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The ophthalmic sector has welcomed new federal policy allowing 60-day prescribing for stable, ongoing conditions such as severe dry eye and glaucoma, which is expected to improve treatment adherence and save patient costs.
The new measure will also mean patients can purchase two months’ worth of medicine for the price of a single prescription. It follows a Pharmaceutical Benefits Advisory Committee (PBAC) recommendation in 2018 that was not implemented by the then-government.
The move affects 320 medicines from 1 September, including more than 80 ocular therapies – most, if not all, are for elevated intraocular pressure and severe dry eye disease.
“The Australian Society of Ophthalmologists (ASO) welcomes any move by government which
saves patients money on their prescription medications,” president Dr Peter Sumich said.
“We expect to see improved compliance with glaucoma medication if they have more availability. On many occasions it is the break between scripts where patients fall down on their habit of treatment and compliance is lost.”
Optometry Australia interim CEO Ms Skye Cappuccio said for some optometry patients, the measure is expected to make it easier and more affordable to access medications.
“Many of the details of the approach are not yet clear, and this is something Optometry Australia is monitoring so we can ensure that optometrists are fully updated before the measure comes into effect,” she said.
However, pharmacies are against
the move, saying it will lead to the closure of many chemists and reduced opening hours, impacting access to medicines. The Pharmacy Guild of Australia said it may also lead to medicine shortages.
“I don’t want to see a Hunger Games stand-off in any community in Australia where some patients get double the medicine they need, while others get nothing,” the guild’s
national president Professor Trent Twomey said.
The government expects general patients to save up to $180 a year if their medicine can be prescribed for 60 days, while concession card holders will save up to $43.80 a year per medicine. At least six million Australians are expected to halve their medicine costs and need fewer visits to the doctors and pharmacist to renew their scripts, saving patients more than $1.6 billion over the next four years, the government said. The PBAC considered the safety profile of the medicines that it recommended, and it will be up to doctors to make a clinical decision about whether 30-day or 60-day prescribing is appropriate for the individual’s circumstances. In addition to ocular therapies,
continued page 8
In his second Federal Budget since coming into power, Health Minister Mr Mark Butler has made Medicare reform his number one priority. With optometry being one of the top bulkbilling professions, the sector’s peak body says it’s vital eye health has a seat at the table especially when it comes to embedding multidisciplinary team-based care.
On 9 May, the Federal Government revealed how it would spend taxpayer money over the next four years, with Medicare the centrepiece of the $101 billion health budget “after nine long years of cuts and neglect”. This comprises critical funding for urgent needs, and reforms with a longer term view.
Among those revealed in the
budget, policymakers committed $445 million to increase incentives for GPs to employ various health professionals to provide team-based primary care. Smaller practices will also be able to complement their teams with the services of allied health professionals that have been commissioned by Primary Health Networks ($79.4m).
There will also be investment in MyMedicare, a new voluntary scheme to create a stronger relationship between patients and their primary care teams. For patients its allows better continuity of care and easier access to telehealth consultations. For health professionals, it will provide more comprehensive information
about regular patients, while giving patients and their care team access to additional funding, tailored to their health needs.
Further, the government will invest $951 million to upgrade My Health Record, making it easier for patients and providers to share information more securely and efficiently.
Optometry Australia (OA) interim CEO Ms Skye Cappuccio said these reforms were not possible without optometrists.
“Fifty-five per cent of Australians have one or more chronic eye condition with 93% of people aged 65 and over having long term vision disorders. These are continued page 8
In this CPD article, UNSW's Dr Sultan Alotaibi and A/Prof Maria Markoulli show why even a mild injury to the brain can have a significant impact on the processes involved in vision.
41
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With excellent stability, an improved injector system and a design that is uniquely forgiving to decentration, it delivers consistent visual outcomes for a broad range of patients and surgical situations.
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Eyewear ranges can be one of the most powerful determinates of success for optical businesses in 2023. They are a way of showcasing the practice’s business identity and, importantly, creating financial freedom.
Some of the country’s successful independents have built their practices around quality eyecare, but some of the top performers have fused this with a retail component that can generate the revenue required to re-invest back into their practice operations and clinical technology.
While it’s true the feel, style and durability of frames are important, what generates the most success is the relationship between the wholesaler, retailer and customer. More than ever, that means bringing suppliers into the tent.
How practices can optimse the relationship with their frame supplier is the focus of this month’s main feature on pages 23-27, recognising what can be achieved in a partnership built on mutual trust, respect and a little commonsense.
There are some simple yet effective strategies that can help practices ensure their eyewear is working harder for them. A strong rapport with suppliers is an obvious starting point; timely payments, fairly assessing warranties, and following through with scheduled rep meetings are just some examples. For suppliers, it’s about providing quality advice, being responsive and timely with orders.
Savvy practices also form deep relationships with a small pool of suppliers, allowing for a more focused brand strategy. This also enables the practice to build stronger ties with suppliers and less time on admin work. Others also focus on dollars banked per dispense, than the margin percentage. It’s important to remember that sales reps are experts of their product.
Optometry has undergone a major transition in recent times – and for independents to thrive, it’s worth exploring all possibilities of their eyewear range.
As ProVision's former CEO Mr Steven Johnston told Insight last year: “You can’t have contemporary clinical excellence without a commercially successful enterprise that can invest in the technology. It is a virtuous circle.”
Just as Insight went to print, SPECSAVERS has taken out the optometry category in the Reader’s Digest 24th Annual Most Trusted Brands survey, followed by EssilorLuxottica-owned OPSM and Laubman & Pank. It marks the fourth year in a row that Specsavers has been recognised, with the company also receiving ‘highly commended’ status in the hearing services category. The independent market research sought opinions from 2,800 Australians’ on
A poster at ARVO 2023 has demonstrated the risk of Nerf guns, a children’s toy that shoots foam projectiles. The study was conducted by Vanderbilt Eye Institute in the US, with the study finding 72% of the Nerf-related hyphema cases occurred in male patients, with 69% of the cases occurring in patients younger than 10 years old. Additionally, 47% had visual acuity worse than 20/40 at some point during follow-up, with 10% of patients having visual acuity worse than 20/40 at their last recorded eye exam.
Optometrists have many special skills and interests, but you’d be hard-pressed to find someone that matches the level of Mr Matthew McClean from Northern Ireland who briefly led the 2023 Masters at Augusta. The 29-year-old trained optometrist found himself leading the golf major, teeing off before many of the big names. He ultimately missed the cut, shooting +7 after two rounds.
Australian actress Margot Robbie revealed that she once lied to her optometrist due to her obsession with Harry Potter. Speaking on the Graham Norton Show, she was speaking to a childhood image of her dressed in a black turtleneck and round glasses on her birthday, saying she lied to the optometrist in order to be prescribed the pair of spectacles.
leading brands across 74 categories.
IN OTHER NEWS, the Lions Eye Institute (LEI) is celebrating two major milestones in 2023: its 40th anniversary, as well as one million patient visits since it first started treating patients. Over four decades, LEI has grown to now: see up to 80,000 patients across WA each year, undertake more than 70 clinical trials per annum, employ approximately 300 people, facilitate some 400 corneal and scleral transplants per annum, and receive up to $5 million in donated gifts each year.
FINALLY, Optometry Australia has commended Health Minister Mr Mark Butler on the Strengthening Medicare initiatives. “The National Scope of Practice Review needs to consider an enhanced role for optometrists in the management of patients with glaucoma and cataract as well as the treatment of age-related macular degeneration and macular oedema, working with ophthalmologists in team-based care environments," interim CEO Ms Skye Cappuccio said.
A recent OneSight EssilorLuxottica Foundation clinic in New Zealand delivered 940 pairs of free spectacles to 827 people. Page 35
Complete calendar page 69.
NEXT
10 JUNE
Myopia Australia's second Myopia Progression in Children Conference invites practitioners to learn and interact with the latest research-proven methods. info@myopiaaustralia.com.au
26-29 JULY
It will be the first event for Dr Jacqueline Beltz and Prof Gerard Sutton as co-presidents, taking place at the Sheraton Mirage, Port Douglas. www.auscrs.org.au
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continued from page 3
hundreds of medicines for conditions like heart disease, cholesterol, Crohn disease and hypertension will be cheaper.
The change will bring Australia into line with New Zealand, the UK, France and Canada where patients already have access to multiple month medications on a single prescription.
Twomey, from the Pharmacy Guild of Australia, said when a similar policy was introduced in the UK, 1,100 pharmacies shut and when it was introduced in New Zealand more than 70 pharmacies closed.
The government said overall demand for medicines will remain unchanged. It also said the reform will not affect medicine availability nor add to shortages. But Twomey said the health minister refused to guarantee patients would receive the medicine they needed or that pharmacies wouldn’t close.
He quoted data from a World Pharmacy Council economist that said the policy would lead to a $3.5 billion cut in patient care to communities around Australia over the next four years.
“That should worry patients,” he said. “This cut to patient care will mean aged care services are reduced and elderly patients may go without medicine.
“This cut will mean parents wanting access to late night medicines for their kids will miss out because pharmacies will be forced to scale back their opening hours. It will put more pressure on emergency departments because people will need to go somewhere when their pharmacy is closed.”
Twomey said the guild would rather see the PBS co-payment dropped to $19, helping Australians with rising cost of living pressures. But on January 1, for the first time in the 75-year history of the PBS, the co-payment was reduced from $42.50 to $30. In the first three months, 5.1 million prescriptions were cheaper, saving Australians more than $58 million.
Once 60-day prescribing is implemented, the government said every dollar saved by the policy would be reinvested back into community pharmacies “and ensure our trusted pharmacists play an even larger role in the healthcare of Australians”.
Twomey said the guild “would be holding the minister to his word” on this.
The government is also investing $350 million to community pharmacy outreach into aged care facilities to ensure older Australians are managing their medications.
Australian Medical Association (AMA) president Professor Steve Robson said the body had been calling for the change since it was recommended by the PBAC in 2018.
STEVE
The decision will also allow up to 12 months’ supply in total from a single script, also saving patients an extra trip to the doctor.
“This is terrific news for consumers taking these medications, as they will now be able to visit the chemist once every two months instead of every month, but still pay a single co-payment – instead of visiting and paying each and every month,” Robson said.
“We know patients are struggling to afford essential medicines as cost-of-living increases continue to bite the household budget and research tells us some patients are skipping medicines because of this – that just shouldn’t be happening. This effectively halves the costs of these medicines for patients, and means more affordable medicines now are a reality for these patients.”
With regard to medicine shortages, Robson said he didn’t think this would be an issue.
“These are medications that people are taking anyway. All we’re really doing is saying that over the course of a year you need to go to a pharmacy six times to pick up a supply of medication rather than 12 times. It shouldn’t really alter the amount of medication dispensed. In fact, it might make it easier because in any given month, only half as many people will be coming into pharmacies to get their prescriptions,” he said.
continued from page 3
the same patients the government’s Medicare reforms are looking to assist through MyMedicare and multidisciplinary team-based care. Often, their eye conditions are linked directly to their other chronic health conditions as well as to their age,” she said.
“Eye health is beset by the same issues identified by the Strengthening Medicare Taskforce that have led to the reforms in the budget: lack of integrated care; freezing (actually cutting) of Medicare rebates; specialist workforce shortages and maldistribution; over reliance on overstretched public hospitals; poor information systems; and eye health professionals prevented from practising to their full scope.”
Cappuccio said as with the broader health system, disadvantaged groups
suffer most. Fifty-nine per cent of women report long term vision issues compared with 51% of men. People in low socio-economic communities without private health insurance wait months, if not years, for public hospital appointments. Indigenous Australians wait more than 50% longer for cataract surgery than non-Indigenous Australians.
“This long-awaited and very welcome Medicare reform package provides the opportunity to rectify these problems, but only if it is recognised that patients’ eye health is an integral part of their overall health, and that eyecare must be part of multidisciplinary team-based care,” she said.
“It is a misnomer to be reforming Medicare and not include optometrists who are responsible for 10 million
Health will receive $101 billion over the next four years.
Medicare-funded patient consults annually, far more than any other allied health profession.”
OA's proposals include:
• Using the National Scope of Practice Review to remove regulatory and funding barriers that prevent optometrists from practising at full scope.
• Including optometrists in multidisciplinary team-based care.
• Ensuring that proven collaborative eyecare solutions which enhance patient access and reduce public hospital wait times are developed at scale in the next National Health Reform Agreements.
• Integrating eye health information sharing into the new data rich My Health record system.
“PATIENTS ARE STRUGGLING TO AFFORD ESSENTIAL MEDICINES AS COST-OF-LIVING INCREASES CONTINUE TO BITE, AND RESEARCH TELLS US SOME PATIENTS ARE SKIPPING MEDICINES BECAUSE OF THIS.”
ROBSON, AUSTRALIAN MEDICAL ASSOCIATION
ASX-listed 1st Group will sell its MyHealth1st platform, which thousands of patients use to search and book eye health appointments in Australia, to HealthShare for $1.25 million.
The divestiture follows 1st Group’s comments in its half year FY2023 report where it outlined its intention to sell MyHealth1st – a digital portal that has facilitated more than 250,000 appointments per month for over 17,000 practitioners in the fields of optometry, ophthalmology, physiotherapy, psychology general practice, dentistry and more.
Mr Joshua Mundey, CEO of 1st Group, said MyHealth1st had developed relationships with many world-class health providers since its inception in 2012.
He described HealthShare as “an industry leader in the Australian digital health landscape”, with leading products and a large user base of patients and health professionals. More than 10 million Australians use HealthShare’s products annually, as well as tens of thousands of
GPs, non-GP specialists and allied health professionals.
“We believe that MyHealth1st’s customers and employees will benefit from HealthShare’s long-term ownership,” Mundey said.
“This announcement represents another important milestone in our strategy to create a focused and profitable healthcare technology organisation that is well placed to capture market share in the fast growing, global hybrid health market.
“The sale of MyHealth1st to HealthShare will considerably reduce net cashflows for 1st Group, allowing for more focused investment of human resources and
financial capital in the growth of its other businesses. This transaction is a positive outcome for shareholders, customers and employers.”
According to an announcement, the deal includes the sale of assets, client agreements, supplier agreements, intellectual property, goodwill, business names and domain names to HealthShare.
Proceeds from the transaction are intended to generate further capital to enable 1st Group to develop its Visionflex telehealth product.
The company’s other businesses include online pet service marketplace PetYeti, and corporate and government solutions platform GoBookings.com.
In 2022, 1st Group merged with Visionflex Pty Ltd, leading clinical virtual care technology company, it expects will create new opportunities for PetYeti, GoBookings and Visionflex customers. The HealthShare-MyHealth1st transaction is expected to take place on 31 May 2023.
Tasmanian optometrist and former president of Optometry Australia (OA) in the mid 1980s, Mr John Rees has passed away. He has been described by the organisation he once led as ‘instrumental in advancing the profession and improving the eye health of many through his dedication and passion’. Rees was inducted as a Fellow of the American Academy of Optometry in 1997, and in 2010 was awarded life membership of Optometry Tasmania. “He understood that the world of optometry was constantly evolving, and that optometrists needed to stay up-to-date with the latest research, technology, and best practices to provide the best care possible,” OA said.
SILMO Singapore, ASEAN Optical Fair, has been heralded a success after running 12-14 April 2023 at Suntec Singapore Exhibition and Convention Centre. Jointly organised by SILMO International and MP Singapore, the show welcomed more than 250 international and local brands from over 15 countries representing most product families and ranges in the optics and eyewear industry. A total of 2,175 professional visitors, optometrists, dispensing opticians and buying groups had the opportunity to browse the latest eyewear, optical products and technologies. “With 50% of its attendance from overseas, SILMO Singapore first edition confirms its ambition to become the new business meeting place in Southeast Asia. Top five of the 44 represented countries were Malaysia, China, Australia, Vietnam and Indonesia,” organisers stated.
EssilorLuxottica and retired tennis legend Roger Federer have signed an exclusive licensing agreement for the design, manufacture, and worldwide distribution of eyewear between the Roger Federer (“RF”) and Oliver Peoples brands. The inaugural collection will launch in the Spring of 2024. “Roger Federer is a legendary athlete, a passionate entrepreneur, and a force in the worlds of fashion and lifestyle. Our shared values and his global influence makes him the perfect partner for us and for the Oliver Peoples brand,” said Mr Francesco Milleri, Chairman and CEO of EssilorLuxottica. Federer added: “I am thrilled to collaborate with Oliver Peoples. I’ve been a fan of the brand for years and have always appreciated their exceptional craftsmanship alongside timeless, elegant designs. We both found great commonality in how we approach our work, and they are a perfect partner for the debut of my RF eyewear collection in 2024.”
Several Australian ophthalmologists have been listed among the top 100 in their field globally in the 2023 Power List, compiled by The Ophthalmologist magazine, with Adelaide’s Dr Ben LaHood becoming Australia’s youngest ever nominee.
Sydney’s Professor Stephanie Watson and WA ophthalmologist Professor David Mackey also made this year’s list, along with New Zealand’s Professor Helen Danesh-Meyer who was named in the top 20, and Professor Mingguang He who has affiliations with the Centre for Eye Research Australia and The University of Melbourne.
The Power List highlights the excellence and impact of the most influential and inspirational people in ophthalmology globally. Now celebrating its 10-anniversary, nominations are provided by surgeons worldwide with the final list determined by a diverse judging panel.
At 39 years old, LaHood is the youngest Australian ophthalmologist and eye surgeon to be included in the global top 100, and the only South Australian to make the list.
He has been recognised for his surgical services professionally as a consultant ophthalmologist at Adelaide Eye and Laser Centre, ParkView Day Surgery and The Queen Elizabeth Hospital in Adelaide, and Senior Lecturer at University of Adelaide.
LaHood is considered a leader in the subject of cataract and refractive surgery, which has seen him attend multiple conferences across Asia and America to educate his peers. As well as a driving force through his digital and social media presence, newsletters, blogs, two podcasts and regular webinar events.
“I am incredibly humbled to be included in this group of the world’s top 100 ophthalmic minds,” he said. “Selection on this list has been a career goal and is clearly a highlight for me. I could not have got to where I am today, without the many opportunities I have been provided by my professional community. "
The NSW Ministry of Health has announced changes to the urgency categorisation of cataract surgery for the second eye of a patient.
From July 1, 2024, a patient presenting for cataract removal for their second eye at a public hospital will be entered on to the elective surgery waitlist as a category 2, resulting in surgery within 90 days. Until then, Local Health Districts will receive additional funding to meet this target for current waitlist patients.
The change was announced on 28 March, three days after the NSW election.
Vision 2020 Australia, whose campaign efforts during the NSW election focused on the unacceptable wait times for cataract surgery in the state’s public hospitals, said it was pleased with the outcome.
“This result is testament to the collective impact of our members and represents a major outcome for the sector,” the peak body said.
The Australian Institute of Health and Welfare (AIHW) Elective Surgery Waiting Times Report 2021-22 shows that NSW is at the bottom of the pile when it comes to cataract surgery.
Almost one in five (19.2%) people in NSW are waiting longer than 12 months before receiving surgery in the public system, a statistic Vision 2020 Australia CEO Ms Carly Iles describes as not acceptable.
“Cataract surgery is one of the most performed surgeries worldwide, and it is highly successful in restoring vision. However, long waiting times can lead to complications and cause thousands to be needlessly blind and lose their independence,” she said.
The Sydney-based International Myopia Institute (IMI) has released the third series of its highly cited White Papers in a special 2023 issue of the top peer-reviewed Investigative Ophthalmology and Visual Science (IOVS) journal.
The first two series of IMI White Papers were released in 2019 and 2021 respectively, and provided consensus and clinical management guidance for myopia development and management.
The latest third series highlights evidence around onset, progression, and management of myopia in less typical young adult and paediatric populations, the role of the choroid in eye growth control and myopia management, and a detailed anatomical paper on non-pathological ocular tissue changes observed in moderate to high myopia.
In addition, the series includes a report on the results of an international survey of practitioners on myopia management attitudes and strategies in clinical practice and a digest which updates the latest evidence from topics covered in previous editions.
IMI was formed following a World Health Organization-Brien Holden Vision Institute (BHVI) meeting on myopia and high myopia in 2015. The organisation comprises a think tank of experts in myopia tasked with developing white papers to generate consensus on the definitions of myopia, high myopia, management of the condition, as well as identify gaps in research.
Several Australian-based experts are involved in IMI White Paper Taskforces such as Dr Kate Gifford, Professor Padmaja Sankaridurg, Professor Mingguang He, and Dr Monica Jong,
“Year on year, there are a growing number of myopia management options available, and it can be difficult for practicing clinicians to keep pace with the evolving evidence base,” said Dr Nina Tahhan, IMI program director and BHVI director of clinical research.
“The White Papers bring together leading experts around the world to provide consensus and summarise the latest evidence to make it easily accessible and readily available for practicing clinicians to implement in practice. The IMI are incredibly committed to developing and disseminating the latest evidence-based research for all to benefit from.”
Professor James Wolffsohn, IMI chief scientific officer, said the IMI had brought together the leading experts in myopia research from across the globe again to ensure that clinicians have the latest information on myopia control to provide the best service to their patients. He said the papers help “highlight areas where more research is required and to guide the ophthalmic industry in the development of products needed for the future”.
Former Centre for Eye Health senior optometrist, Dr Pauline Xu, has been appointed clinic director of the new Eye Health Centre of Western Australia (EHCWA) set to open in June this year.
A state-of-the-art optometry clinic united with the University of Western Australia (UWA) optometry teaching and learning facility, EHCWA provides eyecare services to members of the public, accepts referrals from community optometrists, ophthalmologists, general practitioners, and other health practitioners, and comanages chronic eye diseases in collaboration with ophthalmologists in both private and public sectors.
“EHCWA aims to improve the access and quality of eye health services in Western Australia through the integrated provision of clinical service, education, and research,” Xu said.
It is the only institution in WA offering tertiary training in optometry and has
capacity for 19,000+ appointments per year.
Located in Crawley, next to the UWA campus, EHCWA has also established regional hubs in Broome and Geraldton.
Xu said her role as clinic director has three major components.
“Firstly, lead a team of expert clinicians to provide high-quality and evidence-based eyecare services to patients,” she said.
“Secondly, design and deliver clinical education for the UWA Doctor of Optometry students in collaboration with the course director. Prior to students’ clinical placement in the community, they will need to undertake placements at EHCWA under the supervision of the UWA academics and demonstrate competency.
“Thirdly, my role is to facilitate the conduct of clinical trials under the leadership of the Chair in Optometry Research Professor Allison Mckendrick. My primary focus now is the establishment of the facility which encompasses system
design and process development to ensure operational excellence,” Xu said.
EHCWA is an integrated clinic within a new purpose-built facility comprising 2,500 square metres spanning over four floors, and has state-of-the-art equipment, including OCT, visual field, biometry, aberrometry, ultrasound, corneal topography, wide-field imaging, and intense pulsed light.
“The instruments support our specialty services, including dry eyes, paediatrics, myopia management, ocular pathology, specialty contact lens and low vision,” Xu said.
“We don’t dispense spectacles. However, we are working towards philanthropic support for at-risk populations. Dispensing of contact lenses will be offered in our specialty clinics if they constitute a treatment plan, for example, scleral lenses for keratoconus and orthokeratology for myopia management.”
EssilorLuxottica has presented four-year clinical trial results of its myopia control innovation Essilor Stellest lens at the 2023 ARVO annual conference in New Orleans. The findings show that the group’s myopia control spectacle lens – which became available in Australia in October 2022 –continues to exhibit strong efficacy in slowing myopia progression and axial eye elongation in children in the fourth year.
The clinical trial, which began in 2018, was conducted at the Eye Hospital of Wenzhou Medical University in Wenzhou, China. The study assessed the four-year increase of myopia and axial eye length of children who wore spectacle lenses with highly aspherical lenslets (HAL). Essilor Stellest lenses are based on the optical design of HAL lenses. According to a statement, key findings from the study include:
• HAL lenses saved more than one and a quarter dioptres of myopia on average over four years, “demonstrating conclusive evidence of their effectiveness in slowing down myopia progression in children in the fourth year”.
• Myopia progression and axial eye elongation in children wearing HAL lenses was slower compared to a modelled control single vision lens group, indicating sustained myopia control efficacy of the lenses in the fourth year.
• HAL lenses remain effective in slowing myopia progression and axial eye elongation in older children (11-16 years old) in the fourth year.
The four-year results were presented by Dr Björn Drobe from EssilorLuxottica’s R&D team.
Dr Yee Ling Wong, also from the R&D team, presented findings from a study that evaluated the eye growth of children wearing spectacle lenses with aspherical lenslets and with single-vision lenses in comparison to eye growth patterns in non-myopic children in Wenzhou, China.
These findings concluded that the eye growth pattern in nine out of 10 children wearing HAL lenses full-time was similar or slower than that of non-myopic children, after two years, EssilorLuxottica stated.
