " MARIE-FRANCE TSCHUDIN, NOVARTIS

European drug regulators have followed in the footsteps of their Australian and US counterparts by approving Novartis’ new anti-VEGF therapy.

are often older, can face significant challenges in managing their disease,” Ms Marie-France Tschudin, president Novartis Pharmaceuticals, said.

On 17 February, the Swiss-based drug manufacturer announced the European Commission (EC) had approved Beovu for the treatment of neovascular agerelated macular degeneration (nAMD).

“Beovu, and its ability to resolve fluid, brings great therapeutic value that will help physicians optimise treatments for patients based on disease activity.”

According to the company, the therapy is now is the first EC-approved antiVEGF treatment to demonstrate superior resolution of retinal fluid compared with competing drug Eylea (aflibercept), which is distributed by Bayer. Beovu is also said to allow eligible nAMD patients to begin a three-month dosing interval immediately after the loading phase. The EC decision is applicable to all 27 European Union member states as well as the UK, Iceland, Norway and Liechtenstein. It comes after an approval by the Therapeutic Goods Administration on 28 January and the US Food and Drug Administration in October. “Currently, wet AMD patients, who

A key feature of Beovu has been its potential for extended dosing intervals, which the some in the ophthalmic community believe could be a key factor in helping reduce non-adherence rates. “[This] approval is a step forward for patients in Europe who have been looking for a new treatment option which may help them maintain their sight – and their independence – for longer,” Retina International president Ms Christina Fasser said. “This can really help to alleviate a burden, not only on the patient, but also on those who care for them." Beovu has also received Swissmedic approval for nAMD. Novartis has submitted regulatory filings in Canada, Japan and Brazil. n

ZEISS AND RIKEN AGREE TO COLLABORATE ON FUTURE PROJECTS Optical manufacturer Zeiss has entered into a strategic collaboration agreement with Japan’s Riken Institute to work on new innovations in bioengineering. The agreement, announced in January, will see the German firm combine its optical solutions Riken’s expertise in bioengineering and image data manipulation. Dr Stefan Sacré, head of Zeiss in Japan, said the companies’ combined skills are expected to turn bioengineering plans into viable healthcare solutions. “The success of leading-edge research requires not only groundbreaking ideas but also access and management of advanced scientific equipment. Highest level of instrument availability and advanced image data management are key to efficient R&D,” Sacré said. Riken leaders also welcomed the announcement. “Today’s agreement with Zeiss, a corporation which has

From left: Dr Stefan Sacré, Head of Zeiss in Japan, Professor Dr Hiroshi Matsumoto, President of Riken, and Dr Yoshihiro Aburatani, President Riken Innovation

earned a high level of trust worldwide as a manufacturer of high-precision microscopes and optical instruments, represents a new kind of partnership that does not merely focus on separate research topics,” Professor Hiroshi Matsumoto, president of Riken, said. The Riken institute has been at the forefront of several ophthalmic advances, including the use of donor-induced pluripotent stem cells in eye surgery. n

MYOPIA

TOOLS, TRAINING, TIME:

e r a c ia p o y m o t s r la il p e Th

With an expanding patient group, effective interventions and a strong research-base, the conditions are ripe for optometrists to make myopia management a serious part of their practice. RHIANNON BOWMAN finds out what it takes.

he impending myopia epidemic is one eyecare professionals are contemplating with an equal level of trepidation and enthusiasm.

On the one hand, governments and the eyecare sector are bracing for potentially one of the largest modern-day public health problems that is predicted to impact half of the world’s population by 2050. On the other, a greater understanding of the condition coupled with an expanding suite of effective treatments means optometrists are now better equipped to manage Australia’s 6.3 million myopes and prevent more serious problems later in adulthood.

As a result, an increasing number of eyecare professionals are considering how they can turn this opportunity into a clinical and business success for their practice. However, a recent survey in Australia suggests there could be some way to go. In that study, the majority of local practitioners stated they often prescribed single‐ vision distance spectacles for myopia correction in school‐aged children, despite an awareness of the potential effectiveness of contact lens interventions and atropine. In other findings, 20% of respondents considered the need to purchase additional clinical equipment as a key barrier to practising the subspecialty. In light of these developments, established myopia practitioners explain the necessary treatments, equipment, training, and patient and practice management systems in order to effectively practise myopia control.

INSIGHT April 2020 25

MYOPIA

PURSUIT OF CLINICAL EXCELLENCE To be successful, independent optometrist MR PAUL GRAHAM believes eyecare professionals should avoid a retail-focussed model and place greater importance on counselling and managing patients over a number of years.

At his practice, Harmony Vision Care on the Gold Coast (ProVision), optometrist Mr Paul Graham says as many as 70% of patients are under the age of 17. It is a paediatric practice by default, not design, due to the nature of its services. He has been interested in myopia control from the outset of his professional career. At the time of starting the practice in 2003, he did so intentionally with a corneal topographer in order to prescribe orthokeratology (orthoK) and complex contact lens fittings. “We were then one of the first practices to start trialling MiSight lenses from CooperVision,” he says. For Graham, establishing a myopia clinic has always been less about a business decision, and more about the pursuit of clinical excellence. However, he notes with the removal of the Medicare fee cap, optometrists now have the autonomy to set their own fees for their expertise. “I would encourage optometrists considering incorporating myopia management – or any area of expertise – to change their model of care to move away from a high-turnover retail focussed model and put greater emphasis on counselling and managing patients’ expectations over a number of years. “That means explaining their condition, and making sure they understand, explaining their options and underlining why we are doing all this. Part of the secret to successfully incorporating myopia management in your practice is to give patients your time.”

The Zeiss IOLMaster is considered the gold standard biometer for axial length measurements in myopia patients.

“The research on atropine dosages is not completely clear on the longerterm advantages over the results for managing myopia with orthoK and multifocal soft contact lenses. I refer our patients for atropine management based on a combination of the patient’s wishes and need.”

MAKE A START BUT GIVE IT TIME

DR PAULINE KANG, from the Myopia Control Clinic at the UNSW, says it can take time to develop protocols and establish a fee structure.

For professionals considering myopia, Graham says they need to make a “solid decision to develop their expertise”. This may include completing relevant courses, attending conferences, and reading up on the subject. “Don’t just rely on others’ interpretation. You need to form an opinion guided by your own interpretation of evidence-based research,” he says. “You need to invest in your own education and professional development because there’s two sides to understanding myopia: why it has developed, and how to manage its progression. “If you’re confident in your expertise and your depth of knowledge, your patients will trust you and continue to seek your skills to treat and manage their condition.” Graham says most practices are well-equipped to do some form of myopia management. The level of investment in equipment depends on the extent to which the professional wants to practise it. For example, improving one’s knowledge and expertise with contact lens fitting increases the scope of what a practice can offer its patients. “In my experience, a corneal topographer is a ‘must-have’ for managing myopia patients if you want to offer a full scope of services. An ocular biometer [to measure axial length] is a ‘nice-to-have’. “I’ve been successfully managing myopia control in my patients without measuring axial length, but this piece of equipment will become more prevalent in optometry practices as it becomes less cost prohibitive. We recently added an OCT that does ocular biometry.” When Graham diagnoses a new myopia patient, he informs them of the treatment options in detail and their long-term prognosis. He is not therapeutically endorsed, but still discusses atropine.

INSIGHT April 2020

It’s no secret effective myopia control can become an expensive undertaking for families. That's why having a transparent conversation can help avoid future complications with patients and their parents. “Letting patients know from the outset that there will be an out-of-pocket cost helps manage expectations,” Dr Pauline Kang, senior lecturer at the UNSW School of Optometry and Vision Science and coordinator of the Myopia Control Clinic, says. “Optometrists can also utilise the Medicare Benefits Schedule where applicable, when the case meets the requirements of ‘progressive disorder’, as per MBS item number 10914.” At the UNSW clinic, Kang says patients are provided with an information sheet informing them they’ll be charged for their appointment. For example, an orthoK lens fitting costs approximately $1300-$1400, depending on the lens design, she says, adding the clinic does not include an MBS rebate. “We charge $150 annual myopia control fee. If the patient requires more frequent visits, to receive atropine drops for example, we charge an additional fee. A fee structure that is similar to an orthokeratology fitting annual fee may be suitable for general practice.” According to Kang, myopia control management is a personalised service, with the patients seen more regularly – typically on a six-monthly basis to monitor progression. “There is a shift towards prescribing soft multifocal contact lenses to treat myopia, but atropine is also a common treatment prescribed by

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MYOPIA

therapeutically-endorsed optometrists,” Kang says. “Not all treatments will work for all patients, you can’t predict what will work, it can be trial and error, so it’s important to manage patient expectations, and in difficult cases or for patients who are not responding to treatment, refer to an optometrist with more experience.” To successfully incorporate myopia management into a practice, Kang agrees eyecare professionals need a strong knowledge base and understanding of current evidence-based treatment. She says practitioners should be across current hypothesis of treatment options – and how they work – so they are well-placed to discuss treatment options and gaps in research, while remaining transparent with patients. “For example, atropine is a popular treatment in practice, however, current clinical studies typically investigate treatment over a two-year period only, so we need research to support longer term treatment. The most effective concentration of atropine for myopia control is yet to be determined.” Myopia research is continually evolving, she says, and it’s important for practitioners in the field to stay updated with current literature, including peer-reviewed published research, attending conferences and seminars and participating in online courses. Investment in equipment is another integral element to effective myopia management. However, the cost of acquiring devices shouldn’t necessarily be considered a deal-breaker. For example, Kang says an ocular biometer is a beneficial, but not essential, piece of equipment. “It is not enough just to measure refractive error of a myopia patient – which is why an ocular biometer is beneficial because it can measure the axial length of the eye.” She adds: “They are expensive to purchase, typically upwards of $70,000. The gold-standard is the Zeiss IOLMaster but there are other more affordable products on the market. “If you don’t have an ocular biometer, you can refer your patients to an ophthalmologist or clinics such as ours at UNSW for the axial measurements.”

The BHVI Myopia Calculator is said to be one of the most widely used tools for practitioners when communicating with patients.

and their staff to help explain to patients and parents the urgency for myopia management.” While public awareness of myopia continues to trend in the right direction, Capaldi – who is based in the US – has identified a discrepancy in knowledge-base among practitioners. To bridge this gap, BHVI launched its online Myopia Education Program, which is designed to provide the overarching knowledge necessary for aspiring myopia practitioners. More than 4,000 optometrists around the world have completed the program thus far. The first single-module online course on managing myopia was introduced in 2017 and has since expanded to become a three-module program, with a fourth on staff training beginning last month.

Kang says a corneal topographer is a vital, yet versatile, piece of equipment for prescribing orthoK lenses and contact lenses in general.

“As more eyecare professionals recognise the growing need to service their increasing patient populations, they are seeking ways to gain knowledge to immediately incorporate their learnings into their daily practice,” Capaldi says.

“There’s a lot of corneal topographers on the market – you can purchase a stand-alone model but if you have limited space in your practice, you can buy a model that clips onto your slit lamp.”

“This can be a challenge when everyone is already so busy. As well, many have voiced the fact that they cannot find sequential, methodical courses that flow from A to Z to learn what is needed to get started.”

CALCULATING MYOPIA

Capaldi says the full education program serves up six hours in each module and can be taken over a year’s time at the practitioner’s own pace.

MS PAMELA CAPALDI, director of professional services for the Brien Holden Vision Institute, says a key tool for eyecare professionals is the BHVI Myopia Calculator.