The release of the four-year data follows the recent publication of the three-year
clinical trial findings in the medical journal American Journal of Ophthalmology, which also highlights evidence of continued myopia control efficacy of the lens in slowing down myopia progression in children over three years. When children switched to HAL lenses in the third year after two years of wearing single vision lenses, myopia progression and axial eye elongation decreased significantly, compared to children wearing single vision lenses.
Mr Norbert Gorny, co-chief operating officer at EssilorLuxottica, said the company was proud to share the latest findings at ARVO.
“We look forward to sharing additional data with the scientific community. Such encouraging, evidence-based findings will significantly help to enhance scientific understanding and clinical interest for myopia control solutions like the Essilor Stellest lens globally,” he said.
“To move the needle further, we will continue to advance myopia research, deliver innovative solutions, build partnerships to strengthen awareness and education, share insights and expertise at key conferences, and much more.”
The Optical Distributors and Manufacturers Association (ODMA) Board has revealed Ms Amanda Trotman will head up the association permanently as CEO.
Her appointment follows the board’s consideration of CEO candidates to replace Ms Finola Carey who served ODMA for 27 years and was CEO since 2010. She has taken up semi-retirement.
Trotman has been acting CEO for more than 12 months while Carey was on long service leave. ODMA says she has thrived in the role, after serving as general manager and project manager of O=MEGA21.
“I have enjoyed the acting CEO role immensely and work well with the board,” she said. “I have really loved being able to get out and meet many industry members face-to-face in 2022 and feel I fit in and have a lot to offer the optical industry despite me only being a part of it for a couple of years now.
“I feel my varied industry experience and the range of size and type of organisations I have worked for brings a fresh approach plus my vast events and marketing experience will be well utilised given ODMA’s focus on live events.”
During the recruitment process, the board met to discuss the key attributes of its CEO, given the importance and profile of the role. A performance review was also completed with Trotman by the HR sub-committee of the ODMA Board. The board unanimously voted for Trotman.
Mr Rob Sparkes, ODMA Board chair, said the board was delighted to announced its next CEO.
“Amanda has demonstrated a remarkable ability to work with the board, our industry and partners over the last 18 months. Congratulations Amanda on this well-deserved appointment,” he said. Trotman’s achievements to date included delivering a successful OSHOW22 event soon after the COVID lockdowns, and the implementation of detailed reporting across multiple business areas.
She has worked for major corporations in project management and marketing roles and with not-for-profits in business development roles. She has also previously launched and managed her own enterprises, one in event management and one in small business coaching.
A new oral therapy under investigation for neovascular (wet) age-related macular degeneration (nAMD) has been shown to improve visual outcomes with a “manageable” safety profile, despite adverse events reported in 80% of study participants.
Published in the journal Eye, the Phase 1 study by Chinese researchers evaluated the efficacy and safety of oral vorolanib for nAMD. The therapy could one day be a more convenient alternative to intravitreal injections of anti-VEGF.
Vorolanib (X-82, CM082) is described as a potent oral VEGF receptor (VEGFR) and PDGF receptor (PDGFR) inhibitor, suggesting a more effective inhibition than anti-VEGF injections alone.
In the study, participants received ascending doses of oral vorolanib (25–100 mg daily). In the dose expansion, participants received recommended doses (25 and 50 mg daily).
Between March 2015, and January 2019, 41 people were enrolled in six centres in China.
Treatment-related adverse events (TRAEs) occurred in 33 (80.5%) participants, and grade 3 or higher TRAEs occurred in 12 (29.3%) participants.
No fatal TRAEs were observed – and
increases in the mean best-corrected visual acuity (BCVA) from baseline to Day 360 of +7.7 letters were observed in participants who were administered vorolanib. Corresponding reductions in mean central subfield thickness (CST) and choroidal neovascularization (CNV) area after one year were observed in these three groups.
The researchers concluded that TRAEs after oral administration of vorolanib up to a maximum dose of 100 mg were manageable in the study.
“Given the limitations of the efficacy of anti-VEGF therapy and the burden of repeated intravitreal injections, alternate therapies are being explored. The desire to reduce injection frequency has promoted the development of sustained-release formulations of anti-VEGF drugs, as well as topical and oral formulations,” they wrote.
“Vorolanib, an oral tyrosine kinase inhibitor of both the VEGF and PDGF receptors, does provide important evidence that oral tyrosine kinase inhibitors have efficacy with manageable safety profiles in nAMD. However, we must acknowledge that the systemic adverse profile of vorolanib needs attention, and the potential benefits of vorolanib need to be carefully weighed against the risks.”
CooperVision is expanding its plastic neutrality initiative, with its full range of contact lenses distributed in Australia and New Zealand now plastic neutral.
The company said it would provide an easy way for eyecare professionals and their patients to be more sustainable in their business and lifestyle.
“The initiative is made possible through a breakthrough global partnership with Plastic Bank, a social enterprise that builds ethical recycling ecosystems in coastal communities,” CooperVision said.
For every box of CooperVision contact lenses distributed in Australia and New
Zealand, CooperVision purchases credits that fund the collection and recycling of ocean-bound plastic into the global supply chain, that is equal to the weight of the plastic used in its contact lenses, the blister and the outer carton packaging.
All CooperVision contact lens brands sold and distributed in Australia and New Zealand are included in the plastic neutral initiative, including MyDay, Biofinity, clariti 1 day, MiSight 1 day, Proclear, and cAIR.
There is no enrolment process for eyecare professionals or consumers; anyone who recommends or wears the lenses is participating.
Trinity College Dublin researchers have collaborated with biotechnology company Exhaura Ltd to develop a gene therapy that has lowered intraocular pressure (IOP) in animal models, suggesting that glaucoma can be readily treated with gene therapy–based methods, paving the way for deployment in clinical trials.
The approach could one day replace common treatments for glaucoma such as topical eye drops, which the research team say are critical in preventing disease progression. However, up to 10% of patients become treatment resistant, putting them at risk of permanent vision loss.
In their study, recently published in Science Advances, the team at the Smurfit Institute of Genetics, with Exhaura Ltd, showed that a gene therapy-based approach can decrease IOP in pre-clinical models of glaucoma.
Their single injection of a viral vector – essentially a virus the scientists have hijacked with the purpose of using it to deliver specific instructions to cells in the body – can increase the flow of aqueous fluid. The key instructions are for cells to
opening up the possibility for
therapies for glaucoma.
produce an enzyme matrix (metalloproteinase-3, or MMP-3) that helps kick this process into gear.
“This exciting project allowed us to bridge the gap between academia and industry and work very closely with a gene therapy company to develop a cutting edge therapy that we believe holds immense promise for patients in the future,” said Professor Matthew Campbell, Professor in Genetics at Trinity.
The work used multiple models of disease – as well as donor human eyes –to screen the therapeutic efficacy of the
gene therapy approach. This makes the impressive results all the more promising, the researchers stated.
With many gene therapies focused on more conditions, such as inherited retinal disease, the Trinity team said the understanding of the underlying mechanisms of common diseases is evolving, opening up the possibility for gene therapies for conditions like glaucoma.
Dr Jeffrey O’Callaghan, postdoctoral research fellow at Trinity and first author of the study, added: “Our novel approach to treating glaucoma using gene therapy is the culmination of over seven years of research. We are now hopeful that this therapy will pave the way to the development of treatments for other forms of blinding eye diseases.”
A multidisciplinary team of geneticists, ophthalmologists and translational biologists undertook the study. The close collaboration with Exhaura Ltd also allowed the team to direct all experimental outputs towards the translation of the findings to a regulatory focused clinical program.
The underlying mechanisms of common diseases is evolving,
gene
New Zealand ophthalmologist and author of a new report examining the actions on climate change by Australasian medical colleges, DR JESSE GALE, believes institutions like RANZCO are ideally placed to influence doctors to make meaningful changes to their daily clinical practice.
Anew report examining the actions on climate change by individual Australasian medical colleges – including RANZCO – has found significant variability in their responses to date, ranging from complete avoidance to implementing sustainability into college governance and activities.
The ‘Actions on climate change by medical colleges and dental associations of Australia and New Zealand’ report has been compiled by New Zealand ophthalmologist Dr Jesse Gale and University of Otago Wellington colleagues Mr Henry Oakley and Associate Professor Caroline Shaw.
The document, released in 2022, provides a report card on the performance of medical colleges who participated in the survey in several areas, with RANZCO performing well in several areas. The authors round out the report with recommendations for colleges to take greater action on climate change.
The survey approached 21 Australian and New Zealand medical colleges and dental associations to summarise their activities related to sustainability and climate change, including how they engage members
on the topic and practices adopted by each college’s national office. Five did not respond, and four declined to participate.
Speaking to Insight, Gale says the report indicates there are multiple ways that RANZCO is making progress into embedding more sustainable practices in ophthalmology.
“I think the most meaningful ways are reaching out to our members about improving the sustainability of their practice, because these grassroots effects on clinical practice will have much more impact than any actions in the corporate offices of RANZCO,” he explains.
“We have had a workshop on measuring and reducing footprints at our congress [Brisbane 2022], and a symposium about multiple aspects of sustainable ophthalmology. We are building our sustainable practice guides for cataract surgery and intravitreal injections. These are forming an international consensus, for example with the Dutch Ophthalmic Society and American Academy of Ophthalmology, showing that multiple ophthalmic organisations agree on safe and minimally wasteful techniques.”
Gale says there is a strong appetite from doctors for practical guidance on sustainability.
“The response has been great. At the symposium there was a lot of positivity and fellows wanting to join in on these projects and activities. We’ve had some fellows come back to us for resources and support for them to make changes. It feels like the time has come for these ideas, and people are hungry for them,” he says.
Despite medical colleges being regarded as peak bodies to carry out leadership, education and advocacy, Gale et al’s report found the voice of doctors on sustainability has been from pan-medical organisations such as the Australian Medical Association. In fact, the Council of Presidents of Medical Colleges (Australia) and Council of Medical Colleges (New Zealand) have not formed a consensus statement on their role in climate change.
In terms of RANZCO’s performance, it rated highly in terms of taking a policy position on sustainability by implementing all three important functions assessed in the report: establishing a sustainability committee, publishing a statement/policy and releasing sustainable practice guidelines.
The authors singled out RANZCO for promoting sustainability to members, with college publications on sustainability, a booth at its congress on ‘Choosing Wisely and Sustainability’, and preferred practice guidelines for reducing waste in cataract surgery.
“The practice guidelines importantly are evidence-based to integrate sustainability with safe and high-quality clinical practice, and ongoing updates and revisions on other areas are under development,” the report stated.
When it came to RANZCO’s actions within the college office itself, it achieved two out of four measures by divesting from polluting industries and sustainable building practices, but at the time of publishing the report it was yet to measure the carbon footprint of its corporate
"WE’VE HAD SOME FELLOWS COME BACK TO US FOR RESOURCES AND SUPPORT FOR THEM TO MAKE CHANGES. IT FEELS LIKE THE TIME HAS COME FOR THESE IDEAS."
DR JESSE GALE OPHTHALMOLOGIST
activities and set and emissions reduction target. Interestingly, the college has been carbon-offsetting all staff travel.
In terms of education and engagement with trainees and fellows, RANZCO scored five out of eight, by adopting measures such as making sustainability a topic at congresses, online education to reduce travel, implementing sustainability into the trainee curriculum, and offering resources to help fellows measure or improve sustainability.
However, the college still needed to work on aspects such as sustainability education for fellows and recognising and promoting sustainable practice.
When it came to external advocacy on sustainability, RANZCO scored well by hitting all four targets, such as participation in the multi-college Climate Change and Health Research Project and advocacy on sustainability with politicians and regulators.
In their conclusion, the authors noted the medical colleges “fell along a continuum”, with some acting across many areas, and others focused on a smaller range of actions.
“The area that appeared to have the most scope for improvement was in education and engagement with trainees and fellows,” they reported.
“Sustainability education is also lacking in other health professional training, including medical schools. Engagement and education may also build support within the profession for the other college actions on sustainability. It is important to recognise that some colleges and associations did not think sustainability was relevant to them, one stating that climate change was a social issue, and not an issue for their organisation to have a position on.”
However, others are recognising the immediate need to adapt medical systems to the changing climate.
The authors noted that corporate responsibility – through measurement and reduction of emissions from college activities – is “an important signal to college members that we all must act”.
“Doctors and dentists value practical tools for measuring and reducing emissions from clinical practice. These resources must be supported
With external advocacy on sustainability, RANZCO scored well by participating in the multi-college Climate Change and Health Research Project, promoting sustainability in publications, and advocacy on sustainability with politicians and regulators.
Embedding sustainability in college governance – appointing sustainability representatives at a board level, allocating agenda space, and committing to a sustainable development plan.
Corporate footprints – Recognising and quantifying the emissions from college activities and demonstrating a pathway to net zero across business, buildings and college events. Reporting corporate emissions and reductions in public financial disclosures.
Responsible investment – Declaring an ethical and sustainable investment policy so that colleges are not profiting from polluting industries.
Sustainable events – Hybrid meetings are standard post-COVID, and an option to attend meetings virtually in order to reduce travel must continue to be offered. Meetings should be paperless and eliminate consumption of single use items such as cups.
Promoting sustainability – Celebrating the actions of staff and members through college communications and online networks. This includes case studies, promotion of innovations and bold actions.
Resources and tools – Collecting and presenting research about sustainable practice and identifying barriers to adopting this practice. Facilitating methods to measure emissions from practice, and techniques to reduce those footprints.
Facilitating learning on sustainability – Sustainability and sustainable practice should be a curriculum item for trainees. Accreditation of hospitals as training facilities is one mechanism by which colleges can signal the importance of sustainable practice. It should also be a topic for continuing professional development of fellows.
Advocacy to politicians – Colleges, as voices for their profession, should advocate for bold action at high level to decarbonise the health sector and to pursue bold emissions reductions targets across society.
In terms of education and engagement with trainees and fellows, RANZCO (column two) still needed to work on aspects such as sustainability education for fellows and recognising and promoting sustainable practice, at the time of the report.
Advocacy to industry – Many innovations in decarbonised healthcare will require industry participation, and colleges can act as a professional voice to signal the importance of these changes.
Founded in 2000, Eyecare Plus has evolved in lockstep with the independent optometry landscape. Optometrists who are part of the next generation of business owners discuss how the network helps them focus on what matters most.
With North American backgrounds, business partners Dr Lauren Kimmel and Ms Katy Gabriel come from a region where high quality clinical care is the centrepiece of most optometry businesses. Ocular therapeutics prescribing, advanced technology, a special interest in dry eye and contact lenses, along with a boutique ambience, are ways in which they believe independent practices can also succeed in the Australian market. And if appointments run over time to explain an important diagnosis to a patient, then so be it.
So, in 2020 when the opportunity arose to acquire a practice owned by Mr Stephen Chapman in Warners Bay, 15km from Newcastle's CBD in NSW, it provided the ideal opportunity for them to bring their shared optometric philosophy to life through practice ownership, something the pair had no previous experience in.
The practice had been part of the Eyecare Plus independent optometry network for over a decade already, and the pair thought it wise to continue this, assisting with key business functions such as marketing, benchmarking and optional buying power of frames, lenses and other products. The decision to remain part of Eyecare Plus also paid dividends when the practice was forced into extensive COVID-19 lockdowns, just weeks after they were handed the keys.
“I would love to say that I know a lot about business, but that would be a lie,” Kimmel says. “So much of my education was focused on optometry, biology, chemistry and the sciences. I’m trying to learn the business side and experience has been a good teacher, but day-to-day we still need to be focused on patients. We wouldn’t be optometrists if that wasn’t our first passion.
“Being part of Eyecare Plus gives us the confidence to feel we’ve got somebody to turn to for things like marketing advice and performance metrics. We have access to some aggregate information about how other practices are performing within the network – information that allows us to see how we compare for turnover, billings per consult, stock levels, booking, etc – things that we wouldn’t have a lot of data about otherwise. It doesn’t necessarily tell you what you need to do, although you can ask for advice, but it turns a light on in the dark for new practice owners, like us.”
How the worlds of Gabriel, originally from Canada, and Kimmel, from the US, collided to own a practice on the edge of the picturesque Lake Macquarie is an interesting tale.
Gabriel, who studied optometry at The University of Melbourne and who has an Australian husband, had worked under Chapman at Eyecare Plus Warners Bay for around 10 years. Before working there, she saw a sign on the door for an optometrist position; it was her dream job but her visa status, among other things, meant she didn’t put her name forward. She met Chapman soon after at a CPD evening who agreed to sponsor her. When she turned up for her first day, she was shocked to find it was the practice she saw that day – and has never left since.
Kimmel studied optometry in the US where she met her now Australian husband who was on a tennis scholarship. She moved Down Under with him, initially to Tasmania, before moving to Newcastle where she enjoyed her role working as an employee at an Eyecare Plus practice. She knew Chapman from around the traps, and when he decided to transition away from ownership Kimmel was introduced to Gabriel.
Kimmel and Gabriel both weren’t in a position to acquire a practice individually, so a partnership suited them nicely (the practice also has a third, silent partner). The duo’s complementary skills were a win for the business as a whole: Kimmel came in with a fresh perspective of how the practice could innovate in certain areas, while Gabriel provided the continuity with staff, patients and operations.
“When Stephen decided he wanted to wind down, I quickly put my hand up for it, this is my dream practice, and I was ready to take on the next challenge in my career,” Gabriel says. “Lauren and I complement
“EYECARE PLUS OFFER A GOOD BALANCE BETWEEN OFFERING BUSINESS SUPPORT, WHILE LEAVING YOU VERY MUCH FREE TO RUN YOUR OWN BUSINESS.”
PETER MCKAY EYECARE PLUS TAREE & GLOUCESTERKaty Gabriel (left) and Lauren Kimmel, owners of Eyecare Plus Optometrists Warners Bay.
each other well and have supported each other through the many challenges we have faced in the last two years. It is reassuring to know that we have a similar vision for how the practice should run.
“With Eyecare Plus, I like that we have ongoing support, we can ask for advice, but we don’t feel pressured from head office to do things a certain way. We have the freedom to do what we like, and this includes what products and suppliers we use. Eyecare Plus have always been helpful and supportive – it’s never hard to get hold of someone for advice.”
Another feature of Warners Bay Eyecare Plus is the fact it’s a branded practice. While not all practices opt for this within the network, Eyecare Plus positions itself as Australia’s largest branded group of independent optometrists, which means branded and co-branded businesses can choose to participate in regional and national advertising campaigns, while sharing the costs.
Another point-of-difference is exclusive territories, allowing members to discuss their business and share ideas, without concern that competing practice owners or staff are in the room.
When it came to acquiring ownership of the practice, Kimmel says Eyecare Plus also helped coach them through the process, without overstepping.
“Stephen Chapman built a fantastic business and Katy and I saw some opportunities to put our own mark on it. During the acquisition process, Eyecare Plus provided some support to ensure that both parties came to an arrangement that we all felt great about,” Kimmel says.
“When you first acquire a practice there’s a mountain of things to be done, and they helped us to prioritise the most important tasks. Unique to our situation was that shortly after becoming owners, we went into a hard lockdown. It was so incredibly stressful. Having some access to information about how other Eyecare Plus practices were handling it and performing (benchmarking) let us know where we sat comparably, and reassured us not hit the panic button.”
Further north, Mr Peter McKay’s affiliation with Eyecare Plus dates back to the early 2000s when he joined Eyecare Plus Optometrist Taree, in NSW, as an optometry graduate, working under Mr Ted O’Neill. It wasn’t
long until he acquired a share in the business – one of the first to join Eyecare Plus.
McKay says the network continues to offer significant value almost two decades later, while allowing him to maintain his clinical independence. Around six years ago, he bought out O’Neill and became the sole practice owner, with the head office offering valuable support during this time.
“They were able to provide some formal advice at the time of acquiring the final share, offering some market insights and comparative practice evaluations so that I had confidence I was getting a fair price,” he recalls.
“That strategic input from someone that’s able to see what’s happening in a broader market context and then being able to disseminate that down to an individual practitioner like me was helpful.”
Today, McKay also operates another practice three days a week, 80km away, Eyecare Plus Optometrist Gloucester.
“Eyecare Plus is a great fit for me and there are several advantages when it comes to running my business,” he says.
“I see it has been a fairly cost-neutral arrangement. I do pay a license fee, but I think the time it saves means it pays for itself – not only in supplier rates, but in the time it would take me to brand my own practice and build and manage a website etc. They also help my practice offer better arrangements with customer service and after-sales support –and the work they do around staff training has been beneficial as well.”
McKay also says being able to advertise and leverage a common brand significantly helps his business, boosted by the fact that he is not competing with other Eyecare Plus members within his area.
“Eyecare Plus offer a good balance between offering business support, while leaving you very much free to run your own business. There’s a lot of support in regard to setting up quality marketing and advertising campaigns, and we’ve got an online portal where we can order stock quickly from suppliers. All up, it’s an arrangement that balances nicely with my practices.”
If product is not performing as expected, practices can seek solutions with their sales rep.
Speaking from first-hand experience, former practice owners and sales reps lay the groundwork for how practices can maximise the relationship with their eyewear suppliers to generate the best outcome for their business and customers.
Although both relatively new to their current respective roles, Mr Dylan Oblein and Mr Rob Boelen, have been involved in the industry long enough to speak from experience about business-to-business relationships, particularly frame suppliers.
Joining them in this conversation is Ms Lisa Wymond, herself experienced in manufacturing, importing and supplying frames and accessories to optometry practices, and Mr Aaron McColl, founder of Aaron's Eyewear.
Oblein, business development manager at Eyecare Plus national office, is a former regional manager for George and Matilda Eyecare, and Luxottica, and a product specialist for Device Technologies. He has a handful of tips he thinks are beneficial for practice owners and optical dispensers when working with frame reps.
“As a previous practice owner and manager myself, I’ve been on both sides of the fence. My number one tip is to communicate and meet regularly,” Oblein says.
“Setting up consistent meetings, whether it be monthly, quarterly, or half yearly, whatever suits your business, depending on your volume, helps to stay on trend with the latest fashion for your patients, but also for your staff as well, because it can get stale when a product doesn’t move. It also helps solidify your relationship with your rep because it shows that you’re thinking of them, you’re giving them ‘air time’.”
Oblein says, based on what he has learned, a rep is often open to going that extra mile because you’ve reached out and made their life a little easier by instigating a meeting.
Second to regular communication is establishing mutual objectives. For practices, it’s about outlining their goals and how a particular rep can help take the business to another level. This helps reps feel like they’re ingrained in the culture of the business.
“By taking them on that journey, like a pseudo employee, they feel comfortable to communicate with all your employees, an even potentially popping in on a whim. You can put across what it is that you want to achieve, but also listen to what is going to help them achieve. They feel like they’re being heard.”
It helps to also set expectations of each other – the frame rep and the practice owner – early in the business relationship. Set boundaries, structure each visit, and discuss what services are available from the rep. Oblein’s third tip – “probably the most basic, but most important I think, especially in independent optometry” – is to utilise frame reps’ product training and their industry knowledge.
Optometrist-owners of busy independent practices often don’t have a lot of time to spend on the retail side of the business or coaching teams on comprehensive product knowledge.
“Frame reps live and breathe their product; they know it better than anyone. They’re passionate and infectious with their specialist product knowledge. The features and benefits of a frame are key when you’re selling as a dispenser, so pick the rep’s brain, get to know those features and benefits like the back of your hand, know the product inside out,” he explains.
“The rep will feel like their time has been properly utilised and for the practice owner, they’ll get a better patient experience because the dispenser is communicating that particular product better.”
In his former role as a practice manager, when a supplier had a new range, Oblein would often organise an after-hours team event, such as a pizza night, and invite the rep to present training.
“It takes away from the normal ‘run of the mill’ of the practice owner delivering the same thing over and over again. It keeps the meeting fresh and feels like you’ve got an external vendor coming in.”
He says a rep’s industry knowledge is equally as valuable as their product knowledge.
“Reps work across all different scenarios; independents, corporates, boutique, budget, they’re seeing everything, whereas a lot of practice owners are only seeing their own four walls,” Oblein says.
“Be open to asking them for their thoughts. They’re going to give you honest feedback. It’s invaluable.”
In addition to this, Oblein recommends utilising the frame suppliers marketing assets and in-store promotions – whether it be window displays, in-store print material, or social media assets. Suppliers have access to a library of ready-made content that usually comes at little to no cost for the practice.
“If you have a strong relationship with your rep, and if you’re smart about
worth of window displays booked out, all paid for by the frame supplier.”
Independent owners can use marketing assets to align their practice with
“If that’s something you want to align with, then utilise their marketing collateral. Independent practices don’t typically have thousands of extra dollars to spend on marketing, so utilise what suppliers can offer,” Oblein
Complete a performance review with your suppliers, too, just as you do
“Cross check to ensure your sales metrics are the same so if there’s any anomalies you can address it. Review frames’ performance: look at what may be going well from an average selling price and try to replicate that. If you see pitfalls, work together on how that might be improved,”
“If there’s an area where things aren’t going well, pass it on directly in a respectful manner, not word of mouth or Chinese whispers. Pick up the phone and speak directly. And equally, pass on feedback when things are
Mr Rob Boelen, who joined ProVision in February 2023 as merchandise manager, shares many of the same sentiments.