Clear communication about the importance of myopia management is arguably one of the most important aspects following a diagnosis. To aid this process, BHVI has developed a myopia calculator to help eyecare professionals demonstrate the difference between treatment and non-treatment to patients and their parents. “I am not exaggerating when I say it is the most widely used tool in myopia management in the world,” BHVI director of professional services Ms Pamela Capaldi says. “Thousands of eyecare professionals access this onlineestimator each month to demonstrate to their patients and parents why myopia management is critical. “The calculator provides a quick visual estimator for eyecare professionals

INSIGHT April 2020

“We are told often that one of the key advantages of online learning is that there is no need to pay conference fees, airfares, hotel and other expenses that come along when one travels for education.” According to Capaldi, the first module, Managing Myopia, has been well received, with 98% of participants saying they immediately incorporated their learnings into practice. There is also a course dedicated to complex cases. Once the foundation is laid, the Business of Myopia module is “a quick learn” that covers patient flow, communication, marketing and management. The fourth module, a four-hour myopia management training program for staff, was launched at the Vision Expo East in New York City on 25 March. “One of the costs that is not normally thought of initially is that of training staff to be part of your myopia management team,” Capaldi explains. “This can be a time-drain on a practice so we recommend self-instruction and then group discussion over staff training sessions. "The Staff Training Course equips the team with a broad base to say and do the right things when parents and patients ask questions.” From a business perspective, Capaldi says there are many ways eyecare practitioners can promote myopia management services to their community. Educating the practice’s patient base is a good starting point. “Written newsletters, posts on your website and additional information to

send home with parents and caregivers will open the discussion,” she says. “Outreach to school nurses, childcare centres and other child-oriented service providers – again with an educational intent – will start to grow the word that there are new management methods to slow the progression of myopia.” She adds: “The hope is that with patient awareness growing about the increasing incidence and risks of high myopia that patients will actually arrive to the practice asking for information on the latest management modalities for myopia management. “The most important thing is to get started now. Take the next 10 myopes that sit behind your phoropter and begin offering to manage their progressive myopia on a proactive basis. There are many tools to get you started.”

“For practitioners, aim to keep abreast of the emerging literature in this rapidly evolving area, and consider how to translate that into practice for your patients, but be pragmatic. Your patient wants your professional advice regarding which treatment option would best suit their individual presentation and risk for progression.”

POSITIVE IMPACT

Behavioural and therapeutically-endorsed optometrist MS REBECCA JAMIESON says myopia control aligns with what behavioural optometry stands for.

BUILD YOUR REPUTATION

Independent optometrist ASSOCIATE PROFESSOR ANN WEBBER says offering a suite of myopia treatments was a decision made in the interests of patients, rather than a business decision.

With about 10-15% of her patients being myopic children, Associate Professor Ann Webber, of Clarity Optometrists (ProVision), has a wellestablished clinical interest in paediatric optometry and has pursued extensive post-graduate qualifications and research in this field. “With the accumulating evidence about treatment to slow myopia progression in children, we started to actively manage myopia in clinical practice about seven to eight years ago, including orthoK, low-dose atropine, and dual focus soft contact lenses,” she says. “We’re a practice that aims to provide full-scope advice based on best evidence. The intent of offering treatment modalities was not to grow the practice but to prescribe to current evidence what would be in the patient’s best interests.” According to Webber, myopia management builds the reputation of the practice. “There’s recognition of the expertise and knowledge of the practitioners in the practice, that then helps to build something that’s distinct about our practice compared to our commercial competitors.”

Bayside Eyecare in Melbourne which is also part of ProVision, was also one of the first to trial CooperVision’s MiSight lens when it was released in Australia in November 2016. Practice owner Ms Rebecca Jamieson was also part of BHVI’s pilot myopia management course in 2017. “The course was a brilliant entry into understanding myopia management. In the not-too-distant future, this will be the gold-standard of care,” she says. “It is our duty of care as optometrists to offer our patients best practice care for all eye conditions. There is extensive evidence from research that shows that myopia control strategies slow myopic progression and so we should be offering this to our young myopes”. For Jamieson, as a behavioural optometrist, myopia management has always been an ideal fit. “Namely, preventive eyecare management, and providing patients remediation.” However, like other eyecare professionals in the field, it is the positive impact of her work that she finds most rewarding. “I had a nine-year-old South East Asian myopia patient in last week, and both his parents are myopic. "It’s satisfying seeing a child who could potentially follow in their parent’s footsteps down the path of myopia progression and the risks associated with that including risk of retinal detachment, not progressing, and parents are happy. It’s rewarding, and the impact on your patient’s lives as they grow into adults – you’re positively impacting on their lives.” n

In terms of practice management, Webber says eyecare professionals need to be mindful of time management and patient flow. “Cycloplegic [drops] as part of the refractive error determination is important in both myopic and hyperopic children, so you need to think about how you’re going to schedule patients so that you can incorporate including cycloplegic [drops] as part of your consultation. “Good retinoscopy skills, and binocular vision assessment skills on children are essential. An ocular biometer [to measure axial length] is an incredibly useful piece of equipment and really establishes to the patient’s parent that myopia is related to structure, and helps in the education of parents about what the underlying aetiology is of myopia. “It helps parents to understand the optics of the visual system that we’re correcting with glasses or contact lenses.” Practitioners also need to be aware there are significant costs for families with all the treatment modalities. “For patients from low socio-economic families who can’t afford the cost of contact lenses or atropine drops, bifocal lenses are a cost-effective solution,” Webber says, adding that a new spectacle lens designs are in the pipeline.

Behavioural optometrist Ms Rebecca Jamieson says myopia management has always been an ideal fit for her practice.

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MYOPIA

DEFUSING THE MYOPIA TIMEBOMB:

? ld o h e r u t u f e h t s e o d What

Clinical optometrist DR PHILIP CHENG, who operates The Myopia Clinic Melbourne within his practice Eyecare Concepts, explains the current treatment landscape and why he believes clinical use of axial length measurement will be the next big step for disease management.

yopia management is arguably the hottest topic in optometry today. The worldwide prevalence of the condition is on everyone’s mind and has led to the development of new technology and highly effective treatment options.

In my myopia control clinic in Melbourne, I see all different presentations of myopia daily. Some children come for a routine eye test and are diagnosed for the first time, others are seeking a second opinion after recent diagnosis, and for many who have had progressive myopia for years – wearing increasingly stronger and thicker glasses – their parents are looking for solutions to slow their progression. Many parents discover myopia control methods not through their eyecare practitioner, but from family and friends, and their own research. Some are referred from other optometrists and doctors. I see a range of emotions when I tell parents their child has progressive myopia and what treatments are available. Confusion, guilt, sadness,

INSIGHT April 2020

frustration, anger, despair and hope. It’s all too common I hear parents say that they wish they had known about it earlier. They also wonder why hadn’t anyone told them earlier. I tell them that, regrettably, we cannot go back in time, but we will our best to slow their child’s myopia progression from this point onwards.

In the late 1970s, now-retired Victorian optometrist Mr Maurice Brumer vigorously tried to warn the industry and public about the potential negative effects of wearing single-vision minus lenses for myopia correction. At the time, myopia research and evidence to support his theories were scarce and he was ultimately condemned as an industry disrupter. Forty years on, with our greater understanding of myopia development, perhaps Mr Brumer’s controversial views were ahead of his time. We now have good evidence supporting the use of myopia control interventions. We know the treatments work. Orthokeratology (orthoK), multifocal soft contact lenses, low-dose atropine eye drops, and special spectacle lenses all have a place in our armoury to combat child myopia to maintain better eye health. The sight-threatening conditions associated with myopia – myopic maculopathy, retinal detachment, glaucoma and cataract – are well known. Yet, more than 50% of respondents in a recently published myopia management survey in Australia indicated they still ‘always’ or ‘mostly’ prescribe single-vision distance spectacles for myopia. In correcting myopia with optical means, it appears that when we provide the peripheral retina with hyperopic defocus, eye growth can be modulated and axial elongation reduced. That means prescribing optical aids more advanced than traditional single-vision minus lenses optometrists have routinely prescribed for decades. Among optical interventions, orthoK and multifocal contact lenses, in my

opinion, generally yield the best results in slowing progression, as the peripheral defocus effect is maintained independently of gaze and eye movement. Research shows contact lenses are very safe for even young children. A recent paper by Dr Kate Gifford, PhD, concluded that the comparative lifetime risk from contact lens wear from a young age is less than the risk of visual impairment from high myopia. My experience is that children as young as five or six, with initial help from their parents, can safety and successfully wear orthoK and soft contact lenses for myopia control. Age itself should not be the determining factor, but the maturity of the child and readiness of the family to start the contact lens journey. Recently, the CooperVision MiSight 1 day contact lens received regulatory approval in the US, a landmark decision with significant potential impact on how child myopia is managed. Despite the arrival of new daytime soft lens options, night-time orthoK remains the most popular myopia control treatment in my clinic. The level of interest among optometrists in learning to fit orthoK is at an all-time high. But orthoK fitting demands additional equipment, practitioner skill and experience for best results, whereas multifocal soft lenses are relatively easy to fit and more readily available. For children who are not ready or suitable for contact lenses, new technologies in spectacle lenses like the HOYA MiyoSmart with Defocus Incorporated Multiple Segments (DIMS) optics – to become available in Australia this year – promise to be a gamechanger in managing myopic children using glasses. Traditional multifocal and bifocal lenses can also slow progression for children with binocular vision disorders such as near esophoria and accommodative lag. Practitioners need a good grasp of the current knowledge and evidence base of the various interventions, and to continually update their knowledge as new research findings become available. For instance, while the ATOM2 study (2012) showed promise in using 0.01% atropine to slow myopia progression, more recent analysis of this study and newer studies such as LAMP (2018) suggest a dose-dependent therapeutic effect and to prescribe 0.025% or 0.05% atropine for more effective control of axial elongation. Myopia management isn’t static, but constantly evolving. Part of the clinical challenge is the fact that no two myopes are the same, even from the same family. There is not one treatment that will always be effective for every child. Close monitoring and tailoring the treatment plan for the individual is key to optimal control of myopia progression. That might be to increase the dosage of the atropine, modifying the design of an orthoK lens, changing treatment modality, or adding a secondary treatment such as combining orthoK with low-dose atropine. MEASURING AXIAL LENGTH The single most important technology I have implemented in practice is arguably the measurement of axial length, using the Zeiss IOLMaster optical biometer. Measuring axial length has allowed me to change the conversation with parents about myopia as a refractive error (a vision condition) to eye growth and elongation (eye health condition). After all, if myopia control interventions are aimed at reducing or even halting eye elongation, we need the tools to quantify eye growth and to validate the effectiveness of the treatments we prescribe. This is particularly helpful for kids wearing orthoK lenses where the true refractive status cannot be measured while on treatment, as well as low-dose atropine treatment where the effect on slowing axial elongation appears to be less than the slowing of refractive change. Measuring axial length routinely also allows us to assess myopia-related eye health risks in both kids and adults (eyes longer than 26mm are associated with greater risk of uncorrectable visual impairment), urgency of intervention, and to monitor pre-myopic kids identified at risk of developing myopia (eyes destined to become myopic show an increased rate of axial elongation years before the onset of myopia). While there are aspects of eye growth that we are yet to fully understand,

Clinical optometrist Dr Philip Cheng says close monitoring and tailoring the treatment plan is key to optimal control of myopia progression.

complete biometric data of axial length, keratometry and refraction provide highly valuable information about the status of a child’s myopia to guide and optimise our management strategy. Doing myopia management well takes time. It may require a change to how your practice operates. In my clinic I allow up to an hour for an initial myopia assessment consultation. There is a myriad of tests to carry out – refraction, binocular vision workup, axial length measurement, corneal topography, ocular health assessment, and often a cycloplegic examination. But the most time is dedicated to speaking with the parents about myopia, explaining what it all means, setting the goals of treatment and appropriate expectations, and answering the many questions they often have. Myopia management is both personally and professionally rewarding. There is a great feeling to be had to something positive and proactive. Myopia management is a journey for the child and their family, one that spans many years in your care. By always aiming to provide the best possible experience, my orthoK and myopia control patients are very loyal and their families regularly recommend my clinic to others, helping my practice grow. Eyecare is all about trust. If the parents are happy with the care and expertise you have shown, the siblings and other family members will invariably follow. If you don’t discuss or offer myopia management for a child with myopia, chances are the parents will eventually find out about it elsewhere, and lose trust in your ability to provide the best care for their family. And they won’t be back. In time, I anticipate myopia management will become a standard of care that all patients and parents can expect when they walk into an optometrist. As it should be. No child should have their eyes worsen unnecessarily without at least a discussion about how we may prevent such deterioration. When there are effective, evidence-based ways to prevent vision deterioration and reduce the risks of eye disease, doing nothing but prescribing a regular pair single-vision glasses to a progressive young myope may one day be considered a failure to provide adequate care. The time to start myopia management is now. n

INSIGHT April 2020 31

RESEARCH

ZEISS PRESBYOPIA IOL SATISFIES KEY PERFORMANCE MEASURES

STUDY HIGHLIGHTS BIOMARKER FOR DISCONTINUING ANTI-VEGF TREATMENT

A meta-analysis of scientific studies evaluating Zeiss’ At Lisa tri family intraocular lenses (IOLs) has provided new insight into their performance.