Having held management positions at Bupa, VetPartners, Medical One, and Woolworths, he has a wealth of knowledge to draw on when discussing business-to-business relationships.
Subtle mindset shifts, such as referring to suppliers as ‘partners’ is a small change that can get practice owners thinking differently, he says.
“Suppliers are key stakeholders in the success of any successful practice and should be engaged as partners who support sustainable, commercially viable options to grow the business,” he says.
“A lot of the time, especially in independent optometry, the person buying the frames, whether it’s the practice manager or a dispenser or the owner, they make the mistake of buying based on what they like and they end up with 15 frame suppliers and two ranges from each, so they’re not maximising the opportunity to form partnerships.
“Whereas, thinking through what you need in your frames range, where
“REDUCING SUPPLIERS IS A GLOBAL TREND ACROSS THE EYEWEAR INDUSTRY. CHOOSING QUALITY SUPPLIERS THAT CAN CATER TO MANY OF THE PRACTICES NEEDS IS KEY.”
LISA WYMOND EYES RIGHT OPTICAL
your gaps are, what your demographic is, who your client is, and then having three or four strong partners where you’re stocking six ranges is going to give you a lot more leverage and much stronger partnerships. ProVision is a strong advocate of doing more business with fewer supplier partners.”
By planning and carefully considering the frame range and price points across men’s, women’s and children’s eyewear, then practices can achieve better sale results and have less need for stock rotations that can potentially cause friction with some frame partners.
“The last thing you want is to be ‘that practice’ that constantly wants to rotate stock or send stale stock back in the wrong case with the wrong label, and residual glue from an adhesive label still stuck on the temple, leaving the supplier with little choice but to throw it in the bin,” Boelen says.
“If you’re going to be a good partner, and you’re going to get the most out of the relationship, planning the right range helps prevent these problems arising. There is plenty of variation in frame designs where you can stand
out and be different even when using a small number of partner suppliers.”
Fostering a good business relationship with suppliers also helps practice owners stay informed about new product launches and develop
“It’s important to build ‘best fit’ partnerships that are relationship-based, where the potential sell-through of product is high. This is the win/win outcome for both supplier and practice,” Boelen says.
“And in terms of point-of-sale material, in 2023, you need to think ‘How can we do this in a sustainable way? How can we promote this to our customers digitally? Do we have digital assets that we can send to our customers
“Think about how you can work with suppliers sustainably. It’s important to work together on getting better at doing digital warranties so you’re both not wasting money and resources on packaging and post, going back and forth. Suppliers are a key component of every practice’s success.”
There are three questions a frame supplier’s management team will typically ask when discussing a practice, Eyes Right Optical’s national brands manager Ms Lisa Wymond says.
• Are they easy to deal with?
• Do they do much business with us?
• Do they pay their account on time?
“If the answer is ‘yes’ to all three questions, a practice will be much more likely to get the best out of their supplier, providing both the practice and the patient with the best possible experience,” she explains.
Echoing earlier advice, Wymond says doing more business with fewer suppliers makes the practice a more substantial practice to the supplier.
“IT’S IMPORTANT TO BUILD ‘BEST FIT’ PARTNERSHIPS THAT ARE RELATIONSHIP-BASED, WHERE THE POTENTIAL SELL-THROUGH OF PRODUCT IS HIGH.”
ROB BOELEN PROVISION
“As a buying method, doing small amounts of business with a lot of suppliers doesn’t do anyone any favours. In the end, the practice will not be a financially significant customer to any supplier. Reducing suppliers is a global trend across the eyewear industry. Choosing quality suppliers that can cater to many of the practices needs is key,” she says.
“Practices can improve relationships with their chosen suppliers by working collaboratively with them to identify and address challenges faced by the practice and finding suitable solutions. Reducing suppliers saves the practice a huge amount of time regarding less paperwork and time spent with multiple reps from many companies. This means more time to focus on the best outcome for patients.”
To help reduce the number of suppliers, Wymond recommends finding out what other products your preferred suppliers and sales reps can offer.
“Can your preferred supplier provide a similar product to something that you are currently sourcing elsewhere? Using sales reports generated by the practice management software will help make these educated buying decisions,” she says.
Increasing spend with a supplier also brings additional opportunities for the practice and their patients. This might be in the form of extra staff training, marketing opportunities, VIP-style nights and the supplier going that extra mile for the practice and their patients.
“Seeing reps regularly will keep the best product on the shelf and relevant to the patient’s needs,” Wymond says. “It will also help grow staff’s product knowledge through training, build on dispensing
confidence and strengthen the relationship with the supplier. This attention to product and service helps build patient loyalty and generates repeat business for the practice.”
Understandably, suppliers will go that extra mile for the practice that is easy to work with. And in Eyes Right Optical’s experience, business synergy is readily apparent.
“We like to keep positive, proactive and be easy to deal with. This choice is in regard to our attitude towards the people we work with and also the product and service we provide. It is obvious to us when practices also have this same ethos as the rapport between supplier, practice and patient is second to none,” Wymond says.
“You definitely do ‘get more bees with honey’. Your suppliers are a wealth of knowledge too as they see what is happening nationwide. If a practice is after some assistance or advice on practice related topics, talk to your trusted suppliers as they have seen what works and what hasn’t at practices around the country with similar demographics,” she says, echoing Oblein’s observations.
Wymond also sees mutually beneficial partnerships as the key to long-term successful business relationships, for both practice and the
“Practices that get the best out of their suppliers operate in a fair and reasonable manner. This includes treating their suppliers fairly and with respect. Examples of this are paying on time, assessing warranties fairly, treating sales team members and support staff with respect and not taking
Respecting a supplier also extends to their sales rep and customer service team. Sales reps work on appointments much like practices do; everyone’s time is valuable and should be respected.
“If the practice needs to reschedule an appointment or is running late, it is best to let the sales rep know before and not when they’re walking through the door – let alone if they’ve specifically driven 10 hours interstate for a 9:00am appointment, which is unfortunately a true story,” Wymond
When it comes to warranties, it pays to be fair and reasonable. Suppliers rely on practices using their common sense and judgement to do an initial assessment of a frame for a manufacturer’s warranty claim.
“The supplier will not receive a credit themselves from the manufacturer if the warranty is not a genuine claim – for example, ‘I opened the case and it was just like that’ while the frame looks like it has been stood on,” Wymond says.
“The supplier will unfortunately then bear the full cost of this ‘warranty’ from the manufacturer. Being a reliable practice where the supplier can trust your judgement is much appreciated.”
For suppliers, disingenuous warranties are one problem, not paying on time is another.
“Suppliers understand that sometimes cash flow might be tight or large purchases of equipment may have just been made. If you find yourself in this situation, before an order is placed with a supplier ask if extended payment terms are an option.
"Talk to your supplier and work something out that is fair and reasonable for all. Not paying on time will quickly see relationships deteriorate.”
But, by working together, Wymond knows from experience that practices and suppliers can build strong and mutually beneficial partnerships that deliver the best possible experience for their patients.
“FRAME REPS LIVE AND BREATHE THEIR PRODUCT; THEY KNOW IT BETTER THAN ANYONE. THEY’RE PASSIONATE AND INFECTIOUS WITH THEIR SPECIALIST PRODUCT KNOWLEDGE.”
DYLAN OBLEIN EYECARE PLUSMeeting regularly with sales reps helps solidify a business relationship and stay on track with mutual objectives.
“STOCK ROTATION WAS DEVELOPED ABOUT 15 YEARS AGO AS A WAY FOR WHOLESALERS TO GET NEW PRODUCTS IN STORE AND GIVE PRACTICES AN OPPORTUNITY TO GIVE BACK SLOWER MOVING STOCK.”
AARON MCCOLL AARON’S EYEWEAR
Managing director of Aaron’s Eyewear, Mr Aaron McColl, has witnessed stock rotation become the norm within the industry, but is concerned it is being taken for granted.
“The concept of stock rotation was developed about 15 years ago as a way for wholesalers to get new products in store and give practices an opportunity to give back slower moving stock,” McColl says.
But he has grown uneasy at a prevailing attitude among some practices who feel they can send back any unmoving or slow-moving stock, no matter how old – sometimes even two- or three-years-old.
To help alleviate the cost burden that places on small businesses like Aaron’s Eyewear, McColl introduced a three-to-one rotation policy.
“If a practice wants to send back one frame, they need to buy three from me. It needs to be within 12 months from the date of original purchase and be in perfectly saleable condition. That way, I have an opportunity to resell current season stock and mitigate the cost of potentially writing off returned stock,” he says.
McColl receives frames returned in poor condition, under the guise of stock rotation, that are scratched, dirty, showing residual glue from labels, and nose pads stained by make-up.
“We’re giving the practice an opportunity to recoup their loss, because they haven’t been able to sell the product. But when we raise the issue of the poor condition stock is returned in, they can at times become unreasonably difficult,” McColl says.
Aaron’s Eyewear is a preferred supplier to ProVision and Eyecare Plus, and both groups accept his three-to-one stock rotation policy.
“Both groups are professionally minded and commercially focused. They believe and demonstrate their desire to have a mutually beneficial partnership with their suppliers by treating us professionally and fairly."
McColl says small group or single location practices wanting a one-to-one rotation policy is unreasonable, but also unsustainable and is an issue the industry needs to shine a light on.
“There are not as many independent wholesalers around anymore and some of the smaller players struggle, because they’re trying to appease these demands.”
McColl sees the lack of cohesion among the frame wholesalers as an opportunity for change and hopes certain standards and business practices are adopted by all suppliers, presenting a unified voice.
“I love this industry and I love my customers but it’s time for the frame suppliers to voice what we find acceptable. I call on my colleagues to get together and discuss what we will accept or not from our retail customers, collectively,” McColl adds.
Australian optical’s well-known Wymond family and Morel have forged a close eyewear distributormanufacturer relationship spanning more than two decades, which will go to new heights in July 2023 when they establish a new subsidiary, Morel Australasia.
Twenty-two years ago, when Mr Francis Morel – one of the fourth-generation owners of renowned eyewear maker Morel – flew out from France to visit Eyes Right Optical in Melbourne, it became abundantly clear who he needed to do business with in order to reach Australia’s thriving optical scene.
Both entities share similar traits: family-owned since the start (in fact, both are now operated by siblings), and both are fixated on helping independent practices gain access to unique eyewear that embodies quality design and craftmanship, while appealing to the budget conscious all the way to boutique offerings.
In 2001, Eyes Right Optical made room for Morel on its ODMA Fair display and its eyewear resonated with the local optical industry. They formalised a relationship that started with Morel’s Koali and Öga collections before later expanding into other ranges such as Nomad, Lightec, Marius, and the 1880 collection. Each have delivered success in their own way, hallmarked with Morel’s attention to quality, design, innovation and colour.
Fast-forward to 2023, and Eyes Right Optical and Morel are deepening their relationship, which will reap benefits for independent practices who stock the Morel brands.
From July, a subsidiary, Morel Australasia, will be established and operated locally by Mr Mark Wymond, who is also managing director of Eyes Right Optical. The partnership is set to provide a more streamlined supply of Morel eyewear into Australia, while gaining access to its sophisticated IT systems.
“We’ve had a very harmonious relationship with Morel over the years. They know we are experts in the field down here in Australia and have great relationships with our customers, so the partnership is a much better fit for our shared objectives,” Wymond says.
“It’ll mean we have higher priority of product coming to Australia. Morel have some great IT systems, including their sales app and great reporting capabilities that we will be able to leverage off. It’ll also open doors for us to talk to other subsidiaries around the world and share ideas.”
Morel Australasia will join 15 other subsidiaries established in countries like the UK, US, Canada, Germany, Austria, Finland, Switzerland, Scandinavia, plus more.
“They’ve also said that we can tap into the design process, to try and make product that’s going to suit our market even more,” Wymond says. “For example, combining colour with more commercial shapes that’ll resonate with the Australian market. The partnership is about becoming closer as an entity – we’re no longer only procuring product and selling it, we’re becoming part of their business.”
Wymond was keen to stress that Eyes Right Optical will remain as an entity, continuing to wholesale its usual brands. Morel eyewear will be available through Morel Australasia in Australia and New Zealand.
THE FOUNDER, INDUSTRIALIST AND COMMERCIALIST
Service and quality have become the non-negotiable cornerstones for Eyes Right’s success, something that wouldn’t be possible without relationships with a manufacturer like Morel.
For Wymond, several things set Morel apart. First and foremost, it remains a family-owned company after originating in 1880 in the mountainous Haut-Jura
Natural Park, in eastern France. It was founded by Mr Jules Morel who divided his time between agricultural work in the summer and assembling more intricate components for watches and optical frames in the snowy winter months.
Later, in the 1930s, Mr Marius Morel, a descendent with an industrialist streak, took the company to a new level with the purchase of factories and machines to produce frames at scale. Then it was Mr Jacques Morel’s turn in the 1960s who was assisted by his brothers and sisters to commercialise the Morel name globally.
More than 140 years later, today the company is still family-run by fourth generation brothers Mr Jérôme (CEO) and Mr Francis (head of export) Morel with their sister Ms Amélie Morel (head of communications), the latter who is also president of the major optical event brand SILMO.
Meanwhile, in Australia, the Wymond name has been synonymous with eyewear wholesale for more than three decades. Since 1992, Eyes Right Optical has set the pace by distributing outstanding quality and award winning, design focused fashionable eyewear to the Australian and New Zealand independent optical markets.
It was founded by Ms Gaye and Mr David Wymond, before it was acquired by their children Mark and Lisa Wymond in 2019, with Lisa serving as national brands manager today. Their other wholesale eyewear businesses are Modstyle and Sunglass Collective.
A feature of the Wymond businesses is a willingness to embrace modern information technology and service systems, and a growth mindset, expanding their service from Australia and into New Zealand and the Pacific.
Many of these attributes are present in Morel’s business too. Wymond knows first-hand, heading to France almost every year for the past 10 years where he and Lisa visit the company’s main factory/headquarters, distribution centre and other factories it uses in the region – sometimes when temperatures plummet to -8C.
“The product more than speaks for itself, but it’s also about the back-of-house systems they have built. They’ve always invested in their business, a lot like us,” he adds.
For example, Morel has created what it describes as the largest eyewear design centre in France, where designers, colourists and graphic designers work hand-in-hand to create more than 700 models a year.
It also has its own approved quality assessment laboratory, managed by a trained team dedicated to research and development. Each piece is scrutinised, testing for things like the reliability of the hinges, the resistance of the mechanical parts and the durability of the acetate.
Testament to its ability to innovative, Morel has developed a patented hinge, without screws or welding, which is part of the Lightec collection.
Wymond is excited to see what can be achieved by deepening Morel’s presence in the Australasian market.
“What this means for the Australia and New Zealand market, it will help strengthen our speed to market of product releases, worldwide exposure to ideas and best practice from around the world, there are so many benefits about working closer together,” he says.
Morel CEO Mr Jérôme Morel said the company’s ambition is to become the world’s leading brand in French independent eyewear. With the Wymond family relationship spanning 22 years, he says creating Morel Australasia is the natural next step to strengthen its brand and presence in the region.
Both parties share a passion for eyewear and a level of service that can only be provided by independent, family-run businesses. Morel has been particularly impressed with Eyes Right Optical’s expertise in the local eyewear industry, its customer service, and ability to promote and distribute its products.
“We believe that Eyes Right Optical’s strong reputation and loyal customer base will be a significant asset now to establish Morel Australasia,” Jérôme says.
“Mark Wymond has extensive experience in the eyewear industry and a deep understanding of the Australian market, making him an ideal partner for us
• Morel Lightec – combines lightness and technology for maximum comfort: manufactured from surgical grade stainless steel for lightness and flexibility.
• Marius Morel – Top-quality materials, an attention to detail and finishes that present the consumer with excellent quality products. Known for comfort, quality and sophistication.
• 18 80 collection – revisiting iconic frames while adding a touch of modernity and sophistication. It encompasses everything meaningful to Morel: strong heritage, enhanced by contemporary style.
• Nomad – inspired by global locations such as Cuba, Tokyo, Amsterdam, Berlin, Oslo, Marrakech, Prague and Fiji.
• Öga – uniquely masculine, featuring a Scandinavian design inspired by architecture. Created by Morel in 1997, the brand was the first line used to illustrate the group’s creative potential.
for the creation of our 16th subsidiary in the world (75% of Morel’s turnover is outside France). By combining our resources and expertise, we believe that we can create a powerful force in the Australian eyewear industry.”
By strengthening Morel’s presence in the Australasian market with dedicated customer service and local stock, Jérôme says it will benefit independents on several fronts.
“As an independent practice owner, you can expect to see a wider range of Morel eyewear products available for your customers,” he says.
“Our partnership and the creation of Morel Australasia will enable us to distribute our products effectively throughout Australia, which should make them more readily available. Additionally, we will be able to offer more support and resources to help grow optical businesses and meet their needs. Obviously, as independent business owners ourselves, we understand and will continue to be here for independent practices as we have done for more than 140 years.”
For David Pearson, who oversees Safilo’s Asia Pacific operations from Sydney, being a locally-based subsidiary of a global company is advantageous for two major reasons. It enables access to the most-recognisable brands from overseas, but with the benefit of being nimble enough to respond to market opportunities and facilitate the development of promotional programs and trade activations with local relevance.
For independent Australian optical practices who stock brands from Safilo – one of the world’s largest designers, producers and distributors of eyewear for labels like Carrera, Kate Spade, BOSS, Carolina Herrera and Under Armour, plus many more – it means they can select brands for their demographic while differentiating their businesses in an increasingly competitive marketplace.
“We reap the benefit of access to huge global brands and our own proprietary brands are equally strong. All the digital assets and marketing materials are created centrally to a very high standard and we can then share these with customers – that’s a strong aspect of being part of a global company,” Pearson says.
“We have Safilo’s global support, but there is still a lot of flexibility and responsibility at the local level. For example, in the last two years, we’ve released five or six different Australian-only Carrera models – being able to have the full support of the company, but also the freedom to make what’s right for that market, is invaluable.”
In his opinion, Australian independent practices have always been leaders in clinical eyecare. But a new wave of owners is upping the ante in the retail space, acknowledging this contributes to the practice identity and can help perpetuate the clinical side of the business.
“Clinical eyecare has been a hallmark of Australian independents, which you don’t see in other markets in Asia that I’ve worked in,” Pearson says.
“But the market here is changing. There’s a lot of younger optometrists coming through owning these practices, and there’s more emphasis on improving how they retail eyewear. We invested over $300,000 in store customisations last year for independent practices. Another way we are supporting them is to make our digital assets accessible and easy for those stores to use. They can digitally promote their business online easily without having to generate new content which people think is easy, but when you’re running a small business, it’s tough.”
An exciting new collection from a brand combining celebrity design style, high quality and affordable prices will soon be landing in independent practices in Australia, Pearson advises.
The launch of Privé Revaux fills a nice gap in Safilo’s broad portfolio in Australia that consists of a combination of both proprietary and licensed brands. It covers the full eyewear spectrum, from entry level to timeless classic, as well as fashion-forward and luxury frames, with a high number of stand-out performers across these categories.
“Carrera has been a phenomenal success for us and continues to go from strength-to-strength in Australia. The optical collections in Carrera are really appealing to a broad range of consumers. I think we’re one of the top 10 markets in the world for the brand,” Pearson says.
Carolina Herrera has been another strong performer since its launch in Australia in 2022. Pearson says the brand is relatively well known in the market – and with the release of a new fragrance in May and further plans for continued momentum for the brand franchise, there’s a lot more talk about going forward.
“We also now hold the distribution for Smith Optics, which is one of our own brands, including their ski helmets and goggles, and soon we will announce an Rx prescription program, partnering with a local lab,” he says.
There’s more to come still; Safilo has a large consumer advertising campaign starting in the second half of the year, which Pearson says will be the first time in a while that one of the major companies has invested in consumer advertising.
Safilo’s strong start to the year follows a period of significant growth and change for the company at the local level.
Financially, Australia contributed to a strong 2022 for Safilo’s Asia Pacific region, which posted revenue of €58 million (AU$96 million), up 9.8% on 2021.
The global company’s Australian base used to have its operations and commercial offices in separate locations in Sydney but moved to a new combined head office and warehouse in Peakhurst in October 2021. This facility is now also home to the group’s Asia Pacific headquarters, which
The reach of a global eyewear company with the agility to produce frames exclusively for the Australian independent optometry market is what helps set Safilo apart, as DAVID PEARSON explains.Privé Revaux will become available to Australian independents soon.
was previously in Singapore. It is significantly better positioned for growth and expansion, featuring 30-40% more warehousing space than previously. It’s also creating a better experience for Safilo’s customers, predominantly independent optical practices.
“It has allowed us to invest in additional software, which makes our operations much more responsive and ensures we can really support our customers with their day-to-day business needs,” Pearson says.
“We have greater control and clarity on where stock is and how long it’s going to take to get to our customers. We’re really excited about how it sets us up for the future, and especially the Australian market that we want to invest in.”
In addition to streamlining its operations, Safilo is expanding its local workforce. It is bringing on more sales reps, while not losing its sense of family, with Pearson’s own teenagers lending a hand with picking and packing during the school holidays.
“We’re certainly growing in the independent market and we’re really investing there,” he says.
“We’ve added additional people to our sales teams – I think we probably have one of the largest sales teams in the industry now focused on independent practices. We’re always trying to work with local buying groups – we’re a preferred supplier for ProVision and Eyecare Plus – and we’re trying to work as broadly across the market with a real focus on optical customers.”
Specifically, Safilo has expanded its sales team in South Australia, New South Wales, and Victoria. Each appointee has industry experience; but more importantly, they’ve all come from independent practices.
“They understand what it means to manage inventory, cash flow, and so on, so they can help our customers,” Pearson says. “We’re not adding sales reps
to present more frames; we want knowledgeable people on the ground to help independent practice owners with their frame selection, marketing and in-store merchandising. That’s what we know we need to invest in.”
Pearson says how to best work with suppliers is an important issue for the industry, and believes the days of reps visiting practices to present trays of frames are over. Safilo is advocating a different approach.
“Our reps prefer to spend 20 minutes every time they visit a practice, discussing with the owner who their customers are, what they’re looking for in terms of style, what the trends in the market are, and then, as the expert on Safilo brands, the rep can recommend the products they think are the most suitable for that store and the best brands for their portfolio,” he says.
“Customers who work with us in that way spend a lot less time choosing frames and a lot more time talking with our reps about how they [Safilo reps] can help with their store look and presentation, train new staff, provide digital marketing and brand assets – that’s the stuff that really helps the practice. The focus of our highly trained reps is to help the customer succeed, not to push stock in.”
Investing in the Australian market by helping practice owners promote their range of Safilo frames didn’t come without a cost. As Pearson explains, the Australian Border Force (ABF) decision last year to revoke the acetate eyewear tariff meant the company had to decide to either wear the cost or pass it on.
“That additional cost on businesses like ours, and all the other distributors who bring in eyewear, either gets passed on or absorbed by suppliers,” Pearson says.
“It’s a difficult situation, and I respect the distributors in the market, there’s a lot of great Australian businesses that it would have hurt much more than us. We chose to wear it, and work on our global pricing to make sure that we are competitive globally, on all our brands. At the end of the day, it meant we had less money to invest in the Australian market.”
Pearson is hopeful a new free trade agreement is brokered with Europe soon, as Safilo continues to grow and expand its Australian operations.
“We’re proud to be locating our warehouse, our operations and our people in Australia. Our warehouse manager started with us as a casual when he was 18-years-old; now he’s managing our warehouse, which is shipping 200,000 units a year,” he says.
“We remain invested in the local market and are committed to contributing to the health of independent optical practices.”
“HELP WITH THE STORE LOOK AND PRESENTATION, TRAINING OF NEW STAFF, DIGITAL MARKETING AND BRAND ASSETS – THAT’S THE STUFF THAT REALLY HELPS THE PRACTICE.”
DAVID PEARSON SAFILOJason Thai started with Safilo in Australia when he was 18-years-old and is now managing its warehouse, shipping 200,000 units a year. Safilo’s new Australian head office, located in Peakhurst, Sydney, which is now also the group’s Asia Pacific headquarters.
In celebration of WOOW’s 10 years, this birthday collection is stronger than ever, honouring the boldness and quirkiness of our French brand, and inviting you to cherish the happy holiday spirit, wherever you are. This season new WOOW collection promises to launch you on a journey to the land of holidays and relaxation. After all, when you’re floating above the clouds, what could be better than this little recreation collection to reach your own heights?
Loop in evokes the vapour trails aeroplanes create in the sky: somersaulting colours, materials and shapes combine. Collage wrap around the eye to draw a loop. Gliding flight full of poetry and lightness. Breathe in. Let go. Dare to party, be bold and embrace luxury.
Contact: sales@eyesright.com.au
Safilo is introducing the latest 2023 Spring-Summer Collection from BOSS, marking a new era for the brand with a bold new attitude. The collection features a complete eyewear offering including cool new looks, rich details and new sports styles, as well as many timeless and best-selling shapes. The collection embodies four key themes: function and comfort, active and dynamic, technology and innovation, and style and expression.
The BOSS eyewear collection features many styles which include sustainable lenses. These styles feature the “RESPONSIBLE” claim, used by the fashion house, which is indicated on static stickers, affixed to lenses and easily visible by customers.
The new BOSS Sport introductions are made from 60% bio-based materials.
Another highlight is the Carbon Family, unique with bi-injected temples featuring carbon-fibre and rubber for flexibility, resistance and lightness. This year’s collection also sees Light Wires with new superlight temples, timeless and bestseller shapes, and a functional and durable hinge.
A new collection for women features cool styles and iconic metal detailing consistent with the Fashion House and many styles are manufactured with sustainable materials, also featuring the “RESPONSIBLE” claim stickers.
Contact: au.customerservice@safilo.com or 1800 252 016
world-renowned beauty brow stylist and social media entrepreneur Ms Kelley Baker to release BP0241 BROW BABE (pictured).
After Barton Perreira’s co-founder and designer Ms Patty Perreira and Baker first met in 2014 on Abbot Kinney in Venice Beach, the two creative forces became instant friends and vowed to work together on a project. Inspired by Perreira’s vintage archives and Baker’s beauty line, their Wom en’s Coalition collaboration has resulted in ‘BROW BABE’, a glamorous, oversized butterfly cat eye sunglass frame in custom colourways.
The universally flattering style feature’s Baker’s signature pink heart at the temple, refined gold accents, and Barton Perreira’s iconic craftmanship and attention to detail. Available through Marcolin.
Contact: (02) 8456 0946 or customerservice.au@marcolin.com
MEGA WAYFARER OPTICAL 0RX0840V: Ever since the launch of the first sun models in October 2022, the Ray-Ban Mega Wayfarer has been making modernity its own, building a brave profile and temple from thick, solid lines. Now, enlarging the offering for Spring 2023, a new optical model joins the family. True to its evergreen coolness, the style is available in classic colourways, plus a transparent bi-colour option with a thick Havana temple.
Contact: 1300 655 612
As a leading global accessory brand, it’s no surprise that Kate Spade New York is also a market leader in the optical market. With a catalogue of styles designed to appeal to a broad female market, the recent SS23 collection is also guaranteed to suit those that are drawn to the modern colour combinations and thoughtful details, synonymous with the brand.
Contact: au.customerservice@safilo.com or 1800 252 016
Equal parts classic and cool, the Serengeti Wayne embodies the DNA and expertise of Serengeti Eyewear. For years the iconic navigator shape has resonated with loyal Serengeti wearers, but this modern adaptation is expected to appeal to newcomers alike.
Wayne’s premium stainless steel frame with acetate temple tips is not only eye catching, but will also stand up to the rigors of an adventurous wearer.
For decades, Serengeti has been making some of the most technically advanced eyewear one can find. Specifically, each pair of Serengeti sunglasses come equipped with three-in-one lens technology, photochromic, spectral control and polarisation technologies allow the wearer to see the world at its finest. Combined with its unique hardened, ultra-lightweight mineral lenses; it’s little wonder Serengeti are known globally for its advanced lenses.
Distributed by Sunglass Collective and available on the Serengeti RX Program in a range of colours, Wayne is the ideal choice for those unwilling to compromise on quality.
Contact: info@sunglassco.com.au
Inspired by the artist Monet, this latest eyewear piece from AVANTI uses the finest Italian materials and explores colour, light and shape. A key figure in the impressionist movement, Claude Monet was known for his use of broken colour and quick brushstrokes to capture the fleeting effects of light and atmosphere.
AVANTI explores Monet’s iconic short, quick brush strokes by using unique acetates as seen in the acetate on namesake model ‘Monet’ c1. The vibrant pink and orange colours reflect the candy colours that are on-trend this season, while subtly making it easy for everyday wear with a fine layer of neutral pink on the front.
A best seller at London’s 100% Optical fair, Modstyle is launching Monet in the Australian market. “Monet from AVANTI combines vibrant colour, interesting use of acetate, Italian materials and a fantastic shape. It was extremely well received in the UK and we know our market will love it too,” says Ms Lisa Wymond, a director and national brands manager of Modstyle.
Email: info@modstyle.com.au
Crisp, clear vision is a basic human right, yet many reach adulthood without ever having an eye exam for their uncorrected refractive error. OneSight EssilorLuxottica Foundation is on a mission to change this, recently holding a five-day clinic in New Zealand that changed hundreds of lives.
Ayoung girl turns to her parents beaming with excitement when the trial frame goes on her face. A 78-year-woman has her eyes checked for the very first time. Adults with -8.0 D prescriptions see life in a whole new way, while others with a $2 pair of readers get their first optometrist-prescribed spectacles.
These are just some anecdotes to emerge from a recent five-day clinic in New Zealand – and are real life examples of how the philanthropic work of OneSight EssilorLuxottica Foundation is leaving a positive impression on disadvantaged communities across the region.
Ms Fiona Crimmins was the program leader for the trip to the upper half of the North Island in March 2023, leading a 16-strong team of EssilorLuxottica ANZ staff, including seven optometrists. All up, 940 pairs of free spectacles were provided to 827 people across the clinics held in Tauranga, Whakatane, Rotorua, Tokoroa and Hamilton.
“This clinic had a major impact because, anecdotally, the majority of folks were reporting to us this was their first-ever eye exam … even those who were wearing glasses when they came through the door,” Crimmins says.
“Many just haven’t been in a position in their lives to dedicate the funds or time to seeking out eyecare, which can fall down the list of priorities when you’re trying to pay the bills and get by. It was a very emotional week. There was a lot of gratitude, a lot of hugs and many people were overwhelmed and tearful before sitting down for their refractive exam.”
The OneSight EssilorLuxottica Foundation is premised on the belief that good vision is a basic human right. Uncorrected poor vision still affects 2.7 billion people globally, but through programs like the recent New Zealand clinic, the foundation has set itself the goal of helping eliminate uncorrected poor vision in a generation.
OneSight’s philanthropic work dates back to 1988 and has operated
under numerous banners, but was rebranded as the OneSight EssilorLuxottica Foundation in May 2022. Today, it operates as a single global organisation with eight regional affiliates.
Under the new structure, Mr Wayne Tennent heads the OneSight program across Australia, New Zealand and Western Pacific. However, his experience with OneSight began in 2014, with his previous role as director of programming for Europe, Asia Pacific and the Middle East where he’s established eyecare support in places such as Cox’s Bazar in Bangladesh, inhabited mostly by Rohingya refugees, and on the Greek Island of Lesbos which has provided the gateway to Europe for many Syrian and Afghan refugees.
One of the most important aspects of his role is forming partnerships with governments, NGOs and other like-minded organisations. The aim is to create sustainable access to vision care for the people most in need, fund local vision care programs and raise awareness of poor vision among policymakers and at a community level.
In Australia and New Zealand, he says the OneSight EssilorLuxottica Foundation works with key partner organisations to improve the vision of more than 15,000 people annually. The organisation harnesses the expertise and energy of EssilorLuxottica employees who receive full pay while giving back to their communities.
It achieves this in three ways:
• I ndigenous eye health support: OneSight’s Indigenous Eye Health Program, launched in 2012, provides eyecare and glasses to those in remote communities and is committed to building sustainable access in remote areas.
• R egional and metropolitan eyecare clinics: Working in partnership with schools, community and government organisations, these clinics held in local areas provide eye health screenings, eye exams and glasses to children and adults in need. Some are single-day clinics in priority areas, while others are run across several days.
“IT’S NOT ONLY ABOUT TESTING EYES AND PRESCRIBING WHAT A PATIENT NEEDS, FOR AN OPTOMETRIST IT’S ALSO ABOUT UNDERSTANDING THE PERSON BEHIND THE EYES, WHAT BRINGS THEM IN AND HOW WE CAN MAKE A DIFFERENCE.”
• V ision Voucher program: OneSight Vision Vouchers are issued to people who would not seek treatment through the traditional pathways. These may be those suffering from displacement, homelessness or suffering from dependency issues. They may be exchanged in OPSM and Laubman & Pank stores in Australia and New Zealand for eye examinations and glasses, if required, free of charge. (87 Vision Vouchers were given at the recent New Zealand trip).
Tennent says without partnerships, the program would struggle to exist. In the case of the recent New Zealand clinic, a partnership with the Salvation Army laid the foundation. The charity was able to identify the communities most in need, spread the word to ensure people turned up for the clinics, and provided the facilities where eye screening and exams could occur.
It was a resounding success, with 150-200 people moving through each eight hour, daily clinic across the five days. It’s a significant undertaking taking a large team on a multi-day clinic, so it’s important the maximise the impact of each trip.
“It doesn’t matter who you are, you’ve got to have those key partners to enable you to get to these places, and most importantly, reach the beneficiaries that need your help,” Tennent explains.
“When I first started projects in Rwanda and Zambia, for example, it was about me going in there on a connection within the Ministry of Health or another NGO and starting those conversations. It’s a lot of work because ultimately, you’ve got to secure their support. You can’t do it alone and it can take a long time.”
Now that he’s overseeing Australia, New Zealand and the Pacific, Tennent is focusing on how the OneSight EssilorLuxottica Foundation can expand further into the island nations, with recent visits to the health ministries of the Cook Islands, Vanuatu and Samoa.
“It’s an exciting time for us as a foundation now within this region to understand the problems facing our Pacific neighbours. So far, one of the biggest issues is supply chain and getting access to quality product – and if EssilorLuxottica can’t help with this, then who can? I’m interested to see what we can uncover as I have these conversations and visit these places over 2023.”
Tennent says a regional week-long clinic is already planned for
Vanuatu in October, which will involve 20 volunteers. It’s among six week-long clinics planned for the region in 2023, with 39 single-day clinics planned.
“We’ll provide a quality eye test and a free pair of glasses to those who need it, but in parallel, I’m also understanding who the key partners are, the World Health Organization, Ministry of Health and the key providers to see what gaps there are in providing permanent care. A lot of these projects have multiple streams and I’m someone that likes to strategically understand what needs to be done before charting a journey from there.”
For Ms Sephora Miao, a qualified optometrist, the opportunity to provide life changing eyecare was a major part of why she put her name forward for the OneSight EssilorLuxottica Foundation clinics. She has attended several single-day clinics across Sydney previously, but the recent New Zealand trip – run by Crimmins – was her first five-day program.
For her, it was a reminder of why she pursued a career in optometry. After graduating in 2018 and working at OPSM World Square and then OPSM Castle Towers, she moved into EssilorLuxottica ANZ’s support office in 2022 as optometry engagement manager for ANZ, before being promoted again this year as senior manager of eyecare operations.
“There are many reasons why I wanted to be involved in the OneSight EssilorLuxottica Foundation. The key reason I became an optometrist was a genuine interest to help people see – and the foundation’s mission of helping the world see and providing accessible eyecare to regional communities resonated with me,” she says.
“It’s not only about testing eyes and prescribing what a patient needs, for an optometrist it’s also about understanding the person behind the eyes, what brings them in and how we can make a difference.”
At the recent New Zealand clinic, Miao’s most memorable moments often involved children.
“A lot of them come in and they’ve never had an eye exam before. I found there was high astigmatism in many of the children we saw and when you put the trial frame on you see their faces light up. They turn to their mum and dad to tell them they can see everything, and they begin
– SEPHORA MIAO, OPTOMETRIST
reading everything around the room,” she says.
“That’s such a nice, rewarding feeling when you see how excited they are and the immediate impact you’ve had by doing something that seems so simple for us as optometrists.”
Tennent says the OneSight EssilorLuxottica Foundation is fortunate to have a quality pool of qualified volunteers to choose from, like Miao,
taking time away from their busy roles within OPSM and Laubman & Pank stores to provide eyecare services to those most in need.
Although it’s deeply rewarding work, it’s a hectic schedule providing eye tests and glasses to upwards of 150 people who pass through the door on any given day, before moving on to the next town or city. In saying that, Miao says many of the volunteers would stay longer, if they could.
To put their hand up for this work, EssilorLuxottica ANZ optometrists can apply through the company’s new ‘Get Involved’ campaign, before each person is screened for their suitability.
“The volunteers are effectively hand selected to attend one of these clinics and the business is incredibly supportive to continue paying them while they take a week away from their usual roles to give back to the community and make a difference – not only in the lives of the employees, but the people that we look after,” Tennent says.
Flights, accommodation and other expenses are covered, and volunteers can attend after-hours activities, such as cultural experiences. OneSight EssilorLuxottica Foundation fully funds its own activities, with the money raised through various streams such as in-store customer donations, employees sacrificing a small portion of their wages, and other initiatives.
Miao adds: “In addition to the life-changing work we do, being part of the OneSight clinics also gives the optometrist an opportunity to connect with their colleagues from different states and stores.
“When a group of optometrists get together, you’ll find there’s always a lot of great ideas – and very naturally, we love to share best practice, tips, and insights. The setup at OneSight clinics also looks quite different to the typical consultation room. It’s a change of pace and environment which can be exciting and energising for our optometrists.”
The 16-strong team who ran a five-day clinic in New Zealand. After-hours cultural experiences are part of the experience.
PanOptix® is the most implanted trifocal IOL worldwide and delivers an exceptional high-quality visual experience from far to near, with 99% patient satisfaction.*1-4
Please refer to relevant product direction for use for complete list of indications, contraindications and warnings.
* Based on global Clareon® PanOptix® and AcrySof® PanOptix® unit sales 2021–2022.
† Pooled binocular defocus curve data from six individual studies. Snellen VA was converted from logMAR VA. A Snellen notation of 20/20^-2 or better indicates a logMAR VA of 0.04 or better, which means ≥3 of the 5 ETDRS chart letters in the line were identified correctly.
§ Defined as Miyata grade 0, <25mv/mm2 over 3 years (n=138), and over 9 years (n=20), respectively.
References: 1. Market Scope 2022 IOL Market Report. 2. Alcon data on file, 2022 [REF-18881]. 3. Clareon® PanOptix® Directions for Use_09/2021. 4. Modi S et al. Visual and Patient-Reported Outcomes of a Diffractive Trifocal Intraocular Lens Compared with Those of a Monofocal Intraocular Lens. Ophthalmol 2021;128(2):197–207. 5. Alcon data on file, 2022 [REF-17351]. 6. Lwowski C et al. Visual and patient-reported factors leading to satisfaction after implantation of diffractive EDOF and trifocal intraocular lenses. J Cataract Refract Surg 2022;48(4):421–428. 7. Lane S et al. Evaluation of intraocular lens mechanical stability. J Cataract Refract Surg 2019;45(4):501–6. 8. Alcon data on file, 2019 [REF-05749]. 9. Clareon® PanOptix® Toric Directions for Use. 10. Alcon data on file, 2017 [REF-00516]. 11. Alcon data on file, 2020 [REF-10587]. 12. Stanojcic N et al. Visual and refractive outcomes and glistenings occurrence after implantation of 2 hydrophobic acrylic aspheric monofocal IOLs. J Cataract Refract Surg 2020;46(7):986–94. 13. Oshika T et al. Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl methacrylate. J Cataract Refract Surg 2020;46(5):682–87. 14. Maxwell A et al. Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl methacrylate: an open-label, 3-year follow-up study. Clin Ophthalmol 2018;12:2031–37. 15. Alcon data on file, 2019 [REF-13093].
• Full range of excellent vision with 20/20 vision at all distances.†4
• True comfort at intermediate distance with a natural focal point of 60cm. 5,6
• >9/10 patients are spectacle independent. 5
• Excellent clarity and stability with the glistening-free Clareon® IOL material.§7-14
• Over 2.2 million implants worldwide. 2
• Consistent and controlled IOL delivery with the Clareon® Monarch IV delivery system.15
WITH THE FIRST REGISTERED LOW-DOSE ATROPINE EYE DROPS *1,2
*EIKANCE 0.01% eye drops (atropine sulfate monohydrate 0.01%) is indicated as a treatment to slow the progression of myopia in children aged from 4 to 14 years. Atropine treatment may be initiated in children when myopia progresses ≥ –1.0 diopter (D) per year.1
PBS information: this product is not listed on the PBS
Before prescribing please review full Product Information available via www.aspenpharma.com.au/products or call 1300 659 646
This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at https://www.tga.gov.au/reporting-problems.
EIKANCE 0.01% EYE DROPS (atropine sulfate monohydrate 0.01%). Indication: To slow the progression of myopia in children aged 4 to 14 years. May be initiated in children when myopia progresses ≥-1.0 D per year. Contraindications: Presence of angle closure glaucoma or where angle closure glaucoma is suspected. In glaucoma susceptible patients, an estimation of the depth of the angle of the anterior chamber should be performed prior to the initiation of therapy. Known hypersensitivity to any ingredient of the product. Precautions: Risk-benefit should be considered when the following medical problems exist: Keratoconus - atropine may produce fixed dilated pupils, Synechiae - atropine may increase the risk of adherence of the iris to lens. Use in Children: atropine sulfate monohydrate should not be used in children who have previously had severe systemic reaction to atropine. Use with great caution in children with Down’s syndrome, spastic paralysis, or brain damage. Limited clinical evidence is available for the long-term safety in children and adolescents. Regular eye health clinical reviews recommended during long-term treatment, including the monitoring of anterior segment development, intraocular pressure, retinal health and myopia progression. Consider careful monitoring of anterior segment development with prolonged use in very young children. EIKANCE 0.01% eye drops should not be used in children less than 4 years of age. If children experience photophobia or glare, they may be offered polychromatic glasses or sunglasses. If children experience poor visual acuity, consider progressive glasses. Discontinuation may lead to a rebound in myopia. EIKANCE 0.01% eye drops are not indicated for use in the elderly. Possible effect on the ability to drive or use machinery due to poor visual acuity should be evaluated, particularly at the commencement of treatment. Pregnancy: Category A. Lactation: distributed into breast milk in very small amounts. Interactions: systemic absorption of ophthalmic atropine may potentiate anticholinergic effects of concomitant anticholinergics. If significant systemic absorption of ophthalmic atropine occurs, interactions may occur with antimyasthenics, potassium citrate, potassium supplements, CNS depressants, such as antiemetic agents, phenothiazines, or barbiturates. Concurrent use may interfere with anti-glaucoma agents, echothiophate, carbachol, physostigmine, pilocarpine. Adverse Effects: photophobia, blurred vision, poor visual acuity, allergy, local irritation, headache, fatigue. See full PI for other ophthalmic and systemic AEs. Dosage and administration: Treatment should be supervised by a paediatric ophthalmologist. Instil one drop into the eye as required for treatment. Minimise the risk of systemic absorption, by applying gentle pressure to the tear duct for one minute after application. Should be administered as one drop to each eye at night. The maximum benefit of treatment may not be achieved with less than a 2 year continued administration period. The duration of administration should be based on regular clinical assessment. Each container is for single use, discard after administration of dose. (Based on PI dated 25 November 2021) References:
At the completion of this article, the reader should be able to improve their management of patients with traumatic brain injury (TBI) ...
Including:
• Recognise the ocular conditions related to TBIs
• Review assessment measures available to classify the level of TBI
• B e aware of the symptoms in patients suffering mild, moderate and severe TBI.
Sight begins with the eyes, but the vision process takes place in the brain. In this overview of traumatic brain injury, Dr SULTAN ALOTAIBI and A/Prof MARIA MARKOULLI show that even a mild injury to the brain can have a significant impact on the processes involved in vision.
In the last months of 2022, a large portion of the planet was transfixed by the FIFA World Cup in Qatar. The skill shown by the players was nothing short of impressive, but one skill that impresses particularly is the ability to use one’s head to change the trajectory of the ball. As eyecare practitioners, it is natural to question whether the impact to the head, with force, on a regular basis, could have long-term consequences to vision and eye health, let alone general health. This is a question that is particularly pertinent for athletes playing higher-impact sports such as Australian and American football, rugby, boxing, cycling and even horseback riding.1
When a sudden external force hurts the head, it can induce structural damage to the brain and cranial nerves, causing a change in brain function, and leading to immediate and long-term complications. 2 This is traumatic brain injury (TBI).
The complications associated with TBI include physical, behavioural, perceptual and cognitive problems, memory loss, gut dysmotility, and visual disorders. 3,4,5 Management of TBI symptoms and complications requires collaboration between a team of medical specialists, including neurologists, physiotherapists, psychiatrists, endocrinologists and optometrists. For optometrists, awareness of TBI and its associated complications is necessary as they may play a vital role in not only managing visual symptoms, but also in improving the patient’s quality-of-life.
Several TBI definitions have been proposed. 6 The most commonly used was proposed by the Centers for Disease Control and Prevention in the US, which define TBI as a “bump, blow or jolt to the head, or penetrating head injury, that results in disruption of the normal function of the brain”.7 TBI can occur as the result of falls, sports-related injuries, car accidents, assaults and blasts in war zones.7 The problem
is widespread and increasing, with an estimated 70 million cases occurring annually around the globe, affecting different age groups. 8,9 TBI produces a financial burden to the health system, patients, families and society, estimated to be around $AU530 billion annually.10
Damage to brain tissue occurs in two stages, categorised as ‘primary’ and ‘secondary’ TBI. Primary TBI can be due to focal or diffuse injury,11 and takes place during the initial assault.12 Secondary TBI follows the primary TBI, when the patient’s status deteriorates over time as a result of cellular degeneration, axonal-cell body
Sultan Alotaibi
PhD, MSCO, BSc.
School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
Optometry Department at the College of Applied Medical Science, King Saud University, Saudi Arabia
Maria Markoulli
PhD MOptom GradCertOcTher FBCLA FAAO
Associate Professor, Director of Learning & Teaching, and Academic
Lead, UNSW Dry Eye Clinic, School of Optometry and Vision Science
Deputy Editor, Clinical and Experimental Optometry
Board Member, The Optical Foundation
TFOS Ambassador
39
separation and biochemical cascade,13 leading to cerebral hypoxia, increased intracranial pressure and brain oedema.13,14 Focal injury refers to condensed damage due to either contusion or laceration in a single location, which also can be in multiple areas in the brain.12 Diffuse injury refers to scattered, or widespread, damage of axons, accompanied by diffuse vascular injury and brain swelling.12,13 Diffuse brain injury occurs as a result of the movement of the head during the insult, so specific parts of the brain move faster than others which causes tearing, stretching and induced compressive forces within the brain tissues.12
Diagnosis of TBI is one of its challenges, especially in those with no visible head injury.15,16
It is primarily diagnosed in the emergency department by a combination of measures, including assessment of neurological function, body movement, consciousness and memory. Its severity can be determined using the Glasgow Coma Scale (Table 1), 9 which assesses three aspects: eye-opening, best motor response and best verbal response.