A new study has demonstrated that a particular biomarker can be used to select which age-related macular degeneration (AMD) patients can discontinue anti-VEGF therapy. South Korean researchers recently validated a treat-and-stop (TES) protocol through the identification of OCTAngiography biomarkers that correspond with recurrent sustained exudation choroidal neovascularisation (CNV). According to the team, both treat-andextend regimens and the TES protocol have shown comparable effectiveness compared to fixed dosing schedules, however the guidelines for discontinuing treatment are not yet clear. In total, 128 patients with neovascular AMD (nAMD) were enrolled in the study and split into ‘stop treatment’ and ‘continuing treatment’ groups. The TES protocol was applied to patients who, after three initial monthly injections, were able to extend their treatment. This decision was based on whether their macula had no signs of fluid in an OCT scan and clinical examination. When the macula was free of fluid, the treatment intervals were successively increased by two weeks until three months had passed. Patients then received two or more injections at threemonth intervals – if the macula remained dry treatments were suspended. If at any point a new CNV developed or recurrence of the previous CNV was found, treatment was reinitiated. “Our findings have two main consequences: first, confirming the validity of TES regimens and promoting the possibility of discontinuing treatment,” the study authors said. “And second, verifying the morphologic pattern of CNV on OCT-A after antiVEGF treatment as a useful biomarker determining whether to stop antiVEGF injection or to continue disease suppression by maintenance therapy.” According to the authors, there are no set guidelines for discontinuing treatment. Frequent anti-VEGF therapy can erode the quality of life for nAMD patients and their caregivers, in addition to financial strain and loss of productivity. n

INSIGHT April 2020

"IN INDIVIDUAL STUDIES, KRETZ ET AL REPORTED THAT THE INTERMEDIATE VISUAL OUTCOMES IN A SERIES OF 50 PATIENTS WERE VERY GOOD" ZEISS METAANALYSIS

The company published a whitepaper related to the clinical performance of the presbyopia-correcting IOLs, which have featured in more than 75 peer-reviewed publications by 60 different first authors. The results, based on studies assessing the IOLs’ performance in 9000 eyes of 4,500 implanted patients, predominantly focussed on the Zeiss At Lisa tri 839MP, which was launched to the European market seven years ago. Of peer-reviewed tri 839MP publications, 23 have so far explicitly investigated patient-reported outcomes. In this cohort of studies, eight reported patient satisfaction to have reached 100% and a further nine rated patient satisfaction as greater than 90%. A meta-analysis of the studies investigating visual acuity demonstrated the lens reliably ensures “excellent outcomes regarding visual acuity at far, intermediate, and near distances”, according to Zeiss.

Specifically, for the Zeiss At Lisa tri 839MP, a vast number of studies reported patients achieved an average binocular uncorrected intermediate visual acuity (UIVA) of 0.1 logMAR or better. “In individual studies, Kretz et al reported that the intermediate visual outcomes in a series of 50 patients were very good, with 79% of eyes achieving UIVA of 0.1 logMAR or better, 94% of eyes achieving 0.2 logMAR or better, and all eyes achieving 0.3 logMAR or better. The mean postoperative logMAR UIVA was 0.09 when measured at 66cm.” According to the analysis, the IOLs have also been shown to deliver predictable and stable results over time. Kretz et al reported 90% of 100 eyes treated had a spherical equivalent (SE) within ±0.50 D three months after surgery. Mendicute et al reported postoperative SE was within ±0.50 D in 85% of cases and 83% of cases one month and three months after surgery, respectively. At one and three months, 95% and 97%, respectively, were within ±1.00 D of intended refraction. n

RESEARCHERS UNLOCK COMPLEX SECRETS OF EYE PROTEINS A new understanding of how proteins in the eye are prevented from clumping together has opened up new possibilities for cataract prevention and treatment. Researchers from the Technical University of Munich (TUM) have identified the precise structure of the alpha-Acrystallin protein, one of the protective proteins in the lens of the human eye that prevents other proteins from being damaged. Proteins in the eye are created during embryotic development and do not replenish throughout life, making the role of the protective proteins important to ongoing eye health. Attempts to determine the structure of alpha-A-crystallin had been previously unsuccessful due to its complex structure, however TUM researchers were able to combine cryo-electron microscopy, mass spectrometry, NMR spectroscopy and molecular modelling to develop a model. “Alpha-A-crystallin is extremely

(From left) Dr Carsten Peters and Dr Christoph Kaiser. Image: Andreas Heddergott / TUM

multifaceted,” Professor Sevil Weinkauf, one of the researchers said. “This makes it very difficult to determine its structure. It was only after developing a new strategy for data analysis that we were able to demonstrate that in solution it takes on different structures with 12, 16 or 20 subunits.” The research was recently published in the journal Nature Structural and Molecular Biology. n

TECHNOLOGY

ARTIFICIAL INTELLIGENCE PREDICTS TREATMENT OUTCOME FOR DIABETES-RELATED VISION LOSS A new approach that uses an algorithm to analyse retinal images could help practitioners select the best treatment for patients with vision loss associated with diabetic macular edema. Research leader Associate Professor Sina Farsiu from Duke University said the team developed an algorithm that can be used to automatically analyse OCT images of the retina to predict whether a patient is likely to respond to anti-VEGF. They are now planning a larger observational trial of patients who are yet to undergo treatment to confirm and extend the findings from the pilot study. The research paper, titled Deep learning-based single-shot prediction of differential effects of anti-VEGF treatment in patients with diabetic macular edema, has been published in The Optical Society journal Biomedical Optics Express.

The research team recognised a need to identify patients that would benefit from anti-VEGF therapy – widely used as the first line of therapy for diabetic macular edema – because it requires multiple injections that are costly and burdensome for both patients and physicians, but aren't always effective for every patient. “This research represents a step toward precision medicine, in which such predictions help clinicians better select first-line therapies for patients based on specific disease conditions,” Farsiu said. In their paper, Farsiu and colleagues showed the new algorithm can analyse just one pre-treatment volumetric scan to accurately predict whether a patient is likely to respond to anti-VEGF therapy. “Our approach could potentially be used in eye clinics to prevent unnecessary and costly trial-and-error

treatments and thus alleviate a substantial treatment burden for patients,” Farsiu told The Optical Society.

Sina Farsiu, Duke University.

“The algorithm could also be adapted to predict therapy response for many other eye diseases, including neovascular agerelated macular degeneration.” The researchers tested the algorithm with OCT images from 127 patients who had been treated for diabetic macular edema with three consecutive injections of anti-VEGF agents. They applied the algorithm to analyse OCT images taken before the anti-VEGF injections, then compared the algorithm’s predictions to OCT images taken after anti-VEGF therapy to confirm whether the therapy improved the condition. Based on the results, the researchers calculated that the algorithm would have an 87% chance of correctly predicting who would respond to treatment. n

“I love being a member of Eyecare Plus, the only optometry group to be awarded the most satisfied patients in Australia, two years in a row...” Lara Foster

Eyecare Plus Moss Vale

To join contact Philip Rose 0416 807 546 or philip.rose@eyecareplus.com.au

INTERNATIONAL

OCULAR GENE THERAPY BEGINS ON THE NATIONAL HEALTH SERVICE

UK STUDY FINDS CSCR TREATMENT OFFERS NO BENEFIT FOR PATIENTS New research from the University of Bristol and University Hospital Southampton has concluded that eplerenone offers no benefit for patients suffering from central serous chorioretinopathy (CSCR), and subsequently should no longer be prescribed for the condition. Eplerenone, a drug that decreases the activity of hormones that regulate salt and water in the body, was previously noted to improve the vision of those suffering from CSCR, albeit with only limited clinical data. The drug is also associated with side effects, including increased potassium levels, altered heart rhythms and a decrease in blood pressure. The limited clinical data and negative side effects prompted a study into the long-term effectiveness of the drug, which was funded by the UK’s Medical Research Council and National Institute for Health Research Efficacy and Mechanism Evaluation. As part of the study, 111 patients across 22 sites for 12 months received either eplerenone or a placebo. According to the study, which has been published in respected medical journal The Lancet, eplerenone offers no benefit and its use should cease. “Despite a lack of robust clinical trial evidence, eplerenone and other similar drugs are widely used by ophthalmologists as first line therapy for the treatment of CSCR,” Professor Andrew Lotery, professor of ophthalmology at the University of Southampton and consultant ophthalmologist at University Hospital Southampton, said. “However, as these drugs can have side effects such as hyperkalaemia, which causes a rise in potassium and can affect heart rhythm, it was important to the [National Health Service] that we determine efficacy and safety. “After a year of follow-up, this study found no benefit of treating patients with eplerenone compared to those patients that took a placebo tablet.” Instead, Lotery advocated for ophthalmologists to cease using the medication and instead look to participate in future trials for alternative treatments. n

INSIGHT April 2020

The UK’s national health provider has started treating patients with Leber’s Congenital Amaurosis (LCA) with a new sight-restoring gene therapy.

Robert MacLaren.

"THE NHS HAS BEEN LEADING THE WORLD IN GENE THERAPY RESEARCH WITH SEVERAL SUCCESSFUL CLINICAL TRIALS" ROBERT MACLAREN, OXFORD UNIVERSITY

The National Health Service (NHS) began offering voretigene neparvovec, also known as Luxturna, in February, which is said to be the first in a new generation of gene therapies that are directly administered via injection. Many patients in the trials recovered their night-time vision with the treatment, which works by inserting a working copy of the mutated gene. LCA is a rare type of retinal dystrophy estimated to effect 1 in 80,000 people in the UK and is caused when a person inherits two non-functional copies of a gene known as RPE65, leading to progressive vision loss beginning in infancy that advances to near-complete blindness in adulthood. Luxturna is manufactured by Novartis, reportedly costing approximately £613,410 (AU$1.2 million) per patient. The NHS reached a National Institute for Health and Care Excellence (Nice)-

endorsed deal with Novartis to fund the drug and it is now estimated that as many as 100 patients could benefit. Professor Robert MacLaren, consultant ophthalmologist at Oxford University Hospitals, was encouraged to see gene therapy research finally come to fruition. “We now have our first approved treatment – in this case for a rare form of genetic blindness,” he said. “The NHS has been leading the world in gene therapy research with several successful clinical trials. “The recent decision by NICE to provide this novel treatment shows how the UK is maintaining its global position in delivering first class healthcare.” Mr Assad Jalil, the consultant vitreoretinal surgeon who undertook the procedure at Manchester Royal Eye Hospital, said: “Treating inherited retinal diseases is extremely challenging but gene therapy offers hope to all such patients. Subretinal Luxturna injection is probably the first of many such gene therapy-based treatments, which will become available in the future." n

WHO CALLS FOR EYECARE TO BE PART OF UNIVERSAL HEALTH COVERAGE The World Health Organization is calling on nations to adopt five key recommendations of its World report on vision, including making eyecare an integral part of universal health coverage. The international health body urged member states to implement integrated people-centred eyecare in health systems; promote high-quality research; monitor trends and evaluate progress; and raise awareness and engage and empower people and communities, as part of its recommendations. A resolution passed on 6 February by the WHO emphasised the “disproportionate burden” that vision impairment and blindness places on underserved and vulnerable communities. It also notes that cataract and refractive error are the main sources of vision loss across the world. The resolution raised concerns about the increasing prevalence of myopia,

The WHO's World report on vision.

“especially related to lifestyle factors in children, including intensive near vision activity and insufficient time spent outdoors”. The WHO highlighted the number of people living with blindness is projected to triple by 2050 due to an ageing population, lifestyle and noncommunicable diseases. The report estimated investment of US$14.3 billion ($21.8 b) is required for unaddressed refractive error and cataract. n

CHINESE OPHTHALMOLOGIST AND CORONAVIRUS WHISTLE-BLOWER HAILED A NATIONAL HERO An ophthalmologist who Chinese authorities attempted to silence during the initial stages of the coronavirus outbreak died after contracting the virus himself from a glaucoma patient. Li Wenliang was declared dead on 7 February after failed attempts to resuscitate him at a hospital in Wuhan, the government-controlled Chinese newspaper Global Times reported. The 34-year-old eye doctor was widely regarded as a hero for his bravery to speak out about the virus in December, despite threats from Chinese officials who tried to pacify him while playing down the severity of the outbreak. Li, according to reports, was targeted by police for “spreading rumours” in late December after he posted a warning in his medical school alumni group on the Chinese messaging app WeChat. His message cautioned that seven

patients from a local seafood market had been diagnosed with a SARS-like illness. They were quarantined at Wuhan Central Hospital – where Li worked. He subsequently urged colleagues to wear protective clothing. Four days later he was reportedly summoned to the local public security bureau, which accused him of making false comments and disturbing the social order. He was told that if he continued to talk about the disease he would be “brought to justice”.

the operation before being hospitalised on 12 January and testing positive for the coronavirus on 1 February. He died seven days later from the virus that had infected more than 169,000 people and killed 6500 at the time of writing. Li Wenliang.

Li was one of eight people authorities accused of sharing false information. He agreed to not discuss his concerns in public again. A few weeks later, in early January, he treated a woman with glaucoma without realising she was also a coronavirus patient, The Guardian reported. It appeared he became infected during

Li’s death was also the subject of much confusion across China. The Global Times prematurely announced his death the day before his actual passing, citing friends and doctors, before later deleting the post. Other Chinese media outlets also deleted their reports of his death. According to CNN, the topics “Wuhan government owes Dr. Li Wenliang an apology”, and “We want freedom of speech,” soon began to trend on China’s Twitter-like platform, Weibo. Each gained tens of thousands of views before disappearing from the censored platform. n

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BIG DATA

: a t a d g i B

CRACKING THE EYECARE CODE

Big data is being touted as a key trend that will shape Australian eyecare for decades to come. RHIANNON BOWMAN examines how the sector is grasping a data-driven era and how this will impact future eye health models and policy.

ig data – and its inherent ability to reveal information unavailable to traditional research methods – is becoming a dominant driver in the future direction of Australian eyecare.

Whether it be identifying patterns in care, informing eye health policy or for the development of artificial intelligence-based diagnostic systems, it is widely agreed that data holds the key to overcoming the biggest challenges facing the ophthalmic sector today. Optometry Australia (OA) is among a host of organisations that believe a data-driven approach will help shape the next 20 years of eyecare. In its report: Optometry 2040 taking control of our future, it states that data driven-decision making can improve efficiency and productivity at the system and practice level. It also offers benefits in terms of performance management and quality improvement, while providing more clarity on cost-benefit analysis in patient management decisions. While there is excitement around the transformative effect of big data, its emergence also raises a host of legal and ethical questions to consider. In Australia, OA reports a current “crisis of trust” in data and privacy. As more technology is embedded into practice, it has identified a need to balance the increased capacity for data collection and analysis with

INSIGHT April 2020

trust between the clinician and patient. Insight examines how the sector is carefully embracing a data-driven era. BIG DATA RESEARCH To explain the true power of big data in Australian eyecare, few are as wellcredentialed as Professor Claire Vajdic. An optometry graduate from the University of New South Wales (UNSW), Vajdic later pursued a career in research and a PhD in public health. Since 2015 she has been head of the Cancer Epidemiology Research Unit at the Centre for Big Data Research in Health at UNSW – Australia’s first research centre dedicated to this field. It aims to maximise the use of all possible sources of health big data, and enhance the health and wellbeing of Australians and the global community. “Big data, for example, can help identify those at risk of diseases like diabetic retinopathy, and the best referral or management practice. The datasets we develop are about patterns of healthcare and predicting better outcomes,” she says. “It’s exciting to also think of the future when wearables will come together with administrative and detailed clinical records in order to achieve better patient outcomes.” In health, the term ‘big data’ includes the millions of records generated routinely by health services, real-time clinical data captured at the pointof-care and genomic data produced in research and clinical settings. It also involves health-related data from the population at large through technology such as wearable devices and social media. Vajdic says the centre’s objective is to improve population health, working with clinicians, hospitals and data scientists and using existing

health records. Its research is facilitated by NSW Health’s Centre for Health Record Linkage (CHeReL), and the Australian Institute of Health and Welfare’s (AIHW) Data Integration Services Centre, which link multiple sources of data and maintain a record linkage system that protects privacy.

“WE CAN COMPARE LIKE-WITH-LIKE AND CAN DEMONSTRATE IF A HOSPITAL OR GROUP OF PRACTITIONERS ARE ALIGNING WITH GUIDELINE-BASED CARE”

“Our linked administrative health data is provided to approved researchers only and provides population coverage so we’re able to minimise bias,” Vajdic says. “We can receive linked optometric and allied health data, including Pharmaceutical Benefits Scheme and Medicare Benefits Schedule records, so we can look for patterns in that data at a group level, not individually identified practitioners,” she says.

- CLAIRE VAJDIC

Vajdic says preserving privacy is a key tenet of the centre’s work, and it is serious about a concept termed the ‘separation principle’. This principle means no one working with the data can view both the linking (identifying) information about an institution, clinician or patient, such as name, address, or date of birth, together with the merged analysis (content) data such as diagnostic or treatment information. “As researchers, we are granted access to content data, not identifying variables, for privacy and confidentiality reasons,” she says. “Specialist linkage centres like CHeReL, which take care of the separation principle, have been a wonderful development over the last 10 years; it has transformed the quantity and quality of data we can access and analyse.” Vajdic explains that institutes such as the SAX Institute, based at the University of Technology in Sydney, have also transformed the big data field with developments such as SURE, the Secure Unified Research Environment, a computing solution that brings researchers together in order improve healthcare.

“IT'S MUCH EASIER TO LOSE TRUST THAN TO REGAIN IT, SO WE NEED TO ENGAGE IN TRANSPARENT AND RESPECTFUL DIALOGUE ABOUT DATA USE AND PROTECTION” - KATE TAYLOR

“It’s upped the infrastructure to allow for secure, large-scale data analysis,” she says. “We can access eyecare data captured at a tertiary level, such as cataract surgeries performed in hospitals, or research who is gaining access to the expensive drugs to treat age-related macular disease, whether vulnerable populations have the same access to care, and the risk factors for receiving a later diagnosis. We are looking for patterns in the data. “Data can also illuminate the use of prescriptions for conditions such as diabetes and glaucoma. Using the separation principle, we can look at prescription data for the entire community while preserving the identity of practitioners writing the prescriptions.” Vajdic says researchers can also use linked administrative health data to investigate the safety and quality of health care. “For example, some clinicians may claim they have the ‘most complicated or high-risk patients’ as an explanation for poorer outcomes. We can compare like-with-like and can demonstrate if a hospital or group of practitioners are aligning with guideline-based care. We can compare different models of care and look for any downstream effects.” The future in big data, Vajdic says, will be focused on areas that can be improved and minimising unwarranted variation in care. “Our clinical analytics group has expertise in artificial intelligence, including deep-learning and natural-language processing. Some potentially important clinical data is currently only captured in free-text fields. It is unstructured and we are using these analytical approaches to discover new, actionable insights about patient care and patient outcomes. “Artificial intelligence is aiding pattern recognition and clinical diagnosis using image-based data, such as those generated by various scantechnology in eyecare.” When it comes to ethical and legal considerations of data use, Vajdic

believes these are long-standing strengths of her profession. “We are guided by NHMRC’s National Statement on Ethical Conduct in Human Research. All actors in the big data pipeline also adhere to the Federal Government’s Five Safes framework. It is a risk assessment framework for data access, ensuring safe people, safe projects, safe settings, safe data and safe outputs. “There is also pending Commonwealth legislation expected in the next four to six months from the Office of the National Data Commissioner, established last year. When the legislation passes Parliament, it will be known as the Data Availability and Transparency Act (DATA).” ANECDOTAL TO EVIDENCE-BASED Cloud-based platform Oculo is an Australian company focused on the secure, instant transfer of clinical correspondence between healthcare professionals. Currently, more than 2800 optometrists and 730 ophthalmologists use the system in Australia. From her front-row seat in clinical communication, founder and CEO Ms Kate Taylor believes the medical sector is in the midst of a revolution, transitioning from anecdotal to evidence-based care. She believes future healthcare lies in an analytics-driven approach. “Anywhere that moves from the descriptive to the digital may be disrupted. Eyecare clearly uses a lot of digital technologies for diagnosis and management – and increasingly for communication,” she says. “There's also significant need to improve quality and efficiency for the health system, as well as to better support patients in their own care. Data-

INSIGHT April 2020 37

BIG DATA

driven care tools will offer opportunities on many levels.” With troves of big data being collected, stored and interpreted, it stands to reason that the sector faces inherent challenges of responsible data protection and use. “Healthcare relies on trusting relationships: trust between patients and care providers, trust between colleagues, trust in the system as a whole. Data issues create a whole new element of trust in healthcare interactions, even when we are seeing other sectors breaking trust with consumers,” Taylor says. “It's much easier to lose trust than to regain it, so we need to engage in transparent and respectful dialogue about data use and protection and to recognise that all parties are learning as the technological opportunities grow. That includes patients, providers, policymakers and payers.”

“THE GOAL FOR EVERY OPTOMETRY PRACTICE SHOULD BE TO EMBED BENCHMARK REPORTING AS A KEY COMPONENT OF PROFESSIONAL DEVELOPMENT” - NAOMI BARBER

STRATEGIES SPAWN FROM DATA With 400 stores now open across Australia and New Zealand, Specsavers is uniquely placed to share how big data influences its eyecare model. Last year alone, the company conducted more than 3.5 million consultations – accounting for almost 40% of patients presenting to optometry. Its latest Eye Health Report featured data from 8.5 million patient journeys, making it the largest publicly available data set of its kind in the region, increasing by an additional 3.5 million data points from 2018. Specsavers professional services manager Ms Naomi Barber says that while record management compliance is a critical component, the company is also interested in using the data to develop large-scale strategies to overcome national eye health challenges – such as improved detection and referral rates for glaucoma and engaging people with diabetes for more regular eye tests. “We continue to focus on integrating equipment and software to enable optometrists to capture key clinical information efficiently and accurately. This allows us to collate large-scale data, identify what leads to effective detection of eye disease, and report on trends and variability in practice,” Barber says. “This data is crucial to implementing clinical initiatives that drive enhanced standards of care. We know this because we can measure patient outcomes now.” Specsavers has integrated its patient management system Socrates with e-referral platform Oculo to facilitate accurate, timely, secure and two-way communication with other providers, including GPs and ophthalmologists. The system is designed to place the patient at the centre of communication and, as such, the data Specsavers obtains is patientoutcome centric and underpins its mission “to transform eye health”. These systems have also been key to the development of benchmarks that provide context and a point of reference for optometrists in their practice. Each week Specsavers optometrists receive a personal report which includes a broad range of data, including their Medicare item number utilisation and personal detection and referral rates for individual eye diseases. This is set alongside whole-of-practice benchmarks and national comparisons, allowing each optometrist to compare their activity alongside that of their colleagues. “We believe the goal for every optometry practice should be to embed benchmark reporting as a key component of professional development, to ensure it is readily measured in terms of the benefit to patients,” Barber says. The distribution of benchmark reporting through the Specsavers network has been coupled with key clinical initiatives and is said to have resulted in measurable enhancement to patient outcomes. For example, it was due to their optometrists’ data on glaucoma referrals that Specsavers has been able to validate the correlation between visual field performance and detection of glaucoma approaching population prevalence. “This has resulted in the first ever evidenced-based benchmark for visual field performance in primary optometric practice,” Barber says.

INSIGHT April 2020

INVESTMENT TO IMPROVE INTEGRATION During the past five years Specsavers has also been developing a framework to harness integrated equipment, technology, IT, professional development and collaboration strategies. It plans to use the data obtained from this to draw attention to the challenges the industry faces in eye disease detection. In doing so, it is also able to develop new strategies that are designed to improve eye health outcomes for Australians. “For example, we are now completing a Socrates update that will fully automate the registration of patients with diabetes onto the KeepSight portal, as part of the standard eye test routine,” Barber explains. “When the optometrist sets the recall period, in agreement with the patient, their information will be updated – or registered for the first time – on the KeepSight portal. "This supports the government’s goal of developing a comprehensive record of patients with diabetes engagement with regular eye testing. “This is critical because we know that regular eye testing of patients with diabetes leads to earlier detection of diabetic eye disease which, in turn, helps save sight.” SHARING DATA FOR COMMON GOAL Specsavers has made no secret of its belief that the collection and analysis of patient outcome data is integral for a sustainable model of preventative care. For patients to truly benefit from future advancements in primary practice, Barber notes that information needs to be shared between all stakeholders to ensure eyecare continues to progress at a consistent standard. “Aside from the significant role that data plays in demonstrating measurable impact of clinical interventions, we believe that all patient outcome data collected should be used at a national, regional and individual level to keep optometrists abreast of their practice and the impact they are having on patient outcomes.” To that end, Specsavers will continue to share its data with the Australian Federal Government for a range of purposes and for initiatives such as the Medicare Benefits schedule review process. It also publicly publishes its data through its Eye Health Reports for the wider industry to access. “We do this because we know the data we collect provides vital evidence to substantiate the importance of subsidised eyecare services and the intrinsic need for affordability and accessibility to drive preventative eyecare,” Barber says. n

AI SOLUTION TO THE BIG DATA CHALLENGE Associate Professor Peter van Wijngaarden, from the Centre for Eye Research Australia, says advances in imaging technologies have transformed eyecare in the past 30 years, with the typical eye health consultation today involving the use of several imaging devices.

undoubtedly be monetised in future. van Wijngaarden says the European General Data Protection Regulations (GDPR) is setting a new bar for privacy and data security. Key principles enshrined in the GDPR are that personal data can only be used under six lawful bases (consent, contract, public task, vital interest, legitimate interest, legal requirement) and a key aspect of the provision of data under consent is the right of the data subject to revoke that consent at any time.