Neuroimaging currently plays a major role, particularly in identifying those who require urgent intervention, despite the fact that it has
the limitation of giving false results.17 TBI also can be classified based on the time of injury.18 Cases who had TBI within one month or less are classified as acute, while more than three months are considered chronic.18
Patients with TBI may suffer from various symptoms, including visual disorders. Awareness of these symptoms is essential. Those who have had mild TBI are usually misdiagnosed as there is often no apparent head injury.15 They may lose consciousness for a few seconds or minutes during the incident and may suffer from photophobia, headache, dizziness, confusion, fatigue, sleep disorders, tinnitus, depression and mood changes,19 cognitive impairment, and trouble with concentration, memory and thinking. 6
Patients with moderate and severe TBI may have the same symptoms with a higher degree of severity. 6 In addition, they may also experience repeated vomiting, nausea, muscle spasm, pupil
dilation, slurred speech, sleep paralysis, loss of sensation, sensitivity to light and sound and fluid leakage from the nose or the ear. 6 These symptoms may resolve within 12 weeks after the injury, or persist for months or years.18
Patients with TBI are also vulnerable to further complications, including strokes and neurodegenerative disease. Those with severe TBI have a higher mortality rate of 30 to 35% during the period of six months post-injury. 20 Individuals who are exposed to multiple mild TBIs, such as sports players, may develop chronic traumatic encephalopathy. 21 This term is used to describe brain degradation; there is no cure for chronic traumatic encephalopathy, it can only be diagnosed at autopsy by analysing brain sections. A separation of the brain and dura mater may also develop, leading to a breaking of bridging veins and causing an acute subdural hematoma.1
As a third of the brain is involved in vision and visual perception, 22 75% of patients with TBI have been reported to suffer from a wide range of visual and ocular complications, including visual acuity loss, visual field loss, photophobia, accommodative dysfunction, convergence insufficiency, nystagmus, abnormalities in eye movement, asthenopia and headache, diplopia, strabismus and cranial nerve palsies, 23,24,25,26,27 in addition to ocular complications such as optic neuropathy or orbital trauma. 28,29
Visual acuity loss is common after a head injury, and reports suggest that patients return to normal or close to normal vision after a few weeks.15,30 A study on those with differing severities of TBI found that the majority of patients maintained visual acuities of 6/18 or better. 30 In the same report, those with moderate-to-severe TBI were more likely to experience visual acuity loss, 30 while in a separate large cohort study of individuals with TBI, a lack of association between severe visual acuity loss and severe TBI was reported. 31 No light perception or total blindness is not common and is only found in those with more significant head injuries, such as blast injuries.15,30
Visual field loss is a common issue in TBI, as patients usually have multiple intracranial lesions along the visual pathways resulting in various visual field defects. 27 Patients with moderate-tosevere TBI demonstrate a higher rate of visual field loss compared to those with mild TBI. 27 Types of reported visual field loss include homonymous or nonhomonymous hemianopia,
“AS A THIRD OF THE BRAIN IS INVOLVED IN VISION AND VISUAL PERCEPTION,22 75% OF PATIENTS WITH TBI HAVE BEEN REPORTED TO SUFFER FROM A WIDE RANGE OF VISUAL AND OCULAR COMPLICATIONS.”
quadrantanopia, tunnel vision and central and paracentral scotoma. 27 Management of visual field loss includes using optical aids such as prisms, visual restoration training and compensatory training. 32
Photophobia is a common sensory symptom accompanying TBI. 33,34 Its prevalence is highest within the first week of the injury and declines to a steady level after three months. 35 The pathophysiological reason is not understood, but recent work has linked photophobia to inflammation of the trigeminothalamic pathways. 36
To mitigate photophobia-related discomfort, test the patient’s response to light with different coloured glasses, then prescribe that colour for indoor tasks and dark glasses for outdoor activities. 37 Also, dimming the light of electronic devices while using computers and electronic devices might help to minimise the symptoms. 37
The oculomotor system comprises the eye muscles, their innervation by the 3 rd , 4th and 6 th cranial nerves and the pre-oculomotor centres in the brainstem with their tectal, neocortical and cerebellar afferent paths. 38 The system stabilises eye position and controls its movement in order to preserve the image on the fovea at the highest resolution. 39
Disruption to neuronal integrity due to TBI leads to oculomotor dysfunction13 as reported in 90% of TBI cases. 40 This manifests as abnormalities in eye movement (saccades, pursuit, vergence, and vestibulo-ocular reflex). Oculomotor dysfunction can be assessed using The Craig Hospital Eye Evaluation Rating Scale (CHEERS). 41 This is a grading scale that examines smooth pursuit, saccades, vestibular ocular reflex, vergence, fixation and nystagmus. A high score indicates significant impairment. 42 Other tests such as vestibular/ocular motor screening can be applied as well, in addition to near-point convergence and visual motion sensitivity. 43
SACCADES AND PURSUIT
Saccades and pursuit eye movements are part of cognitive and motor processes and are commonly impaired following head injury.18,44 Symptoms include losing lines while reading and being unable to change fixation from one object to another or track moving objects. 45 Saccades can be assessed by instructing the patient to fixate alternately on two objects. 46 Pursuit accuracy is usually evaluated by moving an object manually in nine directions. 47 Saccade and pursuit measurements have been included in a proposed model of optometric vision care for those with TBI, 48 and evaluation of their subtypes has been reported to may reflect different brain and cognitive functions.18,45
The antisaccade task, which is a saccadic eye movement away from a target, has been shown to correlate with the loss of the white matter in the splenium of the corpus callosum in acute mild TBI. 49
Another study examined six oculomotor tasks in asymptomatic participants, including eye fixation, reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades, and circular and sinusoidal smooth pursuit, in conjunction with brain neuroimaging, and found a significant difference in three measures (antisaccade, self-paced saccade, and memory-guided saccade) between normal individuals and concussed participants, corresponding with neuroimaging findings. 50 Saccades and pursuit eye movement can be improved in those with TBI by applying occupational therapy using eye exercise protocols, such as The Six Eye Exercise protocol and Standard of Care protocol. 42 These protocols use a remedial approach to improve the fixation, tracking, gaze stabilisation, spatial localisation, saccades, and vergence. 42
Nystagmus and symptoms of vestibular dysfunction, 51 such as vertigo, feeling dizzy and unbalanced, were also reported in 50%
PBS Information: Xalatan (latanoprost 0.005% eye drops, 2.5 mL) is listed on the PBS as antiglaucoma preparations and miotics.
Before prescribing please review Product Information available via www.aspenpharma.com.au/products or call 1300 659 646.
Minimum Product Information: XALATAN® (Latanoprost 50 μg/mL) Eye Drops. Indication: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Contraindications: Hypersensitivity to ingredients. Precautions: Change in eye colour due to increased iris pigmentation, heterochromia; eyelid skin darkening; eyelash and vellus hair changes; aphakia; pseudophakia; macular oedema; other types of glaucoma; contact lenses; severe or brittle asthma; herpetic keratitis; driving or using machines; elderly; children; lactation. Pregnancy: Category (B3) Interactions: other prostaglandins, thiomersal. See PI for details. Adverse Effects: Iris hyperpigmentation; eye irritation (burning, grittiness, itching, stinging and foreign body sensation); eyelash and vellus hair changes (increased length, thickness, pigmentation and number of eyelashes); mild to moderate ocular hyperaemia; punctate keratitis; punctate epithelial erosions; blepharitis; eye pain; excessive tearing; conjunctivitis; blurred vision; eyelid oedema, localised skin reaction on eyelids; myalgia, arthralgia; dizziness; headache; skin rash; eczema; bronchitis; upper respiratory tract infection; abnormal liver function. Uncommon: Iritis, uveitis; keratitis; macular oedema; photophobia; chest pain; asthma; dyspnoea. Rare: periorbital and lid changes resulting in deepening of the eyelid sulcus; corneal calcification. See PI for details and other AEs. Dosage and Administration: One eye drop in the affected eye(s) once daily. Other eye drops should be administered at least 5 minutes apart. (Based on PI dated 2 March 2021)
References: 1. NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma 2010 2. Australian Commission on Safety and Quality in Healthcare Active Ingredient Prescribing Guide - list of medicines for brand consideration December 2020
Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma. com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2021 Aspen group of companies or its licensor.
All rights reserved. Prepared: June 2021 AF05768 ASP2528
If clinically necessary for the treatment of your patient, prescribe by brand and disallow brand substitution2
✔
A first choice for glaucoma management1
of acute TBI cases. 51,52 The function of the vestibulo-ocular system is to coordinate the head and eye movement. Assessment of that can be done using dynamic visual acuity. In this test, the best-corrected vision, with and without head movement, is compared. Losing more than two lines indicates vestibulo-ocular dysfunction. 43
Symptoms of vestibular dysfunction may resolve within 21 days in teenage years, 43 and those with persistent symptoms may require further management. Vestibular rehabilitation therapy, provided by a vestibular physiotherapist, is recommended to enhance gaze and postural stability, 53 mediate vertigo symptoms and to hasten patient recovery. 52,53
A ‘return to activity’ rehabilitation plan also can be developed in conjunction with other healthcare providers, involving continuous assessment of the condition, using a graded symptom checklist scale, a review of past medical history to identify risk factors associated with a prolonged recovery, cognitive testing, cranial nerve assessment, cervical range of motion, balance, gait, and vestibular testing. 43
Convergence insufficiency and accommodation dysfunction are also common manifestations of oculomotor dysfunction and have also been reported in mild TBI injury in 43.2% and 37.2%, respectively. 27 Patients may experience difficulties in maintaining normal binocular vision and suffer from eye strain, fatigue and diplopia, accommodative spasm, unable to change their fixation from far to near, and blurred vision after changing their focus point, which affects their performance when doing regular daily life tasks, such as reading and driving. 54
Management involves using optical devices, including prisms, binocular occlusion, and computer gaming glasses. In addition, training and vision therapy with and without optical devices may also enhance the functionality and may improve the quality-of-life of the TBI patients. 40
Patients with TBI may be frequently encountered in optometric clinical practice. Their presentation may include visual and ocular symptoms. Optometrists play an important role as part of the team of medical specialists co-managing these patients.
A key take-home message for optometrists is to enquire about patients’ hobbies and careers at every consultation. If the patient is at risk of TBI due to these activities, extra attention can be paid for any signs or symptoms. And if a patient presents with a pattern of symptoms suggestive of TBI, the optometrist can provide the needed eyecare, deliver vital information to the patient and refer them to TBI rehabilitation and other medical specialists. This will improve their care and treatment and provide higher-quality outcomes.
1. M izobuchi Y, Nagahiro S. A Review of Sport-Related Head Injuries. Korean Journal of Neurotrauma. 2016; 12 (1): 1.
2. B ramlett HM, Dietrich WD. Long-Term Consequences of Traumatic Brain Injury: Current Status of Potential Mechanisms of Injury and Neurological Outcomes. J Neurotrauma. 2015; 32 (23): 1834-48.
3. M arszał J, Bartochowska A, Gawęcki W, Wierzbicka M. Efficacy of surgical treatment in patients with post-traumatic facial nerve palsy. Otolaryngol Pol. 2021; 75 (4): 1-6.
4. At kins EJ, Newman NJ, Biousse V. Post-traumatic visual loss. Rev Neurol Dis. 2008; 5 (2): 73-81.
5. H anscom M, Loane DJ, Shea-Donohue T. Brain-gut axis dysfunction in the pathogenesis of traumatic brain injury. Journal of Clinical Investigation. 2021; 131 (12).
6. I njury. CotRotDoVAEfTB. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans.: national academics press; 2019.
7. D ouglas DB, Ro T, Toffoli T, Krawchuk B, Muldermans J, Gullo J, et al. Neuroimaging of Traumatic Brain Injury. Med Sci (Basel). 2018; 7 (1).
8. D ewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery. 2019; 130 (4): 1080-97.
9. Teasdale G, Jennett B. ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale. The Lancet. 1974; 304 (7872): 81-4.
10. H owe EI, Andelic N, Fure SCR, Røe C, Søberg HL, Hellstrøm T, et al. Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomised controlled trial. BMC Health Services Research. 2022; 22 (1).
11. H uffman JC, Brennan MM, Smith FA, Stern TA. 19 - Patients with Neurologic Conditions I. Seizure Disorders (Including Nonepileptic Seizures), Cerebrovascular Disease, and Traumatic Brain Injury. In: Stern TA, Fricchione GL, Cassem NH, Jellinek MS, Rosenbaum JF, editors. Massachusetts General Hospital Handbook of General Hospital Psychiatry (Sixth Edition). Saint Louis: W.B. Saunders; 2010. p. 237-53.
12. A ndriessen TMJC, Jacobs B, Vos PE. Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. Journal of Cellular and Molecular Medicine. 2010; 14 (10): 2381-92.
13. A rmstrong RA. Visual problems associated with traumatic brain injury. Clinical and Experimental Optometry. 2018; 101 (6): 716-26.
14. G abrielian L, Willshire LW, Helps SC, van den Heuvel C, Mathias J, Vink R. Intracranial pressure changes following traumatic brain injury in rats: lack of significant change in the absence of mass lesions or hypoxia. J Neurotrauma. 2011; 28 (10): 2103-11.
15. H ussain SF, Raza Z, Cash ATG, Zampieri T, Mazzoli RA, Kardon RH, et al. Traumatic brain injury and sight loss in military and veteran populations– a review. Military Medical Research. 2021; 8 (1).
16. P ozzato I, Meares S, Kifley A, Craig A, Gillett M, Vu KV, et al. Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study. BMJ Open. 2020; 10 (2):e034494.
17. H ier DB, Obafemi-Ajayi T, Thimgan MS, Olbricht GR, Azizi S, Allen B, et al. Blood biomarkers for mild traumatic brain injury: a selective review of unresolved issues. Biomarker Research. 2021; 9 (1):70.
18. M ani R, Asper L, Khuu SK. Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis. Brain Injury. 2018; 32 (11): 1315-36.
19. H ellewell SC, Beaton CS, Welton T, Grieve SM. Characterising the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Frontiers in Neurology. 2020; 11.
20. B aguley IJ, Nott MT, Howle AA, Simpson GK, Browne S, King AC, et al. Late mortality after severe traumatic brain injury in New South Wales: a multicentre study. Medical Journal of Australia. 2012; 196 (1): 40-5.
21. Kelly JP, Priemer DS, Perl DP, Filley CM. Sports Concussion and Chronic Traumatic Encephalopathy: Finding a Path Forward. Annals of Neurology. 2022.
22. S heth BR, Young R. Two Visual Pathways in Primates Based on Sampling of Space: Exploitation and Exploration of Visual Information. Front Integr Neurosci. 2016; 10: 37.
23. S telmack JA, Frith T, Van Koevering D, Rinne S, Stelmack TR. Visual function in patients followed at a Veterans Affairs polytrauma network site: an electronic medical record review. Optometry. 2009; 80 (8): 419-24.
24. C iuffreda KJ, Kapoor N, Rutner D, Suchoff IB, Han ME, Craig S. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007; 78 (4):155-61.
25. S abates NR, Gonce MA, Farris BK. Neuro-ophthalmological findings in closed head trauma. J Clin Neuroophthalmol. 1991;11(4):273-7.
26. L ew HL, Tanaka C, Pogoda TK, Hall JW. 50 - Auditory, Vestibular, and Visual Impairments. In: Cifu DX, editor. Braddom’s Physical Medicine and Rehabilitation (Sixth Edition). Philadelphia: Elsevier; 2021. p. 1101-20.e3.
27. M erezhinskaya N, Mallia RK, Park D, Bryden DW, Mathur K, Barker FM, II. Visual Deficits and Dysfunctions Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis. Optometry and Vision Science. 2019; 96 (8).
28. Q iu J, Boucher M, Conley G, Li Y, Zhang J, Morriss N, et al. Traumatic Brain Injury-Related Optic Nerve Damage. Journal of Neuropathology & Experimental Neurology. 2022; 81 (5): 344-55.
29. H e C, Wieder M, Hamade M, Parsikia A, Mbekeani J. Ocular and Head Injuries Associated with Orbital Fractures. Investigative Ophthalmology & Visual Science. 2019; 60 (9):2 528-.
30. B rahm KD, Wilgenburg HM, Kirby J, Ingalla S, Chang CY, Goodrich GL. Visual impairment and dysfunction in combat-injured servicemembers with traumatic brain injury. Optom Vis Sci. 2009; 86 (7): 817-25.
31. F lanagan G, Velez T, Gu W, Singman E. The Relationship Between Severe Visual Acuity Loss, Traumatic Brain Injuries, and Ocular Injuries in American Service Members From 2001 to 2015. Military Medicine. 2020; 185 (9-10): e1576-e83.
32. L ane A. Clinical treatment options for patients with homonymous visual field defects. Clinical Ophthalmology. 2008: 93.
33. H offman AN, Lam J, Hovda DA, Giza CC, Fanselow MS. Sensory sensitivity as a link between concussive traumatic brain injury and PTSD. Scientific Reports. 2019; 9 (1).
34. T heis J. Differential diagnosis and theories of pathophysiology of post-traumatic photophobia: A review. NeuroRehabilitation. 2022; 50 (3): 309-19.
35. M erezhinskaya N, Mallia RK, Park D, Millian-Morell L, Barker FM, II. Photophobia Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis. Optometry and Vision Science. 2021; 98 (8).
36. D iel RJ, Mehra D, Kardon R, Buse DC, Moulton E, Galor A. Photophobia: shared pathophysiology underlying dry eye disease, migraine and traumatic brain injury leading to central neuroplasticity of the trigeminothalamic pathway. Br J Ophthalmol. 2021; 105 (6): 751-60.
37. C lark J, Hasselfeld K, Bigsby K, Divine J. Colored Glasses to Mitigate Photophobia Symptoms Posttraumatic Brain Injury. Journal of Athletic Training. 2017; 52 (8): 725-9.
38. Voogd J. Anatomy of the oculomotor system. In: Sanders EACM, De Keizer RJW, Zee DS, editors. Eye Movement Disorders. Dordrecht: Springer Netherlands; 1987. p. 3-17.
39. O ptican LM. Oculomotor System: Models. In: Squire LR, editor. Encyclopedia of Neuroscience. Oxford: Academic Press; 2009. p. 25-34.
40. S impson-Jones ME, Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disability and Rehabilitation. 2019; 41 (18): 2206-22.
41. P olitzer T, Berryman A, Rasavage K, Snell L, Weintraub A, Gerber DJ. The Craig Hospital Eye Evaluation Rating Scale (CHEERS). Pm r. 2017; 9 (5): 477-82.
42. B erryman A, Rasavage K, Politzer T, Gerber D. Oculomotor Treatment in Traumatic Brain Injury Rehabilitation: A Randomized Controlled Pilot Trial. The American Journal of Occupational Therapy. 2020; 74 (1): 7401185050p1-74.
43. Wallace B, Lifshitz J. Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. Eye and Brain. 2016; 8: 153-64.
44. M urray NG, Szekely B, Islas A, Munkasy B, Gore R, Berryhill M, et al. Smooth Pursuit and Saccades after Sport-Related Concussion. Journal of Neurotrauma. 2020; 37 (2):340-6.
45. K apoor N, Ciuffreda KJ. Vision disturbances following traumatic brain injury. Current Treatment Options in Neurology. 2002; 4 (4): 271-80.
46. L ing MLH, Tynan D, Ruan CW, Lau FS, Spencer SKR, Agar A, et al. Assessment of Saccadic Velocity at the Bedside. Neuro-Ophthalmology. 2020; 44(2): 71-5.
47. H irota M, Kato K, Fukushima M, Ikeda Y, Hayashi T, Mizota A. Analysis of smooth pursuit eye movements in a clinical context by tracking the target and eyes. Scientific Reports. 2022; 12 (1).
48. C iuffreda K, Diana O, Ludlam D. Conceptual Model of Optometric Vision Care in Mild Traumatic Brain Injury. The Journal of Behavioral Optometry. 2011; 22.
49. T ing WK-C, Schweizer TA, Topolovec-Vranic J, Cusimano MD. Antisaccadic Eye Movements Are Correlated with Corpus Callosum White Matter Mean Diffusivity, Stroop Performance, and Symptom Burden in Mild Traumatic Brain Injury and Concussion. Frontiers in Neurology. 2016;6.
50. J ohnson B, Hallett M, Slobounov S. Follow-up evaluation of oculomotor performance with fMRI in the subacute phase of concussion. Neurology. 2015; 85 (13): 1163-6.
51. M arcus HJ, Paine H, Sargeant M, Wolstenholme S, Collins K, Marroney N, et al. Vestibular dysfunction in acute traumatic brain injury. Journal of Neurology. 2019; 266 (10): 2430-3.
52. G urley JM, Hujsak BD, Kelly JL. Vestibular rehabilitation following mild traumatic brain injury. NeuroRehabilitation. 2013; 32 (3): 519-28.
53. H an BI, Song HS, Kim JS. Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises. Journal of Clinical Neurology. 2011; 7 (4):184.
54. S chultheis MT, Whipple EK. Driving After Traumatic Brain Injury: Evaluation and Rehabilitation Interventions. Current Physical Medicine and Rehabilitation Reports. 2014; 2 (3): 176-83.
NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.
At the completion of this article, the reader should be able to improve their management of dry eye disease in children ...
Including:
• Understand the adverse ocular effects of digital device use in children
• Consider the impact on the ocular surface of myopia control interventions
• Understand the value and the shortcomings of dry eye questionnaires for children
• Review clinical management strategies for dry eye in children
Just like adults, dry eye can be uncomfortable and painful for children. Still, there is a genuine lack of data on the subject, which presents several diagnostic and management challenges for the optometrist. The authors explore the systemic, environmental and medical interventions that can exacerbate the condition, and provide clinical management strategies for dry eye in children.
A NEGLECTED FIELD OF STUDY
Dry eye is a chronic condition affecting one in five people globally. Although it has been highly investigated in adults, there is significantly less dry eye research in children. Risk factors which pre-dispose adults to dry eye including digital device use, contact lens wear, Asian ethnicity and female sex have not been well investigated in children. In addition, with increasing prevalence of myopia, clinicians are likely to concurrently manage both progressive myopia and dry eye, as many myopia control interventions may cause or exacerbate dry eye symptoms.
Greater understanding of ocular surface characteristics in children and the potential threat to ocular surface health posed by the challenges of modern lifestyle and myopia control interventions
will enhance eyecare practitioners’ ability to manage their patients more holistically.
Dry eye in adults is diagnosed by the presence of ocular surface symptoms and clinical signs such as low tear break up time (TBUT), corneal staining, meibomian gland dysfunction, fast tear evaporation and increased tear osmolarity. However, limited research in ocular surface in children makes it difficult to draw valid comparisons to the adult ocular surface.1
Surveys investigating the prevalence of dry eye symptoms in children have found less symptoms compared to adults.2 However, these studies used adult questionnaires not validated for use in children. Notably, a recent study found a high number of children (87%) had thin lipid layers using the 75 nm cut off criteria used in adults.3 In addition, variations in meibomian gland function and appearance (gland expressibility and appearance of tortuous glands) were found in children as young as six years.3,4
Similar to adults, there is no association between tear film function and ocular symptoms in children.5 However, children have less experience reporting abnormal ocular symptoms and may not understand the concept of ocular surface discomfort.2 The criteria to diagnose dry eye from normal ocular health may therefore be significantly different in children compared to adults. Greater understanding of dry eye in children is required.
Digital-device use in children is increasing due to their integration into educational models and increased recreational use. However, digital-device use is associated with ocular complications. Studies in adults and adolescents have shown that sustained use of digital devices (smartphones, tablets, computer screens) can trigger disorders of the ocular surface. This includes increased dry eye symptoms, reduced tear film stability and distorted patterns of blinking.6,7
Ngozi C. Chidi-Egboka
OD MPH PhD, FNCO FAAO
School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
Rebecca Dang B Optom/B Sci (Hons) M Optom
School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Australia
Dr Pauline Kang B Optom (Hons) GradCertOcTher PhD FAAO
School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
Smartphone use in children was reported to increase dry eye symptoms and cause immediate and sustained slowing of blinking evident up to one hour during smartphone use.8 Given the increasing use of smartphones and other digital devices by children in the real world, the effects on the ocular surface may persist or worsen over a longer term, causing cumulative damage to the ocular surface.
Optimal blinking is essential to maintain the integrity of the pre-corneal tear film and ocular surface homeostasis.9,10 Incomplete blinking has been implicated as an important marker of ocular surface symptoms during digital device use.6,7 For these reasons, incorporating blink assessment into routine clinical practice is essential.
Research into blink measurements is set to improve due to increased availability and accessibility of technologies such as high-speed digital cameras,11 wearable eye tracking headsets12 and mobile phones13 which provide improved methods for characterising human blinking. Blinking has been measured in children using a wearable eye tracking headset technology that allows free head and eye movement.4 A faster blink rate was associated with greater tear volume, but not symptoms in children.4
Increasing prevalence of myopia globally and in Australia has encouraged increased clinical use of myopia control interventions.14,15 These interventions include peripheral defocus spectacle lenses, soft multifocal contact lenses, orthokeratology and atropine eye drops, many of which can have impacts on the ocular surface of children.
Soft multifocal contact lenses are a popular option for the treatment of progressive myopia and are available in both daily disposable and monthly options. Soft contact lens wear is a key risk factor for dry eye in adults, implicated as a factor for worsened ocular symptoms, distorted blinking, ocular surface inflammation and tear film dysfunction.
A long-term contact lens trial investigating daily disposable contact lens options found minimal impact of lens wear on ocular physiology after six years and very few side effects that would be considered dry eye disease.16 However, ocular surface related symptoms and signs has been found to be more prevalent and severe in children wearing contact lenses compared to non-wearers17 and so dry eye is still an important consideration in this patient cohort.
• Orthokeratology
Orthokeratology lenses involve closed-eye lens wear and so it could be expected that the impact on the ocular surface could be minimal. There have been conflicting reports on the impact of orthokeratology treatment on dry eye symptoms and clinical signs.18,19
Some of the effects include worsened ocular symptoms, increased tear secretion due to ocular irritation, tear film instability and corneal fluorescein staining. The increase in corneal staining was attributed to several factors including cornea hypoxia; mechanical abrasion during insertion or removal of lenses; or thinning of the corneal epithelium due to improper lens fitting. While it is not unusual to
itchy eyelids, which is ameliorated upon switching to non-preserved medications.23
Allergy has also been implicated as a possible risk factor for dry eye disease in both adults and children. Ocular allergy can impact key mechanisms behind dry eye including tear film instability, ocular surface inflammation and damage, and neurosensory abnormalities.24
Studies investigating children with allergic conjunctivitis finds a high incidence of dry eye compared to controls, with reduced TBUT of 6.5 seconds in the dry eye group compared to 10 seconds in the control.5 There have also been suggestions that the mechanical stress caused by continuous rubbing can lead to alterations in structure and function of the meibomian glands, although there needs to be further investigations in this area.24 It is important that clinicians conduct dry eye assessment in children with history of allergies.