This means that a significant amount of data is being generated in each consultation. “Though these data are powerful aides to clinicians in arriving at a diagnosis and deciding on the best treatment plan, it is becoming increasingly challenging for clinicians to assimilate and interpret all of the data that is being generated,” he says. “A rather apt phrase to describe the situation is that each clinical interaction is becoming a ‘big data challenge’ and big challenges warrant innovative solutions.” Accordingly, van Wijngaarden says this challenge has become a major driver for the development of artificial intelligence (AI) solutions. These are being developed for a variety of indications in eye health, but chief amongst these are tools to support image analysis – such as algorithms that can detect and triage retinal diseases from OCT images. These tools, he says, promise to streamline the analysis and interpretation of complex imaging data. Some systems have the ability highlight key image features that may be of interest to the clinician. “Analysis is, however, only one part of the big data challenge. Data collection, curation and storage are important considerations, as are data security and privacy. The capacity to link diverse sources of data for a given patient, such as imaging, demographic and clinical data are also important challenges,” he says.

Peter van Wijngaarden, CERA.

In terms of data storage, van Wijngaarden says each image file is large and many images may be acquired in a given consultation, meaning the challenge of scale becomes significant in a short space of time. There is also the problem of bandwidth for upload to cloud storage – an issue in many clinical sites, especially in rural and remote settings.

This also extends to the right to erasure – the ability for the data subject to request that their data is erased at any time. This poses a raft of technical challenges for companies using large amounts of health data. Similar controls are being applied in other jurisdictions. “Technology may also constitute part of the solution – blockchain, for instance may be used to embed consent with the data itself. "This may help to ensure that data is only used for the purposes for which consent has been granted and that consent remains linked with the data,” van Wijngaarden explains.

Possibly even larger breaches have also been reported in the US.

Finally, van Wijngaarden says it is vitally important that healthcare providers are given access to these data in a convenient, comprehensible and secure manner to translate its potential into improved healthcare for patients. This has implications for technology developers, but also for the training and education of healthcare providers who are increasingly required to be expert informaticians.

Clinical data is also integral for the training of AI systems, and that data has value attached to it. Companies are amassing large clinical databases of eyecare data, which will

“In the torrents of data and technology healthcare providers must not lose sight of the empathy and compassion that is the foundation of the care in health." n

Privacy and data security are also considered important factors. International media have reported major breaches, with the National Health Service illegally handing Google-owned artificial intelligence company DeepMind 1.6 million patient records for a trial – without patient consent.

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RANZCO

RANZCO ANNUAL SCIENTIFIC CONFERENCE: PART 2 In the second part of his report into the 51st RANZCO Annual Scientific Conference, LEWIS WILLIAMS highlights some of the groundbreaking initiatives and research shaping Australian eyecare. THE COUNCIL LECTURE: AN AUSTRALIAN BIONIC EYE Associate Professor Penny Allen, lead researcher on the Bionic Eye Project at CERA who also has associations with the RVEEH and Melbourne’s Austin Hospital, is an experienced vitreoretinal specialist. Her team’s (Bionic Vision Australia [BVA]) main activity is the development of a suprachoroidal (between the sclera and choroid) retinal prosthesis. The project follows her team’s implantation of the world’s first human bionic eye, a 24-electrode prototype featuring platinum and silicon (but no integrated electronics), in 2012. In 2018 a further four retinitis pigmentosa (RP) patients received a second-generation, fully-implanted 44-channel prosthesis that offered a ‘wider’ field-of-view and a greater dynamic range. She described the team’s works as being at least a 10-year journey. RP cases are selected because while the photoreceptors have lost their function, functional, residual neuronal elements remain in the retina that are targeted by the prostheses. The project’s origins can be traced back to Prime Minister Rudd’s Australia 2020 in 2008 when a National Health Strategy/Australian Research Council Research Initiative in bionic vision science and technology was launched. Other bionic eye projects also exist in Australia, including Monash University’s cortical implant, although most are either very early or appear to have been shelved for the time being. Allen’s original team also included fellow ophthalmologist Dr Mark McCombe, with whom she developed the original surgical technique. The original consortium consisted of the Bionics Institute, CERA, the UNSW, the UMelb, and NICTA following the efforts of Professor Hugh Taylor to form a team with suitable resources to tackle the bionic eye project.

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The ‘sharp’ end of their prosthesis, literally, is nanocrystalline diamond electrodes it features. The original UNSW approach proved to be unsuited to human use and was not pursued. Current work involving Professors Robyn Guymer (CERA) and Robert Shepherd (the Director of the Bionics Institute from 2005 to 2017) is taking a two-model approach, suprachoroidal and epiretinal implants. From the outset, Allen and team have also collaborated with Associate Professor Nick Barnes (ANU) researching just how implant-generated visual information should be relayed to patients. The encoding and transmission of visual information to the occipital cortex is still the subject of separate research programmes in several centres around the world. The suprachoroidal space was attractive to BVA because it is a stable and safe location, provided the eye remains healthy. Some experimental work was done on cats because they are more suited to the task than the traditional rabbit model. Cats fitted with the team’s prosthesis that were delivered with 24/7 retinal stimulation showed no long-term deleterious effects, and the implant was tolerated well. A paper published in PLOS ONE in 2014 presented some early results. All recent patients reported reliable phosphenes and the implants remained stable and safe over a two-year period. Duration of the surgical procedure to implant the prosthesis has ranged from 204 to 260 minutes. When the implant patient has not had ‘vision’ for many years, some reeducation has been necessary. The patients are able to discriminate light from dark, gross details of their visual environment, such as a shopping centre they are otherwise familiar with, and are able to track or avoid moving people. Once a feature is detected, such as a pylon in a shopping centre, patients will usually move to touch it to confirm what it is. Such

behaviour is reliable and reproducible. An Activities of Daily Living (ADL) list is used during assessments, which has now been committed to an app for more reliable and rapid data gathering.

Nova Peris

To date, a total of seven patients have been implanted with the 44-channel implant. While there is a significant way to go before retinal implants such as BVA’s will be considered ‘routine’, much of the early research has been successful and the future holds great promise. RANZCO’S LEADERSHIP DEVELOPMENT PROGRAMME (LDP) Convened by the RANZCO Leadership Development Committee chair Dr Cathy Green, the session was opened with an address on leadership by RANZCO President Dr Heather Mack. She defined leadership as leading or commanding a group of people, a country, an organisation, or a profession. Personal qualities of a good leader were: self-belief, self-awareness, selfmanagement, drive for improvement, and personal integrity. The aims of a good leader include the empowering of others, demonstrating a good participation style, engendering a feeling of belonging and teamwork, the coaching of subordinates, and the offering of guidance. Effectiveness can depend on the goodwill of all involved. Mack suggested tangible goals should be written at one- and five-year intervals, and attention should be paid to issues such as work-life balance. Leaders need to promote themselves and inspire followers. Leadership and followership were described as complementary and intertwined. She also noted that great leaders started out as great followers. Leaders are proactive and encourage positive interdependence through members to facilitate working together. As an example of taking the high ground, Mack gave the medical version as “it’s all about the patient”. Leaders were involved in entities such as the Medical Board of Australia, the Health Complaints Commission, and eyecare teams. After her address, rapid-fire session ensued. The first speaker was Dr Genevieve Oliver who spoke about encouraging policies and practices that support the health and well-being of RANZCO’s ophthalmologist members. She advised fellows and registrars to talk to their colleagues and not to feel that opening up to someone is a massive personal risk. She claimed that all colleagues have the same exposure, meaning their experiences are familiar to all travelling the same road. Oliver described mental health as a continuum ranging from healthy all the way through to being ill. People pass through a reacting stage followed by an injured phase before finally succumbing and becoming mentally ill. The very real risk of burnout was itemised as being exhausted emotionally, becoming detached and being cynical, all of which leads to low professional efficiency. She estimated that about half of medical practitioners are affected by burnout and, ironically, many cases of central serous retinopathy (CSR) were stress related. She believes that most practitioners are eager to talk about stress, probably because most are affected by it at some stage of their lives. She gave the physician’s pledge as: “I will attend to my own health, well-being, and abilities.” She advised those in attendance to manage burnout, anxiety, and avoid imposter syndrome. Another recommendation was to prepare mentally for surgery in the operating theatre. She also suggested that attention be paid to maintaining healthy relationships with those around and to consider the ergonomics of all work environments including the clinic. From a RANZCO point of view, the college supports those returning to surgery after a break by offering surgical simulators, surgical mentors, suggesting further reading, providing information on where help is available, providing research and advocacy services, as well as the more obvious sources such as congresses, symposia, and CPD sources. Dr Tanya Karaconji tackled the issues surrounding the transition of ophthalmology trainees to consultants. To study any deficiencies in the Vocational Training Program (VTP), she surveyed current registrars and junior fellows who were fewer than five years out from their fellowship.

THE RANZCO PLENARY This session launched RANZCO’s Reconciliation Action Plan (RAP) and fittingly had Australia’s first indigenous ophthalmologist Dr Kris Rallah Baker teaming up with experienced public health ophthalmologist Dr Ashish Agar as Masters of Ceremony. After introducing the session, the audience was addressed by local indigenous elder Uncle Allen Madden as a Welcome to Country. He has attended other RANZCO events and is probably most famous for his line; “Where there is a will, there are relatives”. The keynote speaker was none other than Australia’s famous indigenous athlete and later politician, Ms Nova Peris OAM who delivered a moving and entertaining story of her parents (her mother was a stolen generation woman), herself, sport politics, and her own family. As an Australian Olympian for 13 years she won gold at the 1996 Olympic Games as a member of the women’s hockey team to become the first indigenous Australian, male or female, to win Olympic gold. Later she converted to sprinting and won two gold medals at the 1998 Commonwealth Games. She was also an Australian senator (representing the NT) from 2013 to 2016. Interestingly, Peris’ athletic prowess was noted early and she was regarded as a future medal prospect at the age of nine. She finished all school years including year 12. She reported experiencing little racial discrimination in the NT, helped by 40% of the territory’s population being Aboriginal. Her original career ambition was to be a PE teacher, but her sporting success meant those plans were deferred. For a while she was also a NT government member before being offered a senate position by Prime Minister Ms Julia Gillard. Her story in her own words was well received. Ms Peris was followed by the Fred Hollows Foundation’s Mr Shaun Tatipata, part of RANZCO’s RAP which has been formulated in consultation with Aboriginal people on the basis that selfdetermination is the appropriate basis of equal health outcomes. The RAP commenced in November 2019 and will continue until November 2021. The overall plan involves not just eyes in its remit. Although the gap between European and Aboriginal health outcomes has still not been closed, according to Tatipata it has narrowed by 50%. The RAP is based on trust and respect. The in-reach (as opposed to the outreach component) seeks cultural safety and appropriate health outcomes that are free from judgement and discrimination.

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RANZCO

In answer to the question on how prepared they were for their respective roles, 33% felt they were somewhat prepared and 38% felt they were prepared adequately. Respondents noted that there was no VTP component that dealt with private practice business aspects, Medicare item numbers, and health fund machinations. As a response, an all-day Survive & Thrive Workshop was created covering topics such as business, insurance, marketing, billing, practice purchase, staffing, HR management, income and wealth management, asset protection, and business structures. An annual business skills workshop has been proposed, which is intended to be integrated into the VTP as an assessable, but not examinable, inclusion. Dr Andrea Ang from Perth’s Lions Eye Institute reported on the trialling of a new surgical assessment system in the Western Australian training network. The systems used are referred to as OSATS (objective structured assessment of technical skills) and NOTSS (non-technical skills assessment). She said prime considerations are procedural safety and care of tissue. OSATS forms are completed and submitted weekly for two months, and usually a total of four to seven forms are then available. A survey based of a modification of the original OSATS form found it to be a valid and easy to use assessment of both professional and technical skills, and users agreed that it was better than the previous assessment system in use before OSATS. Interestingly, registrars felt that weekly submission was too frequent whereas supervisors thought it to be OK. However, senior registrars thought it was a bit like a tick-the-box exercise. A possibility is to require junior registrars to submit forms weekly and more senior staff to submit forms fortnightly. The grading system used is also the subject of clarification by a surgical skills task force. An education process of both registrars and supervisors precedes exposure to the OSATS system. Royal Melbourne Hospital ophthalmologist Dr Elaine Chong reported on her establishment of a corneal service at RMH from almost nothing. While RMH had an eye department, its corneal service had ceased operating a “long time ago”. The project confronted a lack of equipment, staff, and suitable nurses. RMH also has significant responsibility for Down syndrome cases and keratoconus, and lacked CXL equipment initially. Surprisingly, RMH is also a referral site for complicated, multidisciplinary surgical cases that can include eye issues. Basic equipment that was needed included anterior segment OCT (AS-OCT), as well as experienced graft and theatre staff. The aim was to include the usual lamellar procedures (DMEK, bbDALK, DSAEK, DALK, etc., as well as PKPs). It was established early that a good training facility was required as well. Because RMH is located adjacent to the Peter MacCallum Cancer Centre, Chong reported that her new unit also saw a significant number of graft versus host cases. In addition to educating and training ophthalmology registrars, medical doctorates (MDs) were also supervised at RMH as an outpost of the Melbourne Medical School (UMelb). The session’s final lecture was given by Melbourne ophthalmologist Dr George Kong (RVEEH). His topic was fostering modern clinical audit practices in glaucoma units around Australia. He is the audit lead: glaucoma at the RVEEH. An audit’s ultimate aim is the improvement of patient care using national and international benchmarks using the best information available about current practice. He reported that audits in specialist areas were often poor. He attributed some of the blame for that to the time-consuming nature of audits, while acknowledging they compete with service delivery. The RVEEH glaucoma unit has already introduced quarterly audits. The quality and ambition of the projects undertaken, as well as the dedication of those involved, augurs well for ophthalmology’s future in this country. Some success can also be attributed to networking at conferences and the internet, because there is now little excuse for not being aware fully of what peers are engaged in regardless of where they are located.

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THE FRED HOLLOWS LECTURE Always one of the highlights of each RANZCO Annual Scientific Congress, the 2019 lecture was delivered by ophthalmologist Dr Anasaini Cama from the Fred Hollows Foundation. Hailing from Fiji originally, Cama has spent time in many roles, including at the IAPB, and gained several additional qualifications including a MPH. Using 2015 global data, she reported that there were at least 36 million blind people, 217 million with at least mild vision impairment (VI), and 253 million with some VI. Given the cultural and other issues at play, it was not surprising to learn that at least 55% of those with vision problems are female. Also unsurprising, 89% of those with impaired vision reside in low or middle-income countries. 2019 data puts those with VI at 2.2 billion, of whom at least 1 billion suffer from avoidable VI. She described eye health as globally having a lot of inequity and estimated that by 2050 the burden of, and demand for, eyecare will be triple that of today. She stated that the progress made in eyecare over the last 30 years has not kept pace with eyecare needs, meaning that the problem is getting away from those battling to provide eyecare to those who need it. Future challenges include demographic and lifestyle changes already occurring, the difficulty in providing universal health coverage, and trauma and disease prevention, treatment, rehabilitation, and palliative care, especially if those affected are not to suffer financial hardship. Referring to the Pacific region specifically, there are 21 countries occupying 33% of the earth’s surface but hold just 1% of the world’s population. Despite that data, it has 3x the disease burden of the global average. Complications include strong religious and cultural practices, many communicable diseases, general and health education challenges, and, more recently, climate change. Some Pacific islands are already being affected by rising sea levels. In response, health ministers across the pacific region have already created the Healthy Islands Vision education initiative. Cama identified the need for strong political leadership, improvement plans with a budget to make them happen, an increase in the current 1:100,000 ophthalmologist to people ratio, and the need for ophthalmic nurses at a ratio better than 1:50,000. Earlier cataract and uncorrected refractive error were the biggest causes of VI, but now DR is an emerging issue highlighting the importance of lifestyle and diet in developing countries. The region is handicapped by the limited availability of information on diabetes and eye health in general, with few trained or knowledgeable in managing DR, in addition to inadequate service provision throughout the region. A 2009 Fiji health survey revealed that >40% of the population were diabetic and a study by NZ/Australian ophthalmologist Dr Garry Brian found that >60% of those cases were undiagnosed previously. A diabetes-focused eye clinic found that >50% of diabetics had signs of DR, 26% of whom had sight-threatening DR (STDR) and 10% had severe or advanced STDR. At a second-year review of those cases, some 30-50% of them had achieved glycaemic control and with the aid of a laser, most progression of DR had been halted. Special courses have been held for medical practitioners (12 months) and nurses (6 months) that are focused on DR care and treatment. Ancillary health workers are now joining the training programme to broaden the front combating diabetes and its ocular effects. Trachoma has also not yet been conquered, so Australia is truly a Pacific nation on that score. SYMPOSIUM: INTERNATIONAL DEVELOPMENT International development (ID) has retained an important place in RANZCO’s activities, and many training and eye camp endeavours have been conducted over the years. Long-term advocate and ‘doer’ Associate Professor Nitin Verma spoke about early team visitation to outposts such as East Timor/Timor-Leste.

Anasaini Cama

Andrea Ang

Cathy Green

Bill Glasson

Elaine Chong

Genevieve Oliver

George Kong

Heather Mack

Those efforts quickly determined that there existed a large need for eye services in many parts of the Asia-Pacific theatre. He was central to the East Timor Eye Programme (ETEP) that used President Xana Gusmão in its fund-raising efforts. Central to the success of such a programme, other than having the government on side, was having the church on side, as 98% of East Timorese are Catholic. Surprisingly, Verma advised against trying to be a hero with mercy cases because it usually does not work and can adversely affect a programme’s reputation. It should not be conceptualised as a ‘mission’ either. Rather, a 365 day per year on-theground approach is required. Simply, intermittent programmes do not work, and local practitioners and staff are required to work from a national headquarters if necessary. A Master of Medicine level of qualification was recommended, but Verma admitted that suitable candidates were usually difficult to find. A confounding factor is that in some cultures or situations there is very little distinction between a GP and a specialist. This results in practitioners having diminished motivation or interest in bettering their qualifications or gaining specialist status. He believes that some sub-specialty qualifications need to be fasttracked because time is important. Succession planning is also required relatively early in any programme. Support staff include nurses, optometrists, opticians, ocular prosthetists, local eye co-ordinators, and technicians, including instrument service people, because machines need to be kept functioning. He advised teams to standardise on the brands and models of instruments so that all team members become familiar with all aspects of the hardware. Any donated, used equipment must be practical, have a good and useful life remaining, and must have spare parts available. To quote Verma: “programmes are not equipment ‘dumps’”. He says the ETEP will be handed over to locals in 2021.

Queensland ophthalmologist and long-time humanitarian Dr Bill Glasson posed the question: “why be involved in international development?” Although he started at the indigenous end of humanitarian eyecare, he eventually became involved at all levels and locations. He described his main motivation as simply the magnitude of the unmet need in most theatres of operation. He found, and continues to find, the training roles he has filled to be very satisfying, often in a two-way sense, meaning both parties have knowledge to share. He also noted that Australian nurses have been involved in the doing and training of their profession as part of national and international endeavours. He also confirmed that local politicians need to be onside with the programmes as well. In his experience, the collegiality among those involved is very important and helpful to achieving the aims of each project. He described the pathology encountered, particularly the ocular pathology, as being “extreme”. He identified personal improvement as another benefit of participating in outreach programmes and finds that giving back can lead to a lifetime of joy. Dr Anthony Hall, a Zimbabwean native and resident before coming to Australia, addressed the question of where RANZCO, which is not a funding agency, fits into the ID plan. He sees RANZCO’s role as driving the improvement of eye health care through education and standards, as well as being a resource of information for fellows. Other organisations with roles to play include IAPB, Vision 2020, CBM, WHO and other, often local, endeavours. He described ID as having its own language, literature, guidelines, and aims, mostly based on extensive and long-term experience. He also noted the renewed pursuit and importance of child-protection issues, possibly in reference to a scandal involving a UN entity some time ago. RANZCO has an ID committee and accreditation system, as well as an

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RANZCO

John Kennedy

John Marshall

Kerrie Legg

Nitin Verma

Penny Allen

Shaun Tatipata

Tani Brown

Tanya Karaconji

Asia-Pacific International Development (RAPID) advocacy unit. RANZCO also interacts with the QE II Diamond Jubilee Trust, the Commonwealth Eye Health Consortium, PNG Health Systems Capacity Development, and a PNG train-the-trainer programme. In 2020, PNG’s biggest problem is the number of unoperated cataracts. That has led to the formulation of a plan to perform 30,000 cataract surgeries per year by 2030. In a brief presentation, Dr John Kennedy, Chairman of the new ANZ Eye Foundation (ANZEF) detailed his organisation, which has subsumed the 2002 - late 2017 Eye Surgeons Foundation (ESF). ESF fell victim to a combination of declining income and rising operating costs. The new entity is a committee of RANZCO and directly answerable to the organisation. It already has $1 million in donations received mostly from RANZCO fellows, as well as 15% of that total from the public. Kennedy described ANZEF as a lean, economic organisation, with RANZCO’s CEO and four fellows (Drs John Kennedy, Stephen Best, Clare Fraser, and Eline Whist) forming the ANZEF committee. Its foci include research, indigenous eye health, rural eye health in Australia, eye health in the Asia-Pacific, and blindness prevention in the ANZ and Asia-Pacific regions. To assist those goals, Kennedy said ANZEF hopes to “engage all fellows”. THE DAME IDA MANN MEMORIAL LECTURE: A regular feature of the Annual Scientific Congress is the Dame Ida Mann (1893-1983) Lecture, given in 2019 by Professor John Marshall, a British medical scientist and world authority on lasers, particularly their use in medicine and the eye. His presentation was titled Light and the Eye: Chronic Insult or Therapeutic Dream. He commenced by detailing the history of illumination, which consisted of fire until the mid-1800s when electric lighting emerged. Fluorescent lighting followed in the 1940s, up to the current use of LEDs.

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He attributed the development of the first ophthalmoscope to the English polymath Charles Babbage circa 1847, although at the time it was described by Professor Thomas Wharton Jones as having little value. It was not until Germany’s Herman von Helmholtz’s independent invention of said ophthalmoscope in 1851 that use of such an instrument became popular and routine. Helmholtz’s demonstration of his instrument to English surgeon, histologist, and anatomist Sir William Bowman (of Bowman’s layer fame) was central to the wider use of ophthalmoscopy. The use of operating microscopes, slit-lamps, and lasers on or near eyes, commencing in the early to mid-20th century, brought the routine use of high-intensity light sources. This brought concerns of ocular damage, especially retinal damage, to the attention of researchers and users. Later still, the deliberate use of damaging electromagnetic radiation became common, such as in the treatment of tumours, vascular cautery, laser refractive surgery, and FLACS. Very recent developments include Ellex’s 2RT AMD treatment. Marshall’s involvement with lasers commenced in the mid-1960s while he was a young scientist. Concerns about the military use of lasers, overexposure to high light levels, eye radiation protection, and the application of excimer lasers to all kinds of surgery have become his forte. Radiation protection and the applications of excimer lasers to ocular surgery are probably the areas for which he is best known. The breadth of the topics and the relevant side stories covered in his lecture added to the audience’s interest in his presentation. The next RANZCO Annual Scientific Conference, its 52nd, is scheduled to be held in Brisbane’s Convention & Exhibition Centre from 9-13 October 2020. n

ON THE ROAD WITH THE IDEAS VAN ORIGINATING IN QUEENSLAND, THE IDEAS VAN HAS EXTENDED ITS CIRCUIT TO TAKE IN FIVE VICTORIAN CENTRES. MELBOURNE ORTHOPTIST DANIELLE THORBURN RECOUNTS HER EXPERIENCE WITH THE INITIATIVE IN ORBOST.

first became aware of the Indigenous Diabetes Eyes and Screening (IDEAS) Van when I received a phone call asking me to be involved as an orthoptist. I had no prior knowledge of the service, but quickly got up to speed because ‘closing the gap’ has always interested me – I just never knew how, or where, to get involved. DANIELLE THORBURN

SHARED EXPERIENCES AND RICH CONVERSATIONS ARE THE ABSOLUTE HIGHLIGHT OF MY IDEAS VAN JOURNEY THUS FAR

The IDEAS Van is a fully equipped mobile ophthalmic specialist centre fit out with $1 million of the latest equipment and pharmacological products. It has been servicing Queensland since 2014, helping to prevent blindness due to diabetes in Aboriginal and Torres Strait Islander communities. The route extended to include five pilot sites in rural Victoria from mid last year as part of the ‘Look Out Project’. This initiative was developed following consultations with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), Aboriginal Community Controlled Organisations (ACCO) and referral pathway mapping and supported by Rural Workforce Agency Victoria (RWAV). Victoria’s pilot sites include Wodonga, Wyndham Vale, Heywood, Robinvale and Orbost. I was fortunate to provide the orthoptic service in Orbost twice last year, including its inaugural clinical visit. I live in Melbourne and small planes aren’t my idea of fun, so I drove four hours each way, with an overnight stay, and took my husband and three children to make a ‘long weekend of it’. I also had to take leave from my clinical commitments but, luckily, I was supported in doing so. The IDEAS Van is an innovative model of care that not only provides high calibre service but is also advantageous to the patient by minimising travel; preventing loss of time and expenses that would have otherwise been incurred with a commute to metropolitan areas for public-based care. This may be particularly beneficial to those requiring multiple treatments at close intervals such as panretinal photocoagulation or intravitreal injections. The IDEAS Van enables patients to be seen in familiar cultural surrounds within their own community. Transport can be arranged for those that are located in further isolated communities.