Diabetes is a key risk factor for dry eye in adults and there is some evidence to also support this relationship in children.25,26 The prevalence of dry eye in adults with diabetes was found to be 52.8% compared to 9.3% of controls.27 Similarly, the rate of dry eye in children with Type 1 diabetes is significantly higher than that of controls, at 15.4% compared to 1.9%.
There is also evidence that higher HBA1C values correlate with higher the rate of dry eye syndrome.27 Research in adults finds diabetes is
“GIVEN THE INCREASING USE OF SMARTPHONES AND OTHER DIGITAL DEVICES BY CHILDREN IN THE REAL WORLD, THE EFFECTS ON THE OCULAR SURFACE MAY PERSIST OR WORSEN OVER A LONGER TERM, CAUSING CUMULATIVE DAMAGE TO THE OCULAR SURFACE.”
observe mild corneal and conjunctival staining in orthokeratology patients, these adverse effects are generally mild and rare, especially with proper instruction and care.20,21
• Atropine
The use of atropine eye drops for myopia control is increasing however, the potential effect on the ocular surface is not well studied. As atropine is a muscarinic receptor antagonist, topical instillation of atropine might also affect lacrimal gland secretion and alter the tear film on the ocular surface.
While the effect of preserved eye drops has not been studied in children, use of topical drops with preservatives, particularly benzalkonium chloride, have been found to have adverse effects on ocular surfaces in adults.22 Long-term use of topical medications such as required in glaucoma treatment or other inflammatory ocular conditions finds preserved eye drops increase discomfort upon instillation, including burning, stinging, foreign body sensations, tearing and
associated with decreased TBUT and Schirmer test values, and increased fluorescein/rose Bengal staining.25 Therefore, it is important that clinicians conduct a thorough history and assess diabetic children for dry eye signs.
A fundamental first step in the diagnosis of dry eye disease is to quantify patient symptoms with the use of a questionnaire.27 The Ocular Surface Disease Index (OSDI) and Dry Eye Questionnaire 5 (DEQ-5) questionnaires are included in the TFOS DEWS II report as the recommended questionnaires for dry eye diagnosis, but these questionnaires are only validated for use in adult population.
A recent study investigated the use of six existing dry questionnaires including OSDI and DEQ-5 in children.2 The study established that practitioners can reliably use existing dry eye questionnaires
to examine the impact of challenges such as extensive use of digital devices and myopia control in school-aged children, however, it was reported that more time and assistance may be required when using these questionnaires in children. The DEQ-5 questionnaire and Instant Ocular Symptom Survey (IOSS) are recommended for use in younger age children due to their relative simplicity and ease of use.2
As some clinicians may not regularly use dry eye questionnaires,2,28 a thorough history should be conducted including asking questions on systemic health, digital device use and ocular symptoms of dryness, burning, stinging and watery eyes, to identify – or rule out – dry eye.
Tear film and other ocular surface homeostasis markers
Tear film instability, increased tear osmolarity and ocular surface staining are key markers for dry eye disease. Standard clinical assessment of the ocular surface as recommended by TFOS DEWS II diagnostic methodology report28 include non-invasive assessment of TBUT and tear osmolarity, and fluorescein and lissamine green staining of the cornea, conjunctiva and the eye lid margin.
Automated topography systems such as the Keratograph (OCULUS, Wetzlar, Germany) and interferometry technique such as LipiView (TearScience, Morrisville, NC) detects and maps locations of interference in the image capture of the tear film over time. Mapping the spatial distribution of the tear film break-up may provide a more detailed assessment of tear film instability in children.
The eyelid, lid margins, meibomian gland and lipid layer thickness can also be quantitatively evaluated using recent advances in technology that have led to the development of several multi-functionality systems with infrared cameras which allow the video capturing of images for retrospective evaluation. Such quantitative evaluation is useful for tracking of treatment effectiveness.
Selection and modification of myopia control treatment
Spectacle options are the first optical consideration for children with predispositions to dry eye as it does not cause changes to the ocular surface. However, if spectacle options are not suitable or are contraindicated, soft multifocal contact lenses and atropine are alternative options for myopia control. In prescribing atropine, practitioners should opt to use of non-preserved over preserved options and arrange regular follow-up care to ensure ocular surface health is not adversely impacted. While more expensive, switching from preserved to non-preserved formulations should produce less discomfort upon instillation and reduce the likelihood of dry eye.
If contact lens options are preferred for myopia control, appropriate choice of lens modality can be very effective in ameliorating dry eye signs and symptoms. Daily disposable contact lenses are associated with less dry eye symptoms compared to reusable soft contact lens options.29
Therefore, practitioners can consider switching from monthly lens options to daily disposables. In addition, the adjunct use of non-preserved artificial tears can be helpful in managing dry eye symptoms.
Orthokeratology may be another viable alternative to soft contact lenses particularly if children are experiencing symptoms of dry eye with soft contact lenses at the end of the day, although this area of research is still emerging.30,31
Clinicians should endeavour to educate patients on healthy options to reduce the burden of dry eye. Help them develop an awareness of early symptoms and signs of the effect of digital device use and the resultant impact on ocular surface homeostasis.
Educate parents on the screen time recommendations by the World Health Organization and other national health bodies including Australian Department of Health: no screen time for children under two years, not more than one hour daily screen time for children aged two to five years and two hours daily screen time for children under 17 years old.
Encourage parents to manage hours of digital device use and recommend frequent breaks as endorsed by the American Academy of Paediatrics.32 The recommended 20-20-20 rule screen breaks (20 seconds break to look at an object 20 feet away every 20 minutes) for children as practiced by adults can be recommended to avoid developing ocular symptoms.
Consider the ocular surface when selecting optimal myopia control treatments, and use ocular lubricants to moderate contact lens wear effects.
Finally, recommend routine dry eye work ups for high-risk children such as regular digital device users, contact lens wearers, and children known to have abnormal blinking, allergy or diabetes.
REFERENCES:
1. C hidi-Egboka NC, Briggs NE, Jalbert I, Golebiowski B. The ocular surface in children: A review of current knowledge and meta-analysis of tear film stability and tear secretion in children. Ocul surf. 2019;17(1):28-39.
2. C hidi-Egboka NC, Golebiowski B, Lee S-Y, Vi M, Jalbert I. Dry eye symptoms in children: can we reliably measure them? Ophthalmic Physiol Opt. 2021;41(1):105-15.
3. K im JS, Wang MTM, Craig JP. Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population. Ocul surf. 2019;17(1):70-7.
4. C hidi-Egboka NC, Jalbert I, Wagner P, Golebiowski B. Blinking and normal ocular surface in school-aged children and the effects of age and screen time. Br J Ophthalmol. 2022.
5. C hen L, Pi L, Fang J, Chen X, Ke N, Liu Q. High incidence of dry eye in young children with allergic conjunctivitis in Southwest China. Acta Ophthalmol (Copenh). 2016;94(8):e727-e30.
6. J aiswal S, Asper L, Long J, Lee A, Harrison K, Golebiowski B. Ocular and visual discomfort associated with smartphones, tablets and computers: what we do and do not know. Clin Exp Optom. 2019;102(5):463-77.
7. G olebiowski B, Long J, Harrison K, Lee A, Chidi-Egboka N, Asper L. Smartphone Use and Effects on Tear Film, Blinking and Binocular Vision. Curr Eye Res. 2020;45(4):428-34.
8. C hidi-Egboka NC, Jalbert I, Golebiowski B. Smartphone gaming induces dry eye symptoms and reduces blinking in school-aged children. Eye. 2022.
9. C ollins M, Seeto R, Campbell L, Ross M. Blinking and corneal sensitivity. 1989;67(5):525-31.
10. M cMonnies CW. Incomplete blinking: Exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Cont Lens Anterior Eye. 2007;30(1):37-51.
11. N avascues‐Cornago M, Morgan PB, Maldonado‐Codina C, Read MLJO, Optics P. Characterisation of blink dynamics using a high‐speed infrared imaging system. 2020;40(4):519-28.
12. C hidi-Egboka NC, Jalbert I, Chen J, Briggs NE, Golebiowski B. Blink Rate Measured In Situ Decreases While Reading From Printed Text or Digital Devices, Regardless of Task Duration, Difficulty, or Viewing Distance. Invest Ophthalmol Vis Sci. 2023;64(2):14-.
13. G odfrey KJ, Wilsen C, Satterfield K, Korn BS, Kikkawa DOJOP, Surgery R. Analysis of spontaneous eyelid blink dynamics using a 240 frames per second smartphone camera. 2019;35(5):503-5.
14. French AN, Morgan IG, Burlutsky G, Mitchell P, Rose KA. Prevalence and 5- to 6-year incidence and progression of myopia and hyperopia in Australian schoolchildren. Ophthalmology. 2013;120(7):1482-91.
15. H olden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42.
16. Woods J, Jones D, Jones L, Jones S, Hunt C, Chamberlain P, et al. Ocular health of children wearing daily disposable contact lenses over a 6-year period. Contact Lens and Anterior Eye. 2021;44(4):101391.
17. U chino M, Dogru M, Uchino Y, Fukagawa K, Shimmura S, Takebayashi T, et al. Japan Ministry of Health Study on Prevalence of Dry Eye Disease Among Japanese High School Students. Am J Ophthalmol. 2008;146(6):925-9.e2.
18. Yang L, Zhang L, Jian Hu R, Yu PP, Jin X. The influence of overnight orthokeratology on ocular surface and dry eye-related cytokines IL-17A, IL-6, and PGE2 in children. Cont Lens Anterior Eye. 2021;44(1):81-8.
19. D uong K, McGwin G, Jr., Franklin QX, Cox J, Pucker AD. Treating Uncomfortable Contact Lens Wear With Orthokeratology. Eye Contact Lens. 2021;47(2).
20. N a K-S, Yoo Y-S, Hwang HS, Mok JW, Kim HS, Joo C-K. The influence of overnight orthokeratology on ocular surface and meibomian glands in children and adolescents. Eye & contact lens. 2016;42(1):68-73.
21. C ho P, Cheung SW. Retardation of Myopia in Orthokeratology (ROMIO) study: A 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077-85.
22. Fraunfelder FT, Sciubba JJ, Mathers WD. The Role of Medications in Causing Dry Eye. Journal of Ophthalmology. 2012;2012:1-8.
23. B audouin C. Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma. Acta Ophthalmologica. 2008;86(7):716-26.
24. V illani E, Rabbiolo G, Nucci P. Ocular allergy as a risk factor for dry eye in adults and children. Current Opinion in Allergy and Clinical Immunology. 2018;18(5):398-403.
25. Z hang X, Zhao L, Deng S, Sun X, Wang N. Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. Journal of Ophthalmology. 2016;2016:1-7.
26. A kinci A, Cetinkaya E, Aycan Z. Dry eye syndrome in diabetic children. Eur J Ophthalmol. 2007;17(6):873-8.
27. S eifart U, Strempel I. The dry eye and diabetes mellitus. Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 1994;91(2):235-9.
28. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15(3):539-74.
29. C halmers RL, Keay L, Hickson-Curran SB, Gleason WJ. Cutoff score and responsiveness of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) in a Large daily disposable contact lens registry. Contact Lens and Anterior Eye. 2016;39(5):342-52.
30. G arcía-Porta N, Rico-Del-Viejo L, Martin-Gil A, Carracedo G, Pintor J, González-Méijome JM. Differences in Dry Eye Questionnaire Symptoms in Two Different Modalities of Contact Lens Wear: Silicone-Hydrogel in Daily Wear Basis and Overnight Orthokeratology. BioMed Research International. 2016;2016:1-9.
31. D uong K, McGwin Jr G, Franklin QX, Cox J, Pucker AD. Treating uncomfortable contact lens wear with orthokeratology. Eye & Contact Lens. 2021;47(2):74-80.
32. A merican Academy of Pediatrics. Council on Communication and Media-Media use in school-aged children and adolescents. Pediatrics. 2016;138(5):e20162592.
NOTE:
KYLEE HALL provides a glimpse into the major task of bringing Cylite’s homegrown OCT to market, and opens up on the unique challenges she faces as CEO.
When building incredibly complex technology from the ground up, at-scale, each day can present new challenges – some known and others unexpected. Adapting to this and making tough calls for the sake of progress is often how a company successfully transitions from a start-up to fully-fledged business.
This knife’s edge – teetering on excitement and uncertainty – is one that Cylite CEO Ms Kylee Hall finds herself balancing on daily as the company moves closer to the anticipated market launch of its Hyperparallel OCT (HP-OCT), quietly clearing major hurdles over the past 12 months that few would realise are necessary when bringing a new type of OCT to market from Australia.
Since Hall last spoke with Insight in July 2022, Cylite’s significant milestones include moving into a new facility that has tripled its production capability and received the all-important ISO:13485 certification to ensure the quality of its production systems and processes. The company has also received validation of its Focus software for CE and subsequent ARTG listing, and has streamlined some of the time-consuming, manual manufacturing processes.
Some challenges remain, but when highlighting these, Hall is hoping the industry can appreciate the incredible work occurring in Cylite’s suburban Melbourne facility. Although it’s been slated for some time, the official launch isn’t far away, scheduled for the combined O=MEGA23 and World Congress
“This is an extremely intricate piece of optical technology the team are building. There is a huge focus at the moment to dive deeply into the system and look for opportunities to streamline the complex engineering. We are transitioning and making improvements each day,” she says.
“For me as CEO, it’s about challenging the thinking to ensure people have the longer term in mind. We’re going from the mindset of a company focused on R&D to something that needs to be mass produced the same every time, every day, with the same quality and reproducibility – that’s the ultimate aim.”
The reason there’s so much excitement around Cylite’s HP-OCT doesn’t simply come down to the fact there’s an Australian company designing and manufacturing an OCT machine on home soil.
Most people assume it’s a retinal OCT first and foremost, but the opposite is more accurate – it’s primarily an anterior segment OCT with the main goal of using the precision of OCT for corneal tomography and measuring axial length. Cylite has also developed a retinal lens and is currently funnelling a lot of energy into its retinal capabilities.
What makes the technology unique is its ability to obtain true volumetric, or 3D, images of anterior segment and posterior structures in a series of snapshot captures. Users can then take a B-scan slice of the eye in any direction, X, Y or Z (enface) axis while obtaining precise measurements of the various ocular surfaces. Industry-leading rates of more than 300,000 A-scans per second allow it to capture a full biometry scan in seconds without the need for eye tracking software for motion artefact-free scans.
“We have several other exciting projects in the R&D pipeline, but they are a little way off being ready to discuss at any length,” Hall adds.
OCT is one of the more complex instruments in modern day eyecare – and it’s fair to say the average user may never fully appreciate what’s involved in bringing one to market, especially without the backing of a large multinational.
“To give you an example, one challenge that all equipment manufacturers face, is part obsolescence. If a part reaches end-of-life, we are usually given 12-18 months warning, so that we have time to make alternative plans. Ideally, you’d just replace it, but many components can’t be purchased off-the-shelf, and this can have a flow-on effect for the engineering of the system,” Hall says.
“But on the other hand, when you look at our progress from the past year, the improvements and iterations have been incredible. For example, there was a process (optical alignment) that used to take a team member up to two days to complete, it now takes only five to 10 minutes thanks to the work of our mechatronics team who have introduced robotics into the process.”
On the ISO:13485 certification of Cylite’s new facility, Hall says it was a significant undertaking. The team needed to build three HP-OCTs from scratch over several days under the watchful eye of an external audit team. Safety and quality are non-negotiables when it comes to developing medical devices.
“You’ve got to show your work instructions, and how you have followed them, as well as the calibrated equipment used, then they audit the build and the build quality of the product itself. They audit your entire quality systems, so it’s quite a milestone achievement for the whole team, especially our production, NPI (new product introduction), regulatory and quality departments, who led the multi-day audit.”
The company has also seen improvements in the supply chain, but ongoing freight costs, as a result of COVID, have made budgeting difficult.
“Supply chain impacts with regards to both delivery timelines and freight costs continue to greatly impact the ability to accurately plan and budget,” Hall says. “We’ve only recently had some electronic components come
down from 80+ week lead times to around 40 weeks, which has helped, and our operations team are doing a great job ensuring we have a plentiful supply of the components we need.”
In terms of Cylite’s Focus software in the HP-OCT, Hall says senior product manager Mr Matthew Wensor has led a huge effort to ensure it is suitable for the end user.
The software is driving the user interface, and is what many eyecare professionals will arguably judge the company for. There’s been a significant emphasis on continuing to evolve the software, while ensuring it is ready for action, particularly for optometrists wanting to conduct scleral lens fitting, other advanced contact lenses and myopia management.
“Our Focus software had to go through a stringent verification and validation process to receive CE MDR approval . This involved a significant evaluation showing 15 individual professionals how to use the system, before they then attempt to drive it and then give you feedback,” Hall says.
“That was a huge process and ultimately we received the validation we needed to say that what we’d created was intuitive and easy-to-use for the operator.”
Hall has a wealth of experience in the ophthalmic industry, serving in senior roles within ZEISS and Device Technologies. While this has served her well, transitioning to a company like Cylite – which is going from an R&D-heavy business to one focused on large scale manufacturing, sales and marketing – is a unique challenge.
Making tough strategic calls, vital recruitment decisions and dealing with unexpected challenges are all part of life as a CEO.
However, she has found comfort in a quote from Mr Jim Fader, the co-founder of animal-free milk company and Australian start-up Eden Brew: “Dream big, run hard, consult broadly, stay positive. It’s a roller coaster, so
if you are in a down, an up is around the corner, and vice versa. Celebrate your successes but keep some energy for tomorrow. Prioritise yourself –founders feed last and give everything to the business. If you aren’t at your best, the business feels it.”
Hall acknowledges the role of CEO of Cylite differs from those at more established OCT companies. The unknown of tomorrow and the excitement around the unique technology they’re producing only serve as fuel.
“Sometimes you’re making decisions and haven’t necessarily got all the information you would like, but a decision is required to move things forward. I’m constantly assessing what we need to deliver on a quarter-to-quarter basis and even down to a more granular week-by-week basis, and I'm having to make some tough decisions. Sometimes that’s saying ‘no we’re not going down that path’ because it will blow out the timeline, especially now that we are at the pointy end of bringing our HP-OCT to market,” she says.
“What I’ve found tough is that we’ve been saying we’re coming to market for some time now, but there’s some exciting development projects in the pipeline as to why that hasn’t occurred yet, and it’ll all make sense soon enough.”
In other company updates, Cylite’s staff count has almost tipped 90, but this will increase dramatically over the next few years as it ramps up production and exporting capabilities. Several new roles become available each quarter, and these are mainly focused within the software and production teams but soon the company will build out its local sales and marketing team.
Internationally, distributors have travelled from Europe to visit Cylite for some hands-on time with the HP-OCT. Hall says the attention has been flattering.
“But a big priority is ensuring the most robust leadership team possible that will help the company transition seamlessly through this next growth phase. Of course, we have a long-term five-plus-year strategy, but five years is a long way off, so I also have a 12- to 18-month strategy and plan that outlines quarterly goals and deliverables,” she says.
The HP-OCT is also the focus of several large studies, some of which are to validate the technology and improvements made, and others are to help Cylite gain entry into more international markets.
The system was on display at ARVO 2023 in New Orleans, a popular event among ophthalmic academics.
“The quality of our imaging and amount of data we are capturing in one biometry scan is what always garners the most interest from eyecare professionals,” Hall says. “We were recently in London at 100% Optical with both optometrists and ophthalmologists visiting us. The feedback was overwhelmingly positive.”
“I’M CONSTANTLY ASSESSING WHAT WE NEED TO DELIVER ON A QUARTER-TO-QUARTER BASIS AND EVEN DOWN TO A MORE GRANULAR WEEK-BY-WEEK BASIS, AND I'M HAVING TO MAKE SOME TOUGH DECISIONS.”
KYLEE HALL CYLITEInside Cylite’s clean room where the vital assembly stage is performed under strictlycontrolled conditions.
Many current myopia control interventions work well – but when young progressing myopes venture outside on the advice of their eyecare professional, their eyes are often unprotected from the sun. This was the impetus for HOYA to broaden its MiYOSMART range to incorporate two new sun lens options.
For Australian eyecare professionals wanting to control myopia with proven interventions, it’s been an exciting time as many new products come to market, particularly in the spectacle lens category. Myopes now have access to a suite of solutions that will correct their refraction and slow progression, but what options are there when heading outdoors into harmful UV rays and intense sunlight?
In the flurry of headlines about myopia innovations, it’s important not to lose sight of one of the most important positive factors – outdoor daylight. In fact, in a 2022 position paper, RANZCO recommends children spend at least two to three sun-protected hours outdoors daily.1 The college also called for a more nuanced approach towards sunlight exposure that optimises UV exposure, but not to the level that results in vitamin D deficiency, and, importantly, maintains exposure to sufficient high-intensity sunlight to minimise myopia progression.
But a problem remains: of the myopia interventions available, few can offer continuous myopia management indoors and outdoors. This means children may not be receiving effective myopia management with single-vision sunglasses, could be avoiding heading outdoors due to the sunlight intensity and/or photophobia, or may be out in the sun without adequate protection. Ophthalmic lens manufacturer HOYA Vision Care has acknowledged this gap in myopia care – and in July 2023 will launch the MiYOSMART sun range, comprising:
• MiYOSMART Chameleon – photochromic spectacle lenses, offering an all-in-one solution to myopia management and protected outdoor activity. It rapidly adapts to the level of sunlight and fades back to clear indoors in seconds.
• MiYOSMART Sunbird – polarised spectacle lenses that work as an addition to MiYOSMART clear spectacle lenses, for extra protection from intense sunlight and glare. It also offers vibrant colours and rich contrast in bright light.
While protecting from sunlight, the lenses incorporate HOYA’s DIMS technology found in the company’s original non-invasive MiYOSMART clear spectacle lenses, launched in Australia in October 2020. The technology has been shown to slow myopia progression by 60% in children aged 8 to 132 after two years, with more recent six-year data showing the treatment effect has been sustained over time.3
Mr Ulli Hentschel, national training and development manager for HOYA Lens Australia, says increased time outdoors is one of the major factors for tackling myopia onset and potentially progression – and he expects the new MiYOSMART sun range to have high uptake in sun-drenched Australia.
“If we have children already wearing MiYOSMART clear lenses and we’re trying to encourage them to spend more time outdoors, then we’re potentially exposing them to increased sunlight exposure and additional UV. By creating MiYOSMART Chameleon and MiYOSMART Sunbird, we’re offering something that addresses two major issues – allowing children to spend more time safely outdoors, along with the treatment effect of a proven optical intervention,” he says.
“HOYA has also done a lot of work in the past year around combining atropine with MiYOSMART for those progressing beyond the treatment target, and the new sun range could be beneficial to patients who may have issues with photophobia due to atropine dilating the pupil.”
To support the introduction of the MiYOSMART sun range, HOYA held an advisory meeting where four independent experts, suggested by the International Myopia Institute (IMI), provided a consensus on daylight and myopia management.
They found the role of outdoor time in children with myopia is still unclear but it was scientifically accepted that spending more than 80 minutes a day outdoors in daylight has a preventive effect on the onset of myopia and possibly reducing progression.4 The experts mentioned that each 45
October 2020 – HOYA launches MiYOSMART in Australia and New Zealand
Oc tober 2021 – HOYA, Haag-Streit and Device Technologies create alliance to help eyecare professionals gain easier access to Lenstar Myopia biometer
November 2021 – Ho ya Vision Care Australia & New Zealand reveals new Oliver Wolfe Junior frame collection – suitable for MiYOSMART
M ay 2022 – Six-year data shows MiYOSMART’s myopia control effect is sustained over time. Also confirms patients who stop wearing MiYOSMART show no rebound effects when compared to the initial progression rates during the two-year randomised control trial or with the general population.
J uly 2023 – HOYA launches MiYOSMART Chameleon & MiYOSMART Sunbird sunglass ranges.
minutes additionally spent outdoors can prevent 20% of the onset of myopia. “The longer the optical treatment options are worn, the greater the expected effectiveness of the treatment will be,” they added.
Emphasising the importance of sun protection from UV rays, the experts said this was important to avoid the risk of early cataracts, damage to the conjunctiva and potentially the retina.5
When it comes to understanding the role of light transmission on myopia management lenses, the consensus group stated UV rays should be cut below 380nm – a standard in sun protection.6 However, from animal studies in a white paper from the IMI, it is unclear which visible wavelengths play a role in regulating eye growth.7 It may be the full visible light spectrum, light intensity and child behaviour influence on the axial eye length rather than a particular wavelength itself.8
The experts mentioned that even with sunglasses, children will still be exposed to more intense light outdoors than indoors and still have the positive effect of daylight for myopia management.9 Hence, HOYA says myopic children should be encouraged to partake in any activities outdoors, from vigorous play to quiet reading.