The IDEAS Van has been in operation since 2014, covering vast distances to treat Indigenous patients.

The Orbost service takes place at Moogji Aboriginal Council which provides health services to the East Gippsland community. Patients presenting to the clinic have been referred via a retinal screening program within the Moogji ACCO (and externally reviewed), local GPs or the Australian College of Optometry rural service.

extended time with patients for discussions ranging from local fishing spots and history of the broader community, to the region itself and exchanging stories of our families. I also found myself sitting outside with family and friends of patients, providing further opportunity to hear of a culture that differs from mine.

At the inaugural visit last July, patient numbers were kept low to allow for orthoptist, optometrist, ophthalmologist, and local Moogji Aboriginal Council staff to test how this would work. Apart from familiarising ourselves with each other, the physical surroundings were also new to us. The van consists of three rooms enabling a comprehensive service by optometrist, orthoptist and ophthalmologist.

These shared experiences and rich conversations are the absolute highlight of my IDEAS Van journey thus far and it has been enormously rewarding. It has broadened my understanding and appreciation of the Aboriginal and Torres Strait Island people.

The space is much larger than may be expected with the optometric room, fully equipped with all desired testing equipment. Patients enter through the orthoptic area which includes OCT, angiogram facilities, retinal camera and biometric equipment. The ophthalmology room allows for detailed initial assessment (or review), treatment with various lasers and a safe environment for intravitreal injections. Most of the investigation prior to the patient seeing the ophthalmologist is performed by the optometrist, allowing time for me to assist with injections and laser procedures. The orthoptic room is also utilised for patients to sit while dilating. This allowed

I encourage anyone considering new experiences or wondering how to be involved with ‘closing the gap’ to be bold and volunteer for experiences outside your comfort zone, or postcode. n

ABOUT THE AUTHOR: Danielle Thorburn is a Senior Orthoptist at Austin Health, Casual Lecturer in Orthoptics at La Trobe University and newly appointed Clinical Services Manager (Victoria), IDEAS Van. She has a post graduate diploma in health research, is on the Victorian branch Executive Committee for Orthoptics Australia and is also Coordinator of Paediatric Community Vision Screening . ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au

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DISPENSING

HOT TIPS FOR SUCCESSFUL DISPENSING: PART 1 WHEN IT COMES TO EFFECTIVE OPTICAL DISPENSING, THERE IS A WEALTH OF INFORMATION TO AID PRACTITIONERS TO GET THE BEST OUTCOME FOR THEIR PATIENTS. JAMES GIBBINS BOILS IT DOWN TO SOME OF THE KEY ELEMENTS.

ur industry has many experienced optical dispensers who are in an excellent position to pass on pearls of wisdom to the next generation. Imagine a world where each new practitioner had to slog through that long process on every learning point?

JAMES GIBBINS

IT IS THE OPTICAL CROSS WHICH WILL DETERMINE EXACTLY WHERE THE THICKNESS WILL LIE, AND THIS THICKNESS WILL ALSO BE DICTATED BY THE RELEVANT MERIDIANS IN THE FRAME SHAPE

While there’s no question some of the best insight is learned via personal experience, there are many ‘hot tips’ that can be passed on from an able experienced teacher to the hungry and teachable learner. I have been in our industry now, on and off a little, since 1983, and have some key advice gathered from my own experience or via my mentors and teachers. Tip No 1: The most obvious and significant tip for any optical assistant (unqualified with the Certificate IV in Optical Dispensing) is always – get your qualification! This certificate comes with a stack of training in lens theory, practical dispensing skills and the all-important interpersonal and retail skills. It is this qualification, and the knowledge and skills that come with it, that separates the Qualified Optical Dispenser from the Optical Assistant. Not in any way am I trying to devalue the role of optical assistants who perform some outstanding work. But the view of our team is that every optical assistant is by definition on an optical learning pathway, and that pathway always leads to the Certificate IV in Optical Dispensing. It enables the dispenser to perform at a higher level and offers benefits to the employer and the workplace to have a higher trained practitioner. It also empowers the dispenser for life having it featured proudly on their resume. Tip No 2: What comes first when dispensing, frame or lenses? So often, when the patient is waiting for the appointment, we might suggest a good use of time is to consider the frame selection. This is fine, providing the patient knows the final decision needs to be confirmed after the eye test and the prescription is obtained. This is because good frame selection is often dictated by the prescription. Many patients have

INSIGHT April 2020

Getting the spectacle handover right contributes significantly to the success of the overall dispense.

thought the selection was settled before the eye test, only to be told after that what they had selected is in fact inappropriate, and selection needs to be repeated. Tip No 3: Learn the importance of the optical cross and how to apply this information. Very often, the optical assistant will see the prescription in terms of sphere power – is it small, moderate or large? The same is considered for the cylinder power, which will also have an axis attached to it. And they will have a rough impression of how much the power sizes contribute to the completed lens thickness. However, it is the optical cross which will determine exactly where the thickness will lie, and this thickness will also be dictated by the relevant meridians in the frame shape. There is far more detail to this skill than can be covered here. And of course, the basic rules of the optical cross are: sphere power only on the axis meridian, and sphere power combined with cylinder power on the opposite, perpendicular meridian. Tip No 4: A critical point in the dispensing exchange with patients is the “handover” or the “collection”. Getting this relatively simple part right can contribute significantly to the overall success of the dispense. The moment the patient is about to receive their spectacles, you are

faced with the question – do we as the optical professional take the lead and, with informed consent, place the spectacles on to the customer? Or do we hand them over for the customer to place on themselves? This has been a controversial question in the past and continues to polarise opinion. Traditionally, and still today as taught in many textbooks and colleges, the student is advised to take the lead and place the spectacles on the customer. However, in today’s climate, we sense most of our customers would prefer putting on the spectacles themselves. Frame checking and alignment can then be undertaken, of course, after the customer’s informed consent. This approach will also help avoid the potential traps some of us are familiar with, such as unfortunate pokes into ears, eyes, hair clips, wigs and toupees, hats, scarfs and hijabs, and even possibly a prosthetic! Far preferable to let the customer pop them on first, and then we can apply our skills to the frame alignment. In part 2, we will consider six more ‘hot tips’ including frame adjustment, final checking and progressives ordering. n

JAMES GIBBINS is a qualified optical dispenser with over 30 years of experience in both retail dispensing and dispenser training, and is a director and senior trainer with the Australasian College of Optical Dispensing.

MANAGEMENT

SURVIVING THE LOSS OF KEY PERSONNEL TEMP STAFF OR LOCUMS CAN FILL THE VOID OF AN ABSENT STAFF MEMBER, BUT ONLY OFFER A SHORT-TERM SOLUTION. KAREN CROUCH EXPLAINS HOW SUCCESSION PLANNING CAN BE BENEFICIAL TO A BUSINESS AND ITS STAFF.

n a recent article, I emphasised the importance for practices to have a comprehensive Business Continuity Plan. This involves the development and maintenance of a meaningful Risk Management Plan which often focuses on major catastrophes or businessthreatening incidents.

KAREN CROUCH

IN SOME CASES, SUCCESSION PLANNING IS FRUSTRATED BY THE LACK OF WILLINGNESS TO ‘LET GO’ FOR FEAR OF BECOMING LESS VALUABLE

Sadly, in less vigilant practices, risk management is sometimes overlooked or downplayed. After all, critical, business threatening incidents are rare, such as loss of entire premises. However, an important element of risk management and day-to-day practice operations relates to a practice’s most important resource: employees – whether that’s clinical or administrative, casual or permanent. The most effective way to ensure continuity of healthcare under less than optimal conditions is meaningful and effective succession planning. In most practices, particularly those with relatively small staff numbers, each person is a virtual ‘specialist’, focused on specific duties documented in individual position descriptions and KPIs (key performance indicators). For example, the practice manager will invariably possess specific knowledge, experience and skills applicable to their position. Likewise, clinicians often operate as single work units on which much reliance is placed for patient care. So what happens when one of the key personnel is absent for planned or unplanned reasons, such as vacation, extended sickness, or even resignation? Of course, there will always be access to agency temps and locums, but that invariably results in temporary reductions in efficiency and effectiveness, not always due to lack of personal ability. For the temporary staff member or locum clinician to operate as an effective service provider, they must meet the basic requirements of becoming familiarised with the practice’s clinical and administrative protocols, including compliance with cultural and behavioural

expectations of the owners. While agency temps or locums provide a convenient stop gap, they are merely ‘temporary’ fixes as their titles denote. However, despite the transitory nature of this option, the problem could remain unaddressed if it was caused by absence of ‘internal relief’, i.e. another employee of similar status, but perhaps less technically qualified, who could continue to perform duties of the unplanned vacancy. For example, a practice manager exits the practice on short notice for personal reasons, and other reception staff are incapable of filling in, albeit at a less competent level, for sheer lack of experience or exposure to the PM’s duties. Recently, one of my relatively selfsufficient clients had expanded her practice in a short period of time to the point where she required advice on how to manage the sudden growth. Among other challenges of a rapidly growing business, she could not even consider a relaxing three to four-week holiday because some of her vital tasks required daily attention; a clear sign of the absence of a trained successor! In some cases, succession planning is frustrated by the lack of willingness to ‘let go’ for fear of becoming less valuable or even more dispensable. We commonly assume another staff member will simply absorb the extra workload of an absent colleague but the aforementioned reduction in efficiency/ effectiveness, not to mention increase in stress levels, is the inevitable result. So, how do you mitigate the impact? The following points are useful in developing a meaningful plan: Ensure all employees appreciate the importance of a succession plan to cater for absences, whether planned or unplanned. An effective approach could be to highlight the benefits of acquiring skills and experience by performing duties of higher ranked personnel. A ‘higher duty allowance’ can also be a form of recognition/incentive. Ensure each staff member has a comprehensive position description

Upskilling existing staff ensures self-sufficiency.

listing roles and responsibilities, including key deliverables. Identify main tasks that must be performed to ensure proper job performance or at least to avoid errors or omissions, particularly if they relate to patient healthcare. Implement an ‘upskilling program’ e.g. receptionist periodically performs tasks of the practice panager. Staff numbers permitting, identify a staff member who could ‘understudy’ each person (more difficult for clinicians but equally important to try) during a period of absence. Apart from mitigating impacts of planned or unforeseen absences, staff generally appreciate the opportunity of performing different tasks and, where applicable, acquiring new skills. Job rotation also results in greater job satisfaction and wider absentee cover. These measures should render a practice more self-sufficient and reduce hiccups when employing agency temps or locums. n

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

INSIGHT April 2020 47

OPTOMETRIST – ESPERANCE, WA

OPTOMETRIST – WHANGAREI, NZ

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

OPTOMETRIST – BENDIGO, VIC

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

JOIN OUR TEAM

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

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

OPTOMETRIST – KATHERINE, NT

Contact the relevant Professional Services Manager for the region to discuss these opportunities and more:

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

OPTOMETRIST – WAGGA WAGGA, NSW

We have one full-time graduate or experienced optometrist position available at our OPSM Wagga Wagga Practice. We are looking for passionate and motivated individuals to join the team.You will be part of our industry leading team and will have the opportunity to work alongside likeminded optometrists to ensure the highest possible standard of patient care. You will also play a pivotal role in building loyal and trusting relationships with the community to grow the practice. High salary package is on offer for the right candidate. On your days off connect with nature at one of the many reserves, enjoy the Aviation Museum, or visit the local winery.