On the question of whether combining sun protection with an optical treatment like MiYOSMART would have a greater overall effect, the independent experts said the evidence wasn’t available yet.
“It requires further investigations to find out if the treatment effect is influenced by the combination of myopia management spectacles alongside sun protection filters compared to the current studies on clear spectacle lenses,” they reported.
“A potentially beneficial effect of using myopia management spectacles lenses in combination with protection from intense sunlight may occur if this leads children to spend more time outdoors or increases the overall wearing time of the optical myopia management treatment. Photochromic lenses would make it easier for the child to have one pair of spectacles for both indoors and outdoors.”
They conclude: “The possible slowing of myopia progression by increasing the wearing time of defocus optics could be positively influenced by prolonged exposure to daylight when symptoms from intense sunlight would be less disturbing due to inbuilt sun protection.”
THE OPPORTUNITY FOR OPTICAL PRACTICES
Hentschel says it made sense for HOYA to develop two MiYOSMART sun lens designs to cater for the differing needs of progressing myopic children.
MiYOSMART Chameleon, considered an all-in-one solution, could be suitable for children who find it inconvenient to change their glasses when they step outside. The lens rapidly adapts to the levels of sunlight, providing children with as much protection as they require at any time.
When developing MiYOSMART Chameleon, Hentschel says the company had to take a different approach to that used on its Sensity light-adaptive photochromic range.
“We had to come up with a different way of manufacturing MiYOSMART Chameleon, adopting a technology where the photochromic layer is not applied on the front surface so that the DIMS treatment zone is not affected,” he says. "These lenses adopt a Patented Molded Laminate Photochromic Film Technology to preserve optical performance of DIMS Technology."
With MiYOSMART Sunbird polarised spectacle lenses, Hentschel says these are an ideal addition to MiYOSMART clear spectacle lenses, for continuous myopia management indoors and out. Patients who adopt this approach will likely require two pairs.
“For a patient that’s particularly glare sensitive, and this goes back to those on combination treatment involving doses of atropine, having a polarised sunglass in MiYOSMART Sunbird that cuts out more of the light compared to the photochromic lens may be more beneficial. And if there’s a need for darker sunglasses, then that’s potentially the better option,” he explains.
“But I see the potential of MiYOSMART Chameleon photochromic becoming a more standard option because they’re really clear indoors and then the child doesn’t have to have a separate pair for outdoor use. I see it more as a go-to product that addresses the majority of needs most of the time.”
Acknowledging that additional pairs lead to increased costs for parents, Hentschel says HOYA is running a special promotion that will help bridge the gap.
In addition, for MiYOSMART Chameleon, all children who received these lenses will get a 30-day “satisfaction or free exchange” warranty, meaning they have the option to switch back to MiYOSMART clear spectacle lenses free-of-charge within 30 days of receiving MiYOSMART Chameleon.
Alongside the launch of the MiYOSMART sun range, HOYA will launch a campaign called: ‘Protect how they see the world’, to raise awareness of the importance of outdoor time and sun protection in children.
MiYOSMART Chameleon is an all-in-one photochromic lens, while MiYOSMART Sunbird are polarised and work in addition to MiYOSMART clear lenses.
1. R ANZCO Position Statement: Progressive Myopia in Childhood – 2022
2. L am CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.
3. L am CSY, Tang WC, Zhang A, Tse D, To CH. Myopia control in children wearing DIMS spectacle lens: 6 years results. ARVO 2022 Annual Meeting, May 1-4, Denver, US.
4. J onas JB, Ang M, Cho P, et al. IMI prevention of myopia and its progression. Invest Ophthalmol Vis Sci. 2021;62(5):6. https://doi. org/10.1167/iovs.62.5.6Morgan IG, Wu P-C, Ostrin LA, et al. IMI Risk factors for myopia. Invest Ophthalmol Vis Sci. 2021;62(5):3. https://doi.org/10.1167/ iovs.62.5.3
5. B ackes C, et al., Sun exposure to the eyes: predicted UV protection effectiveness of various sunglasses. J Expo Sci Environ Epidemiol. 2019 Oct;29(6):753-764. doi: 10.1038/ s41370-018-0087-0. Epub 2018 Oct 31. PMID: 30382242; PMCID: PMC6803516.
6. I SO 8980-3:2013(en)Ophthalmic optics
7. Troilo D, et al.; IMI - Report on Experimental Models of Emmetropization and Myopia. Invest. Ophthalmol. Vis. Sci. 2019;60(3):M31-M88. doi:10.1167/iovs.18-25967.
8. Z hang, P., Zhu, H. Light Signaling and Myopia Development: A Review. Ophthalmol Ther 11, 939-957 (2022). https://doi. org/10.1007/s40123-022-00490-2
9. L anca C, Teo A, Vivagandan A, Htoon HM, Najjar RP, Spiegel DP, et al. The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention. Transl Vis Sci Technol. 2019;8(4):7.
Starting her career as an optical dispenser while studying orthoptics, Ms Lucille Gergis transitioned into optometry, opening a greenfield boutique practice in the heart of High Street Armadale’s premier shopping precinct in Melbourne’s leafy east in April this year.
“I’ve been in the industry for about 20 years. I’ve worked in both corporate and independent practices and done a lot of fly-in, fly-out, regional and rural. I always had at the back of my mind to open my own practice that focuses on quality rather than quantity – I’m not interested in volume – and COVID was the catalyst for me to open my practice, Eye St.,” she says.
Despite housing some of the world ‘s most exclusive eyewear designers, it’s quality and attention to detail, that sets Gergis and Eye St. apart.
“Whether it be frames or lenses, we really do focus on quality. We find out where products are made, rather than just selling brands. I’m not selling luxury; I’m providing quality products and service.”
To meet her quality standards, Gergis invested her time in researching frame and lens manufacturers, and consulted industry colleagues.
“I spoke to a couple of other independent practice owners, and we were discussing what do you do for patients who have really high prescriptions or someone who comes in and says, ‘I want the best of the best’. They introduced me to Tokai Optical and once I physically saw their products, that was it. They have the thinnest lenses in the world and even their most basic lenses are superior. It’s just the most incredible quality,” she says.
“We’re not just providing Tokai because it’s a premium lens – the price difference from that to another company isn’t significant. We’re offering the best that we can without impacting the purse strings for our patients and ourselves.”
For Gergis, one of the most valued characteristics of Tokai lenses is its Eternal Skin Coat, which protects the skin around the eyes from UV and near-infrared, the latter reaching deeply into the true skin and causing aging effects such as wrinkles and sagging of the skin.
“It is one among a number of products Tokai has that we’re excited about offering to our patients. Another is the Lutina material, which is capable of blocking 100% of UV light and about 94% of blue light. We offer that as standard on all our Tokai-made lenses,” she says.
“We’ve got a lot of people wanting particular tints on their lenses: not their sunglasses, but optical frames, and Tokai do an incredible job with their tints, which are in fashion currently.”
In addition to consistently high product quality, Gergis can’t fault the service she and her team receive from Tokai’s Australian base.
“If I ever have an issue, I can call my local rep or the lab in Queensland and they don’t stop until it’s resolved. If it’s something they can’t do, they’ll contact Japan and I’ll get an answer. If it means they have to come to me, they will. I’ve had their reps come and help us out with customers before,” she says.
“Their support is very personalised, you do get to know everyone. If I have a question about a particular patient and I’m not sure which lens to prescribe, they’ll make recommendations and ensure we get it right. It’s almost like the patient is their customer.”
Established in 1939, the Japanese lens maker is steeped in more than 80 years of history, and, as the general manager of Tokai Optical Australia explains, the Japanese philosophy ‘Kodawari’ is deeply rooted in Tokai’s culture.
“A relentless pursuit of perfection, attention to detail, and meticulous craftsmanship are the minimum requirements if you want to be great. The term for such devotion is known as Kodawari,” Mr Justin Chiang says.
“The philosophy is reflected in the Tokai management principle, including displaying uniqueness in product development, customer-first policy, participation in management by all employees, and environmental policies.”
As a subsidiary, Tokai Optical Australia has been living up to the philosophy that its Japan headquarters exemplifies.
“Without any manufacturing in Australia, we focus on personalised customer support and individualised fitting. From placing the orders to the package for shipment, we look at the detail to ensure our customer experience with Tokai,” Chiang says.
“For example, for each order we receive, we calculate lens thickness and check the frame curve before proceeding with the order and advise our
Two independent practices – one in Melbourne, the other in Brisbane – have a shared appreciation for Tokai Optical’s attention to detail that doesn’t go unnoticed by their patients.Eye St. owner Lucille Gergis (right) and optical dispenser Angela Dexter. Optical dispenser Euny Mitchell, of Eyecatch Optical in Brisbane, trying a Tokai trial lens on a patient.
customers if there’s a better option within the parameters they request. At Tokai Optical Australia, we take special care with each fitting to ensure the finished quality matches Tokai standards.
“We believe many small changes in detail make our world and lives better; this is how we see quality and details.”
Chiang says Tokai’s customer-first policy means all its activities are carried out with the aim of growing together with its customers.
“We understand the importance of growing with our customers in the industry as a whole. The development of online resources for education is in place and updated continuously. We also share our inspiration with customers through product innovation or daily customer support.”
Chaing adds that Tokai considers the durability of its multicoating to be essential. Regardless of the lens design and material, the coatings must be strong to handle daily life and be long-lasting, he says.
“With such a concept, Tokai Optical developed multicoatings that are not only scratch resistant but also made to weather wear and tear. As a result, we are able to produce some of the most durable multicoatings on the market.”
Tokai also lays claim to developing the thinnest lens material, 1.76 in refractive index, and its patented ‘slice thin’ technology can reduce the thickness of plus prescriptions to provide customers with thinner and lighter lenses.
But the company’s attention to detail in its products doesn’t end there.
“All our lens material has maximum protection against ultraviolet – and even against high energy violet (400-420nm) – to ensure all Tokai lens wearers receive the best protection possible. Free-form technology to enhance visual clarity and minimise peripheral distortion is the basic feature
A pursuit of perfection is also incorporated in the company’s environmental policies, which is striving to achieve a target of making its Tokyo factory a
“A zero-emission facility is a factory where 100% of all industrial waste and general non-industrial waste, such as burnable trash and raw garbage, discharged by the factory is recycled into resources,” Chaing says.
“At Tokai’s factory, cooking oil used in the canteen is recycled and turned into biodiesel, and excess lens material is recycled and turned into charcoal for generating energy. Our target of domestic discharge averaged out per employee is 50g per day, and the results over the past year were 9.7g per day.”
An initial inquiry from a patient about Tokai Optical lenses a few years ago prompted the team at Eyecatch Optical in Brisbane to seek more
It wasn’t until owner optometrist Ms Sonia Shin and optical dispenser Ms Euny Mitchell saw the lenses in-person at O=MEGA in Melbourne that they realised what they were missing, and began placing orders with the lab in
“We prescribe a lot of Tokai’s Lutina material and their multifocal lenses, and customer feedback is amazing. The team are very professional, they
which can suppress 380 to 500 nm blue wavelength – for patients who have had glaucoma, cataract and LASIK surgeries.
For Mitchell, as part of the dispensing team, it’s the education and training that Tokai provides which prove invaluable.
“Justin [Chiang] comes to our practice and teaches us about their products, so our dispensing team get to know their catalogue of products better and then we can make informed recommendations to our customers. I think that works really well,” she says.
Ultimately it’s Tokai’s detail-orientated approach to business and making sure that the optometry practice and dispensers have all the relevant information they need.
“A lot of dispensers working in a practice have a lot of stress that a lens is not covered by warranty if there are any issues. We hardly ever have any issues but when it happens, Tokai have excellent warranties. We feel very comfortable recommending them,” Mitchell says.
“THEY SHARE EXTENSIVE PRODUCT INFORMATION AND HELP WITH TROUBLESHOOTING – THAT’S PART OF THE REASON WHY WE ORDER TOKAI LENSES.”
EUNY MITCHELL EYECATCH OPTICALTokai Optical is known for the tints it can offer for its lenses. The lens maker is synonymous with meticulous craftsmanship, as displayed in these mirrored sunglasses.
The theme of Orthoptics Awareness Week 2023 is: 'Connect. Collaborate. Care'. To bring the campaign to life, Orthoptics Australia has teamed up with Insight to highlight local orthoptists who work with other health professionals to enhance eye healthcare accessibility both clinically and in the research sector.
In 1984 Westmead Brain Injury Unit was first established to specifically provide rehabilitation to patients who had received a traumatic brain injury (TBI) from incidents such as motor vehicle accidents. I was fortunate to be working in the eye clinic at Westmead Hospital at that time and became involved in the unit assessing and treating TBI patients.
Fast forward to 2001, and I commenced a private orthoptic practice in northwest Sydney and started seeing these brain injury patients in a private capacity as well as seeing the usual ocular motility conditions that an orthoptist treats in adults and children.
Working with TBI is extremely rewarding. Their eye problems are usually quite complex and challenging with many co-morbidities, particularly as the incidence of eye problems in TBI is found to be 70%. TBI will commonly involve damage to the cerebral cortex, as well as the brainstem and cerebellum causing visual changes unique to these neurological areas. Conditions include ocular motility disorders causing diplopia from cranial nerve palsies, nystagmus or eye movement paralysis from brainstem/cerebellum damage in association with visual field defects such as homonymous hemianopias and visual perception issues from damage to the cerebral cortex.
Other eye problems can also include keratoconus, which can be accelerated from the oxidative stress of the interventions for the TBI. The development of myopia can also be strongly associated with high-speed motor vehicle accidents. It is not uncommon for TBI patients to also develop optic atrophy.
As such, assessment of this patients is multifactorial and often requires lengthy consultations as well as involvement of ophthalmology and optometry. I am fortunate to have good access to both professions in my practice.
Assessment of a TBI patient’s vision and eye disorders always involves the initial review of reports or conversations with other allied health professions such as occupational therapists, speech therapists, physiotherapists, rehabilitation physicians, psychologists and neuropsy-
chologists prior to the consultation so that you can be fully prepared to assess the patient. This can often involve joint consultations with other allied health professionals present for the consultation to gain insight into the patient’s difficulties and their impact on their rehabilitation.
These TBI patients often have speech difficulties such as aphasia and cognitive deficits with short-term memory issues and lack of insight into the seriousness of their neurological condition.
Treatment of eye conditions will often involve the prescribing of glasses, fusion training, saccadic and scanning eye training. Any home exercises given are often supervised by carers or allied health providers such as the occupational therapists in conjunction with in-clinic treatment.
The legal ability to meet the vision standards for driving often arises when seeing these patients, as the typical patient seen with TBI is a male in their early 20s who are keen to return to driving. Vision standards for driving need to be carefully scrutinised and guarded advice given to all health professionals involved. An on-road assessment maybe required in a joint capacity with a driver trained occupational therapist. With their specialised knowledge of eye disorders occurring in TBI, an orthoptist plays an important role working within the multidisciplinary team.
As healthcare professionals, communicating effectively with patients is essential. However, what would you do if a patient has trouble explaining what is wrong with their vision? Perhaps they’ve had a stroke and now have aphasia (a language impairment), or they’ve struggled with communication since they were young, and now at the eye clinic, they have difficulty answering your questions. When you finally manage to work out the nature of their vision impairment, what if they cannot understand the diagnosis and treatment options? This is a challenging situation, but is the reality for many people who live with communication impairments and the healthcare professionals who care for them.
My research project aims to bridge the gap between individuals with dual impairments and access to eyecare. Trying to tackle this issue requires partnerships with multidisciplinary team members. Our team consists of orthoptists and speech pathologists, and we are working to improve the quality of care provided to this population.
We conducted a review of the literature and found that communication partner training is extremely beneficial for healthcare professionals as it increases their confidence and competence when interacting with people with communication impairments. However, we did not find any studies that included eyecare professionals or patients with dual impairments. Many training programs also use visual cues as a compensatory strategy for verbal communication impairments, which may not be ideal for patients with both impairments. This is why our starting point for this project was working with orthoptists and speech pathologists who currently interact with people with dual impairments.
We first conducted a survey to obtain a snapshot of practice of orthoptists in relation to managing patients with dual impairments in clinic, what supportive communication strategies they’re using in clinical practice and what else they need to provide person-centred care. We found most participants felt they had not received sufficient training regarding supported communication and that there is an “absence of resources targeted specifically to orthoptists”.
This study was followed by focus groups to gain a deeper understanding of their experiences in interacting with people with dual impairments. We recruited orthoptists and speech pathologists to understand how these professions interacted with individuals with dual impairments. Key issues they raised included the importance of interdisciplinary collaboration and the lack of training available. Participants highlighted the effectiveness of having a speech pathologist present at an orthoptic assessment and vice versa. With these collaborative consultations, it is also an opportunity for clinicians to learn from each other and implement these skills in their future practice. Regarding training, participants who work in general practice all reported not having training in supported communication despite also seeing patients with dual impairments in their clinical practice.
The last phase of the project involves working on potential resources to better support eyecare professionals in communicating effectively with this population. The literature shows that the adult population with communication impairments has been the most studied, so we decided to collaborate with a research team that developed an online self-guided training programme (interact-ABI-lity; abi-communication-lab.sydney. edu.au/courses/interact-abi-lity/) that covers communication changes after acquired brain injury (including aphasia, dysarthria and cognitive-communication impairments).
T hrough further studies we hope to determine whether this program helps orthoptic students gain greater knowledge of communication impairments and effective strategies and explore any other modifications needed to provide eyecare professionals with relevant training. Although there is currently a lack of training for the paediatric and lifelong communication disability populations, we hope that by using interact-ABI-lity as a starting point, in future we can adapt it further for these other populations, and that speech pathologists can also benefit from knowing about the impact of vision on their clinical practice. We hope through this project, eyecare professionals will be better prepared to support patients with dual impairments, and their equitable, positive access to person centred care.
NOTE: co-authored by A/Prof Emma Power and Dr Amanda French.
Patient-centred care for patients with an acquired brain injury requires a multidisciplinary approach, but not all hospitals and rehabilitation centres have access to orthoptists or eyecare services. The development of resources for non-eyecare health providers is helping overcome this problem.
An acquired brain injury (ABI), such as stroke can occur at any age, but in most cases, incidence is greater in older patients and therefore more likely to have a pre-existing ocular condition present on hospital admission. For acute ABI, initial investigations are performed by emergency medical personnel, with a range of visual problems often remaining unrecognised as they are not targeted by existing neurological screening tools or protocols. Research reports that up to 73% of stroke survivors have some form of acquired or pre-existing visual impairment 1 , supporting the need for better screening processes to identify visual problems in these patients.
ABI is complex, with both motor and sensory defects possible. Patient-centred care is best supported by a multi-disciplinary team of healthcare practitioners, each with a specific expertise. Orthoptists have specialised skills that aid in recognition and management of neurological and age-related ocular conditions, which is advantageous in team care of patients who have an ABI, including stroke.
Unfortunately, not all hospitals or rehabilitation facilities looking after ABI patients have direct access to orthoptic or other eyecare services. Therefore, as an outcome of my PhD, there now exists a specifically designed and validated Vision Defect in Stroke Screening Tool (VDiSST) and an accompanying eLearning module titled: ‘Understanding the Vision Defect in Stroke Screening Tool’. The agenda for both resources is to enable non-eyecare health practitioners, in the absence of orthoptic and other eyecare services, the ability to identify and refer for further assessment, a range of pre-existing and newly acquired vision impairments in survivors of brain injury. 3
Patient-centred care in ABI requires a multidisciplinary approach, therefore when designing and evaluating these two vision screening resources, it was important to collaborate and discuss level of need and impact with a range of stakeholders which include healthcare practitioners working in this area. Connections were facilitated through a variety of organisations, including the Agency of Clinical Innovations (ACI), the University of Technology Sydney (UTS), NSW Local Health Districts and Liverpool University. Specific health professions consulted, recruited and then contributing to data collection, throughout included nurses, occupational therapists, physiotherapists, speech pathologists, and orthoptists.
The vision screening tool was used in a pilot project run at UTS to promote interdisciplinary collaboration. Using a stroke scenario, students from five disciplines (nursing, speech pathology, physiotherapy, orthoptics and pharmacy) were guided to provide collaborative care to a young stroke survivor. Once graduated and working within their intended profession, it’s hoped this experience would encourage them to continue working collaboratively and not in siloes because they don’t fully understand the role of other disciplines or how they can help each other’s overall care of a stroke survivor. Feedback accumulated from students from all disciplines participating in the pilot found this a rewarding project. Currently, two publications and discipline specific accepted conference presentations promote the success of this project. While each health profession does have its own area of speciality, there are times when our interests overlap and learning from each other is part of lifelong education. As orthoptists if we can actively communicate and make others aware of expected or actual visual limitations and, in turn, collaboratively learn from others’ disciplines for communal patients, this would serve to only improve everyone’s ability to provide efficient patient care ensuring successful outcomes. 4-5
As part of a recent pilot, five disciplines covering nursing, speech pathology, physiotherapy, orthoptics and pharmacy come together to care for a stroke
1. R owe FJ, Hepworth LR, Howard C, Hanna KL, Cheyne CP, Currie JJPo. High incidence and prevalence of visual problems after acute stroke: An epidemiology study with implications for service delivery. 2019;14(3):e0213035.
2. C ourtney-Harris M, Jolly N, Rowe F, Rose K. Validation of a vision-screening tool for use by nurses and other non-eye care health practitioners on stroke survivors. Contemporary nurse a journal for the Australian nursing profession. 2022;58(4):276-284. doi:10.1080/103 76178.2022.2104334
3. C ourtney-Harris MD. The evaluation of a vision screening tool for the detection of vision problems in stroke survivors. University of Technology Sydney; 2022. Thesis.
4. L ucas C, Power T, Kennedy DS, Forrest G, Hemsley B, Freeman-Sanderson A, Courtney-Harris M, Ferguson C, Hayes C. (2020) Conceptualisation and Development of the RIPE-N model (Reflective Interprofessional Education – Network model) to enhance interprofessional collaboration across multiple health professions. Reflective Practice 2020, 21(5); 712-730 9
5. H ayes, Power, T., Forrest, G., Ferguson, C., Kennedy, D., Freeman-Sanderson, A., Courtney-Harris, M., Hemsley, B., & Lucas, C. (2022). Bouncing off Each Other: Experiencing Interprofessional Collaboration Through Simulation. Clinical Simulation in Nursing, 65, 26–34. https://doi.org/10.1016/j.ecns.2021.12.003
Optical Dispensers Australia’s inaugural two-day conference and gala event has been heralded as one of the largest gatherings in Australasian optical dispensing history, bringing a new level of professionalism to the industry.
There’s nothing like an event to galvanise an industry, especially one that has been calling for a level of organisation that reminds optical dispensers – and the broader ophthalmic community – why they are often considered the lifeblood of the industry.
The first biennial Optical Dispensers Australia Conference was a resounding success in many ways. The two-day program featured a strong calibre of speakers – with a nice balance of technical, fashion and sales topics – who spoke to a full and engaged room at the Sydney Masonic Centre. The trade space included a diverse mix of industry suppliers, from frames wholesalers and lens companies to equipment suppliers and optometry networks.
A highlight saw everyone gather for the ODA Gala evening under
the Sydney Harbour Bridge at Luna Park. This is where ODA held its first National Excellence Awards, recognising the achievements of outstanding dispensers. This dual event was combined with a graduation ceremony for Certificate IV in Optical Dispensing graduates from the Australasian College of Optical Dispensing.
Speaking at the ODA Gala, ACOD director and senior trainer Mr James Gibbins, who is also on the ODA Advisory Board, said the combined prize-giving event was unprecedented in his 40 years within the industry. A record 260 newly-minted dispensers graduated from the latest ACOD cohort, with 54 of those attending the gala evening from all states and territories and New Zealand.
“This is the most significant gathering of optical dispensers in the history of our industry in both Australia and New Zealand,” he said. “With more than 240 people, this is the largest gathering we’ve seen, and includes industry leaders, corporate representatives, suppliers, educators as well as experienced optical dispensers and brand-new graduating dispensers.”
ODA CEO April Petrusma speaking at the ODA Gala at Luna Park, Sydney.ODA CEO Ms April Petrusma concurred, saying it represented a major leap forward. Her organisation exists for several reasons, but one of those is to raise the profile of optical dispensing, which has seen highs and lows since the profession was deregulated many years ago.
“It is the very first time that an event of this magnitude has taken place in Australia to celebrate all things dispensing,” she said.
“Optical dispensers are absolutely vital to the success of optometry. They fulfil roles in many forms across manufacturing and fitting labs, specialist clinics and in retail practices. To our colleagues, we are an essential part of a clinical team and to our patients, we are the face of the practice in which we work.
“A qualified optical dispenser truly is a highly skilled, multi-talented professional and part of our objective at ODA is to elevate the perception of our profession both within the optical industry and in the eyes of the general community.”