NSW/ACT: Elizabeth Kodari elizabeth.kodari@au.luxottica.com QLD/NT: Brendan Philp brendan.philp@luxottica.com.au VIC/TAS: Melissa Downing melissa.downing@luxottica.com.au SA: Sophie Pym sophie.pym@luxottica.com.au WA: Mario Basso mario.basso@luxottica.com.au NZ: Jonathan Payne jonathan.payne@opsm.co.nz

OPSM.COM.AU/CAREERS

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SPECSAVERS – YOUR CAREER, NO LIMITS Partner Recruitment – Optometrist joint venture partnership opportunity – Specsavers Cairns Earlville, QLD Specsavers are currently on the lookout for an experienced optometrist to join us as a joint venture partner in our Cairns Earlville, QLD store. The store is located within the Cairns Stockland Centre, which houses over 90 specialty stores including major retailers such as Coles, Big W and BCC Cinemas. The store itself boasts 2 fully-equipped testing rooms with OCT, 5 dispense desks and over 1,000 frames on display. Specsavers Cairns Earlville opened in 2009 and has built a loyal database of patients over the last 11 years. This is a rare opportunity to make your mark and build a profit earning business.

SRS – Specsavers biggest salary package is back! Following the success of our $225k package that we released last year – the largest ever offered by the business, we have decided to bring it back with additional locations available. These new positions offer more than double the salary of a metropolitan store and come with a host of benefits. On top of the increased salary, there is the potential for fast-tracked career progression, access to state-ofthe-art equipment including OCT and a dedicated and supportive team to ensure the best outcomes for all patients. Optometrists with a minimum of two years’ experience in Australia or New Zealand who have previously worked at Specsavers are encouraged to apply.

SRS – Locum and MOT opportunities across WA We are currently seeking experienced optometrists for ongoing locum opportunities across Perth, and are also recruiting for a Drive In, Drive Out (DIDO) position that will be based within WA. A DIDO position allows you to explore Western Australia and Perth with the opportunity to mix work and leisure. By joining Specsavers, you will have access to state-of-the-art technology including OCT, and work alongside a hard-working retail team who are committed to providing excellent customer service. We are looking for passionate optometrists to help us on our mission to transform eye health all over Australia and New Zealand.

Graduate Recruitment – Specsavers Airlie Beach, QLD Grad Program Looking for the perfect start to your optometry career? Discover your potential with our Airlie Beach team and the Specsavers’ two-year graduate development programme. As a graduate optometrist with Specsavers Airlie Beach you will work with cutting-edge equipment such as OCT and be part of a passionate team with a goal to transform eye health within the local community. With a diverse patient demographic and lucrative package on offer, Specsavers Airlie Beach welcomes a passionate optometry graduate to join the close-knit team. The graduate program provides newly qualified optometrists with a dedicated mentor, support network and structured program to assist you in your development.

SRS – Perm and locum opportunities across New Zealand Thinking of a sea change? With 54 stores across New Zealand, we have an abundance of opportunities for experienced optometrists. Whether you enjoy the hustle and bustle of city life, or prefer the relaxed outdoor lifestyle, we can offer you the perfect location. You will have access to state-of-the-art market leading technology including OCT, and work alongside a passionate and supportive retail team. At Specsavers, we value our people and not only offer competitive reward and benefits, but also on-going development and training.

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

SO LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership (JVP) enquiries: Maria Savva – Partner Recruitment Manager maria.savva@specsavers.com or 0401 353 587 For NSW/ACT, SA & WA enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134 For QLD/NT & VIC/TAS enquiries: Madeleine Curran – Recruitment Consultant madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries: apac.graduateteam@specsavers.com

Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

DISPENSER - SYDNEY

Eyecare Plus provides business support and marketing services to over 155 clinically focused independent full scope optometry practices throughout Australia. Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment, including an OCT in the majority of our practices. Eyecare Plus offers three membership options; branded, co-branded and unbranded. Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training. We also actively assist Optometrists and Dispensers who are looking to establish their own practice. If you are looking to buy, or sell, an optometry practice, please contact us.

The practice is looking for a requires a part-time/casual dispenser. It is equipped with state-of-the-art equipment and the latest fashion eyewear. Essential requirements include a positive and professional attitude, a great work ethic, exceptional customer service skills, confidence in sales, attention to detail, effective problem solving skills, and the ability to learn quickly. At least two years’ experience is preferred but not essential. Flexibility to cover staff holidays and sick leave is highly regarded. This is a unique opportunity to work in a small team environment, where ongoing skill development is encouraged, and where remuneration is competitive. Only potential candidates will be contacted.

For more information call Philip Rose: 0416 807 546 or email: Philip.rose@eyecareplus.com.au.

RECEPTIONIST/ OPTICAL DISPENSER - BRISBANE Eyecare Plus Alexandra Hills is an independent Optometry practice that has been established since 1989. We have a special interest in paediatrics, contact lenses, sports vision and we are Brisbane’s only Colour Blind Sight Centre. We are looking for a motivated person for a Full Time / Casual position. There will be on the job training and training courses that we will send you to. Previous optical experience necessary. Reception duties are also part of the position. Please email your CV to Aphrodite Livanes: apli2@bigpond.com Phone: 07 3824 1878 or 0407 585 952

Please apply with your CV and cover letter to kingsgrove@eyecareplus.com.au.

OPTICAL DISPENSER – CORRIMAL We are seeking an experienced dispenser for a casual position without weekend work. Corrimal is a short drive south of Sydney, with easy access to great beaches and Wollongong.The following skills and attributes are desired: Relevant experience within the optical industry. Exceptional patient/customer service. Appreciates continuing education. Knowledge of Sunix management system. A Cert IV qualification in Optical Dispensing (preferably completed) is highly desirable.Remuneration will be commensurate with experience and qualifications. Please apply with your CV and cover letter to y.wang@eyecareplus.com.au

OPTOMETRIST – TAREE AND GLOUCESTER

CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/

We are seeking a full time Optometrist to join our established and growing practice. The Mid North Coast of NSW offers a relaxed lifestyle with a low cost of living, fantastic sporting facilities and schools all within 3 hours of Sydney. We need an Optometrist with good clinical skills, a caring nature and an ability to clearly explain concepts to our patients. We have an IPL, OCT, Topography, Anterior Segment Photography and Automated Perimetry. Plus, we have a highly skilled and experienced team of dispensers and assistants. Those seeking a part time position are welcome to apply. New or recent graduates are welcome.

OPTICAL DISPENSER / SALES ASSISTANT: Brisbane. Sydney. Corrimal NSW. OPTOMETRIST: Taree & Gloucester. Gosford. Wagga Wagga NSW.

Please apply with your CV and cover letter to p.mckay@eyecareplus.com.au

2020 CALENDAR APRIL AUSTRALIAN VISION CONVENTION Surfers Paradise, Australia 4 – 5 April (Full virtual conference) infoqld@optometryqldnt.org.au

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

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

ASIA-PACIFIC ACADEMY OF OPHTHALMOLOGY CONGRESS

ANZSRS MID-YEAR MEETING 2020

Xiamen, China 22 – 26 April (Postponed 5-9 August) 2020.apaophth.org

Melbourne, Australia 23 – 14 May (Cancelled) ranzco.edu/events

MAY ARVO 2020 ANNUAL MEETING Baltimore, USA 1 – 7 May (Cancelled) arvo.org

WENZHOU INTERNATIONAL OPTICS FAIR Wenzhou, China 8 – 10 May (Postponed) opticsfair.com

O-SHOW 2020 Sydney, Australia 16 – 17 May (Cancelled) o-show.com.au

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

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

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

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

JULY JUNE VISION 2020 INTERNATIONAL OPTICIANS ASSOCIATION SUMMIT Bangkok, Thailand 7 – 13 June ioassn.org

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

Dublin, Ireland 12 – 16 July vision2020dublin.com/

ORTHOPTICS AUSTRALIA VIC BRANCH JULY SCIENTIFIC MEETING Creswick, Australia 25 July orthoptics.org.au INSIGHT April 2020 49

SOAPBOX

CAN WE CLOSE THE GAP BY 2020? Item 12325 for non-mydriatic retinal photography and the inclusion of a retinal exam in the Health Adult exam MBS 715. The Commonwealth has now provided non-mydriatic retinal cameras to more than 150 Aboriginal Medical Centres. To promote the need for annual screening exams, a range of health promotion materials has been developed with community input and are available on the Indigenous Eye Health Unit’s website. Similarly, a range of more technical materials to help clinic staff are also available, including a free online course on grading diabetic retinopathy.

n 2008, Aboriginal and Torres Strait Islander adults had 6x more blindness than other Australians. The leading cause was unoperated cataract followed by uncorrected refractive error, diabetic retinopathy and trachoma. One third had never had an eye exam. This led to the development of the Roadmap to Close the Gap for Vision, launched in 2012. The roadmap recognised the pathway of care, or the patient’s journey, was complex – like a leaky pipe. If only one or two leaks were fixed, the water would still drip from other parts of the network. It also set out a long-term plan to provide well-coordinated regional care and local support for Indigenous people that was appropriately resourced to meet population-based needs. Since 2012, Indigenous eyecare has significantly improved with strong support from the Aboriginal Community Controlled Health sector, eyecare stakeholders and successive governments as set out in the roadmap’s 2019 Annual Update. Last year’s report on Indigenous Eye Health Measures by the Australian Institute of Health and Welfare (AIHW) shows the number of outreach eye examinations for Indigenous Australians had tripled, the rate of eye exams for those with diabetes and the number of cataract operations had both more than doubled, and trachoma rates were falling. This is the result of numerous changes in the eyecare system; organised

INSIGHT April 2020

regional networks, changes in Medicare item numbers, enhanced screening for diabetic retinopathy and a lot of work that has been done on trachoma. However, more needs to be done, especially when it comes to eyecare for those with diabetes. The rate of diabetes in Indigenous Australians has increased from about one tenth that of non-Indigenous Australians in the 1970s to now be 4x or 5x higher. Everyone with diabetes is at risk of blindness, with up to 98% preventable with regular exams and timely treatment. Every Indigenous person with diabetes needs to have an eye exam each year. They may have a normal exam or they may need referral for retinopathy. However, those with diabetes are also at increased risk of cataract and refractive change, so referral pathways need to be developed for these issues as well. For these reasons, people with diabetes form a key target group for Indigenous eye services. They account for 75% of the Indigenous adults who need an eye exam each year, and the subsequent referral pathways for refraction and cataract surgery can be used by all whether they have diabetes or not. However, AIHW reports that only 42% of Indigenous Australians with diabetes actually had their required eye exam – well below the rate for non-Indigenous Australians. This is despite the new MBS

It's clear regional stakeholder networks require additional funding for optometry and ophthalmology outreach services, and local case-management to meet the region’s population-based needs. This would enable all those needing examination or referral to be properly managed. Further, people requiring treatment for retinopathy, whether by laser or intravitreal injections, should have ready access to bulk-billing or public hospital services without long waits. The Strong eyes, strong communities report by Vision 2020 Australia and its members has set out the requirement for additional government funding. Although in 2019 the Council of Australian Governments Health Council set the elimination of Indigenous avoidable blindness by 2025 as a high priority – also included in the Long Term National Health Plan – we are still waiting for additional funding committments. Despite the strides being made, further efforts are still needed to improve the screening and treatment of diabetic retinopathy and help close the gap for vision. We all have a role to play in this. n Name: Melbourne Laureate Professor Hugh Taylor AC Qualifications: MD, BS, LLD(Hons), DO, BMedSci, FAAHMS, FRANZCO Workplace: Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne Position; Harold Mitchell Chair of Inidgenous Eye Health Location: Melbourne Years in profession: 49

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