Back to the conference itself: delegates enjoyed a rich program, starting with Clinical Professor Alexander Holden, from the University of Sydney, discussing how private health practices can ethically become profitable businesses. He highlighted the importance of focusing on the lifetime value of a patient. Longer term strategies – such as recommendations that will save customers money but cost the practice revenue in the short term – demonstrates a willingness to put the patient’s needs first, and builds a more sustainable relationship based on trust.
Mr Michael Nasser, general manager of Opticare, delivered an interesting presentation on the impact of artificial intelligence on the future of optometry marketing. Innovations like personalised marketing – where AI algorithms analyse consumer data to create personalised
patient recall campaigns – are just one example, along with predictive analysis tools that can anticipate consumer behaviour, identify patterns and inform businesses strategies.
Today, he said many firms are also using chatbots that interact with customers in real time to answer questions and provide personalised assistance. AI is also being used for content optimisation to ensure the practice’s website lists prominently on search engines and social media. Nasser also delved into the potential of ChatGPT, one of the most advanced chatbots developed by OpenAI and released in November 2022. He asked the system to generate five social media posts for a practice that wanted to promote a ‘use it or lose it’ health fund campaign, which is common in the optical industry. The bot was given many inputs, and came up with several posts that could work as a useful starting point for practices.
On day two, Ms Jessica Kingsley, from ZEISS, delved into the issue of myopia and why every diopter counts. She also offered a few details on a new myopia control spectacle lens that ZEISS will be launching in July. Mr Justin Chiang, from Tokai Optical Australia, discussed the crucial role of upselling for optical businesses, but doing so in a way that focuses on selling the “value”. Being thoughtful of the customer’s background, observant of their behaviours, knowledgeable of the product, ambitious when setting standards and dealing with complaints, and finding innovative ways to connect with customers are the key to successfully executing an upsell, he said.
The program was rounded out by Mr Craig Johnston, from Younger Optics, who delivered an engaging presentation on the short history of polarisation and the challenges of incorporating this with prescription lenses. He also covered a unique photochromic polarised product
ODA National Excellence Awards recipients:
Rookie of the Year
Charlote Swailes, Specsavers Karinyup, Western Australia
C ommunity Champion Award
Bobby Bugden, Be Seen Eyewear, Lismore and Ballina, NSW
CEO’s Member Dedication Award
Keeley Wicks, Wicks Eyecare, Keilor, Victoria
Role Model & Leadership Award
Sarah Thompson, Will Street Eyecare, Bendigo, Victoria
Outstanding Practice Owner Award
Belinda Musitano, Eyes@Optometry, Western Australia
ODA National Medal for Optical Dispensing Excellence
Lisa Raad, Pinpoint Vision, Sydney NSW
ACOD graduates who attended the ODA Gala for their graduation ceremony. The trade floor was a hive of activity during conference breaks.(Transitions Drivewear lenses), and offered some key tips for dispensers when explaining the value of polarisation and how to check lenses appropriately.
Overall, Petrusma said the turnout of ODA’s inaugural national conference exceeded expectations, so much so that part way through the planning process the organisation had to upgrade the room it would use at the Sydney Masonic Centre.
“In the past, events like this have been rather sparse for optical dispensers and other practice support staff and I think the registration response we have had demonstrates just how much our profession values and desires educational development and networking opportunities of this type,” she said.
For more information, speak to your local Rodenstock Account Manager.
“Our delegates travelled from nearly every state of Australia to be here – with an extra special mention to our guests that are visiting us from New Zealand and Japan.”
The conference marked a new peak for ODA since its inception just 16 months ago, in January 2022.
In that time, ODA has also:
• G rown to almost 2,000 subscribers with varying levels of memberships
• H osted 15 webinars and two ‘make your own eyewear’ workshops
• H eld its first sell out mini conference in Perth
• H osted a volunteer day in Brisbane visiting the Lions Recycle for Sight headquarters with its members
• G ained the support of several big-name industry corporate partners.
Rodenstock MyCon lenses are built to correct myopia, controlling its progression in children while ensuring sharp vision.
The conference floor was full and engaged on both days.
April Petrusma (left) presenting Lisa Raad with the ODA National Medal for Optical Dispensing Excellence.
Name: Peter Lock
Position: Store manager and optical dispenser
Location: Warrnambool & Portland Eyecare, Victoria
Years in industry: 34
profession?
As a 17-year-old who’d just finished Year 12, I planned to follow my mates into a building or plumbing apprenticeship. After celebrating the end of secondary school, the local newspaper was the only source of job opportunities and while skimming the Saturday Warrnambool Standard, sitting there was my entry into the world of optics. OPSM were looking for an apprentice in optical fitting and surfacing. I never knew such a thing existed, but after some research I was excited, and a qualification and schooling at RMIT in Melbourne sounded cool for someone from country Victoria. Somehow I got the job. The week-long training blocks at RMIT, underground in the optics ‘dungeon‘, was fun. We had many great times that are still discussed today.
2. What are your main career highlights? Successfully completing my apprenticeship through the RMIT system was an early highlight. Being in the industry for 34 years, the last 24 in practice management, has been the source of my greatest memories and continues today with the amazing team at Warrnambool & Portland Eyecare. Seeing dispensers get their opportunity before growing into leaders and teachers themselves has been rewarding. The friendships and relationships with people from the various sectors of our optical community has provided many highlights, especially during conferences and trade fairs. I’m sure O=MEGA23 will produce highlights galore.
3. What are your strengths as an optical dispenser and what excites you about your job?
Product knowledge and being confident as an optical dispenser. It gives the patient confidence in you to guide them towards the right frames and lenses for their needs. Seeing people wearing a frame that complements their personality is a great feeling – and they may not have even tried that frame if you didn’t give them the confidence to give it a go. On a different note, I had a young boy come into our practice a few years ago – all he wanted to do was play footy but his everyday glasses were not suitable. I arranged a pair of sporting goggles and now every time I see not-so-little Darren, he has a beaming smile and
Peter Lock’s extensive dispensing career has also seen him move into practice management.
his dream to one day play for his beloved Collingwood Magpies is alive. He makes me smile every time.
4. If you could go back and provide advice to yourself at the beginning of your optical dispensing career, what would you say?
You don’t know what you don’t know. And I still don’t know what I don’t know.
5. What do you see as the key opportunities and challenges facing the future of optical dispensing in Australia?
There are opportunities for optical dispensing to be more regulated as an industry and I believe that will happen as courses are now government-funded, in part, which will hopefully be attractive for employers to put their staff through formal training options. The challenges we face is being able to attract people to our industry. We have a low profile for whatever reason, and I’m hoping ODA can boost this in the future. Gaining a foothold with secondary school career advisors would be a huge benefit. There would be a tiny percentage of school kids that would look at optics as a career.
6. How do you ensure your skills and knowledge stay up to date in such a fast-moving industry?
Keeping up with the latest in our industry is almost a day-to day-prospect. At Warrnambool & Portland Eyecare we facilitate regular visits from our lens companies who keep us up-to-date, usually over a nice dinner, of course. We also make use of the ProVision training opportunities they provide. The resources and CPD events provided by ODA are also a great platform to upskill and stay current. It’s important to show support and make use of all the training and information available.
7. Why did you become a member of Optical Dispensers Australia, and what value do you see in the organisation?
I see the organisation as being a great concept to bring dispensers together and share knowledge and experience. To have regular events and networking opportunities was also very appealing to me.
8. What would you say to others thinking of joining Optical Dispensers Australia?
The more the merrier. If ODA can build its member base, the benefits for all members will grow. Get involved and help make our industry the best it can be. Don’t sit on the sideline looking on, get involved in the game!
PRESCRIBING SPECTACLES FOR EXTREME CASES OF HYPEROPIA, MYOPIA, ASTIGMATISM AND OTHER CASES OF HIGH AMETROPIA CAN BE A CHALLENGE FOR ANY PRACTITIONER. APRIL PETRUSMA PROVIDES TECHNICAL TIPS SO DISPENSERS DON’T GET CAUGHT OUT.
APRIL PETRUSMA
“PROBLEMS WITH FIELD OF VIEW LIMITATIONS CAN ARISE IN HIGH PLUS (+) POWERED LENSES DUE TO THE CONVEX LENS DESIGN CONVERGING LIGHT WHICH AUTOMATICALLY DECREASES THE FIELD OF VIEW.”
There are numerous situations and prescription types that present with potential problems. In part 1, we discussed interpreting the prescription and uncovering ocular conditions to give the dispenser the best chance of providing a positive visual outcome. Now we will look at some of the potential problems associated with high ametropia and the optical dispenser’s role in getting right.
In optics there are different types of chromatic aberrations but the one of greatest concern for high ametropic prescriptions is transverse chromatic aberration (TCA). This commonly occurs in the periphery of high-powered lenses due to the prism induced at the edges, leading to what is commonly known as ‘colour fringing’. The rainbow effect that is seen by the wearer is the result of colour separation caused by the prism splitting white light into its various colour components and can be quite troublesome.
TCA becomes worse the more the patient’s eye strays from the optical centre and is significantly increased by higher lens powers, low Abbe values, big lens diameters and large back vertex distances (BVD). Aside from the
lens power, the dispenser has a large level of control over each contributing factor and can reduce or eliminate the problem through recommending smaller frames, reducing the BVD and selecting appropriate lens materials.
Just as higher index materials refract light better, they also reflect it more. When rays are bouncing back and forth off the lens surfaces, dim blurry images occur resulting in ghosting. Without an anti-reflective coating, moderate to high hyperopes wearing aspheric lenses with a flat back surface would see reflections of everything behind the lens, including their own eyes.
The importance of anti-reflective coatings for high prescriptions and high index materials is inarguable and doesn’t stop at clear lenses. Applying an anti-reflective coating to the back surface of sunglasses to eliminate bounce back is just as crucial as it is for indoor lenses.
When the retinal image size is decreased or increased by a lens in comparison to the original image size produced by the uncorrected eye, spectacle magnification occurs. This is what corrective lenses are supposed to do
and is not a problem if the prescription is similar in both eyes.
It can become an issue, however, in patients with anisometropia when there is a significant difference in the refractive error between the two eyes, resulting in different image sizes (aniseikonia). The differential magnification of the two images would cause problems fusing the image together and may give rise to symptoms of diplopia. There are many factors that affect the severity of the spectacle magnification including: lens power, BVD, lens material, surface curves and lens thickness. Changing one or more of these variables will affect the image size and can help to balance them.
As an example, for a hyperope, the dispenser can minimise the image produced by the higher-powered lens by flattening the base curve (aspheric designs), choosing a thinner material and decreasing the BVD by moving the lens bevel toward the front on the stronger lens.
The patient’s field of view is the area through which vision is possible and can be restricted by facial features, spectacle frames and lenses. Problems with field of view limitations can arise in high plus (+) powered lenses due to the convex lens design converging light which automatically decreases the field of view. This reduction of the field of view can then lead to additional problems like ring scotoma but can be improved by reducing the BVD as much as is comfortable and practical.
The higher the power of the lens, the greater the prism angle at the lens edge and the more the light falling on the prism will bend. In high plus (+) powered lenses (particularly lenticular designs), the light falling at the edge of the lens bends towards the centre (which is the prism base) in such a way that it does not reach the pupil and therefore, can’t be seen. This results in a wedge-shaped blind area all around the periphery of the lens known as ring scotoma. As the person turns their head, objects can then appear to jump in and out of this
blind area, commonly referred to as the ‘jackin-the-box’ phenomenon, which can be quite confronting for the wearer.
The further the lens sits away from the face, the more this becomes a problem as the eye is more likely to stray to the lens edge. Reduction in the BVD is a vital step in eliminating this issue.
The BVD is the distance between the pole of the cornea and the back vertex of the spectacle lens along the optical axis and is a measurement that should never be underestimated. We are already aware how it affects several other problems, but should also acknowledge that increasing and decreasing the BVD will also change the effective power of a lens. If the test BVD is different to that of the spectacle position in a high-powered lens, the prescription should be compensated accordingly.
When a plus (+) lens is moved closer to the eye, it loses perceived power by the wearer, therefore a stronger powered lens would be needed to give the same effect. The opposite occurs for minus (-) lenses, therefore requiring a weaker lens to produce the same outcome. The reverse applies for lenses moved further away. The higher the lens powers, the larger
this effect becomes and the more imperative it is to compensate the script accordingly using the BVD formula: Fe = F / (1-dF) or a BVD compensation table.
THICKNESS, WEIGHT AND APPEARANCE
Lens thickness is obviously troublesome but isn’t just a problem on its own. Thick lenses contribute to all the other list of problems noted above as well as adding to the weight and unsightly appearance of lenses. They add to an increase in chromatic aberrations, spectacle
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magnification issues and field of view limitations just to name a few. Choosing aspheric lens designs, reducing BVD, increasing refractive indexes, selecting small lens diameters and evenly shaped frames are all key solutions to minimising overall potential problems.
Active eye tracking –enhances reliability.
Full and Fast Thresholds VF Testing plus Neuro, Kinetic, Ptosis and Estermann tests
FDT Testing
Stereopsis
Visual Acuity and Contrast Sensitivity
Colour Testing (Ishihara, D15 and Advanced Colour Tests)
Eye Mobility and Strabismus
The choice of frame and position of wear plays an important role in minimising potential problems.ORTHOPTIST KATIE GEERING SHARES FIRST-HAND THE WORK, AND REWARD, IN DEVELOPING A DEDICATED PAEDIATRIC ORTHOPTIC DEPARTMENT WHICH IMPROVED PAEDIATRIC EYECARE AT SYDNEY’S CHILDREN HOSPITAL.
ince 2012, the Humpty Dumpty Foundation, with the support of NSW Health, has been recognising outstanding achievements and contributions in health care by awarding the Michelle Beets Award. Michelle Beets was a devoted and highly respected nurse who tragically lost her life in 2010. This award is given to health professionals who are seen to be providing outstanding paediatric health care within the health system.
I was fortunate enough to be named the 2022 Michelle Beets Metropolitan award winner.
I have been working as the head orthoptist at The Children’s Hospital Westmead since October 2009, and across the Sydney Children’s Hospital Network since March 2019.
The award nomination recognised the work I have been contributing to in the space of clinical trials, the volunteer work I have been involved in in remote Fiji, as well as improving the paediatric service at Sydney Children’s Hospital Randwick.
Like many awards of this nature, it is
an award that is deserving of the whole team of orthoptists I work with across the two sites. I am fortunate enough to work with nine dedicated paediatric orthoptists who constantly strive to provide the best paediatric healthcare possible.
In March 2019, the eye service at Randwick had reached a crisis due to the lack of a dedicated paediatric service. Wait times were extensive and the level of care required was not possible with the current staffing model.
It is important to note that the service provided was of a high quality, however, the difficulty was in the shared nature of the service. The service suffered as a result of a strained healthcare system.
Over the course of a few years, it was decided to create a dedicated paediatric eye service at Randwick. This involved employing paediatric orthoptists and implementing triage protocols to ensure referrals were seen in a timely manner.
There was a large backlog of patients that needed to be screened. With the help of the team at Randwick we were able to ensure all patients on the
waitlist were contacted and offered an appointment if they still required one. This task was huge as we had over 700 patients waiting to be seen. We were methodical and structured in our approach and ensured each patient was provided the care they had been referred for.
The key to the success of this project was teamwork, dedicated paediatric staff and the collaboration of the ophthalmology and orthoptic department.
By implementing structure to the clinics, a triage protocol, and additional staff, we have been able to improve the eye service for the patients within the Sydney Children’s Hospital local area health.
We have also added sub specialities such as contact lens teaching for patients with congenital cataracts. The collaboration of the eye service across the network has strengthened the eye clinic at both Westmead and Randwick. We share resources and continue to ensure we are providing evidence-based care of the highest standard.
To receive an award for the work that I have achieved over the last decade is a privilege and honour. I would like to thank the team of orthoptists and ophthalmologists I work with, as well as Orthoptics Australia, for ensuring my skills are of the highest standard through continuing education. I have wanted to be an orthoptist since I was five-years-old, so to now be a clinical lead in my chosen field is a dream come true. Thank you.
ABOUT THE AUTHOR: Katie Geering is Head Orthoptist at The Children’s Hospital Westmead and also works across the Sydney Children’s Hospital Network.
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
THIS PROJECT WAS TEAMWORK, DEDICATED PAEDIATRIC STAFF AND THE COLLABORATION OF THE OPHTHALMOLOGY AND ORTHOPTIC DEPARTMENT.”The new dedicated paediatric orthoptic clinic at Sydney Children’s Hospital Randwick.
BUILDING EFFECTIVE RELATIONSHIPS WITH PATIENTS DOESN’T ALWAYS INVOLVE SIGNIFICANT EFFORT, BUT CAN HAVE A SIGNIFICANT BEARING ON THEIR TREATMENT OUTCOMES, WRITES AVANT’S DR PATRICK CLANCY.
uilding rapport with patients is essential for a successful doctor-patient relationship. It needs to be open and trusting, starting from the first interaction and developing it as therapeutic perspectives and goals change.
As an ophthalmologist, building rapport helps encourage patient compliance in managing chronic conditions, such as
“We tend to only see our patients a couple of times a year if they’re relatively stable, so we rely on them actually using their drops and understanding why. If you want to suggest alternate treatments, again it comes back to trust,” ophthalmologist Dr Jenny Danks says.
Here are some core elements of patient rapport building, with insights from Dr Danks.
While you want to maintain professional boundaries, friendliness and courtesy with patients help build rapport and trust. Try to find some common ground, too.
“Identify something to do with their work or home situation that you can relate to, that helps build rapport. It helps me remember something about that particular patient more than just their clinical details,” Dr Danks says. “And be a bit open yourself. It helps to open a conversation.”
US surgeon and author, Dr Atwal Gawande, recommends asking your patient an unscripted question, to develop a connection. Something like: "What would you be doing today if you weren’t here?"
EXPRESS EMPATHY
Empathy is about understanding, being sensitive to someone’s feelings or experiences. It means actively listening and repeating what you’ve heard to show you understand. It also means checking the patient acknowledges your understanding. This helps patients feel you genuinely care and understand them.
Non-verbal communication such as eye contact, nodding and facing your patient, reinforce empathy. Being aware of your communication style and how to adapt it to suit each patient comes with experience and is part of the ‘art’ of medicine.
AVOID RUSHING THE PATIENT
Time can be a challenge, especially if consultation or procedure schedules are
delayed. But no matter how busy you are, always show patients you have time to listen to them and give them your full attention.
In ophthalmology, you sometimes need to be particularly patient, especially with people who don’t like having their eyes examined. As Dr Danks explains, taking your time to tailor your clinical approach to each patient is important. For example, there’s a proportion of patients who don’t like being touched, which has specific implications to the clinical approach. If you’re going to do something, the ‘how’ is important.
Most patients want a say in their healthcare, so have them participate in decisions about treatment options, goals or outcomes. Use layperson’s terms and ask questions, to help you understand the patient’s expectations. Encourage them to ask questions, so you can provide clarification and reassurance where needed. Consider asking:
• what the patient wants to achieve in the visit, to gauge their priorities and expectations
• how they feel about their care plan
• if they understand what you’ve discussed or have more questions.
“It’s better to lay the options out for consideration, then [have] a follow-up appointment when the patient has had a chance to write down their questions and revisit on a second or a third occasion,” Dr Danks says. “With our specialty, [it] requires an understanding of the patient’s lifestyle and their visual needs, as well
as their concerns when you’re planning a procedure. It’s important they feel comfortable to divulge their needs and worries about risk.”
Respect your patients as individuals and talk to them as equals, even though they come to you for your medical expertise. Sometimes a patient will make a decision you don’t agree with or they don’t follow advice. Avoid scolding – it’s not always what is said, but how it’s said. You can accept your patient’s decision without agreeing with it, and by showing you understand their thoughts and feelings, you maintain their trust.
Have a procedure in place for advising patients about how you’ll manage any delays. If you are running late, give a reason if appropriate (e.g. emergency cases). If you tell a patient you’ll do something after your consultation, follow through and do it. This may include sending more information to them, or emailing them a referral letter. Consider sending your patients a copy of your letter back to their referring doctor.
Building rapport with patients doesn’t always involve a big effort, but it can make a big difference.
“SOMETIMES A PATIENT WILL MAKE A DECISION YOU DON’T AGREE WITH OR THEY DON’T FOLLOW ADVICE. AVOID SCOLDING – IT’S NOT ALWAYS WHAT IS SAID, BUT HOW IT’S SAID.”ABOUT THE AUTHOR: DR PATRICK CLANCY MBBS FRACGP, is a Senior Medical Advisor for Advocacy Education and Research at Avant. Empathy can be conveyed through non-verbal communication such as eye contact, nodding and facing the patient.
bad profits, and acknowledging you cannot have delighted patients without delighted employees. It boils down to whether you’re seeking one-off value or lifetime value from your patients. That means you need to make careful considerations around the upselling of products and services, a common tactic in eyewear. Is it something you believe the customer would truly benefit from, and is it attainable for them? Or are you risking a breach of that trust?
The lifetime value of a customer is always higher than a one-off patient, regardless of how much they might spend in any given moment. It’s important to remember that trust equals a willingness to return for their care and, in turn, spend. They will recommend you to their friends and family; nothing is more powerful than word-of-mouth marketing.
optometrists, ophthalmologists and other health professionals shouldn’t be ashamed of. Afterall, they have facilities to run, technology to purchase and staff to pay.
History shows us healthcare was birthed in the marketplace – take the Code of Hammurabi; a collection of rules from ancient Mesopotamia that, amongst other commercial matters, set fees for surgeons. And Socrates, who said: “tell me, your physician … is he a moneymaker, an earner of fees, or a healer of the sick?”
I remember as a child I went with my father to purchase a second hand car from an elderly lady. Upon giving her the cheque, she said once it had cleared with the bank, we could return and take it away. My father, a practising psychiatrist at the time, gave her his business card, and upon learning he was a doctor, she let us take the car on the spot.
It comes down to trust. And therein lies the difference between health professionals, and those who sell used cars who have no duty to the
providing health services.
Across the board, we are seeing a shift away from the idea of getting all you can out of a customer, to thinking about: how can one generate more profit through a relationship built over a longer period of time, enshrined by giving clients real value that keeps them engaged and returning as customers.
It’s about playing the long game, which may occasionally be at a short-term cost.
Some of the biggest corporations in the world, like Amazon, adopt this approach. In fact, companies who focus on consumer delight are twice as likely to out-perform their competitors, and experience a 20% reduction in consumer attrition. They’ve also eliminated ‘bad profits’ from their business models, such as those irritating fees when changing your plane ticket, or late fees from banks.
So how might this look in an optical practice? It’s about championing consumer-focused innovation (such as giving a taxi voucher for a patient feeling unwell after their consult), identifying and managing sources of
Next time there’s a patient looking at the most expensive frames on the rack, think how they might respond if you show them a similar pair at half the price that you think will equally suit their look. The ‘capitalist’ would say you’re cheating yourself out of profit, but the ‘consumer capitalists’ would say that’s a wise move because when it’s time for a new pair they will return because they trust you. You put them at the centre of the experience.
Today, people are less tolerant of a power imbalance between the health provider and themselves. They want to feel empowered, a feeling that can only come from a trusted advisor – you.
Name: Clinical Professor Alexander
Holden
Qualifications: BDS LLM MDPH
MComDent PhD MRACDS(DPH) FACLM
FCGDent
Affiliations: University of Sydney, Specialist in Public Health Dentistry, Director of Karaden Dental Group, Director of Australasian College of Legal Medicine
Location: Sydney Years in industry: 12
THE LIFETIME VALUE OF A CUSTOMER IS ALWAYS HIGHER THAN A ONE-OFF PATIENT, REGARDLESS OF HOW MUCH THEY MIGHT SPEND IN ANY GIVEN MOMENT.
JUNE
ASO BUSINESS SKILLS EXPO 2023
Sydney, Australia
2 – 4 June asoeye.org/events
BCLA CLINICAL CONFERENCE & EXHIBITION
Manchester Central, UK 9 – 11 June bcla.org.uk/Public/Events/ BCLAConferences.aspx
MYOPIA PROGRESSION IN CHILDREN CONFERENCE
Sydney, Australia
10 June myopiaaustralia.com.au
WORLD GLAUCOMA CONGRESS
Rome, Italy
28 June – 1 July worldglaucomacongress.org
JULY
AUSCRS 2023
Port Douglas, Australia 26 – 29 July auscrs.org.au/2023-conference
AUGUST
TASMANIA LIFESTYLE CONGRESS (TLC)
Hobart, Tasmania
5 – 6 August taslifestylecongress.com.au
WORLD CONFERENCE ON OPHTHALMOLOGY & EYECARE
Rome, Italy 21 – 23 August eyecare.thepeopleevents.com
OPHTHALMOLOGY UPDATES!
Sydney, Australia 26– 27 August ophthalmologyupdates.com
SEPTEMBER
ORTHOKERATOLOGY SOCIETY OF OCEANIA CONFERENCE
Gold Coast, Australia
1 – 3 September www.facebook.com/OrthoKSO/
O=MEGA23 & WORLD CONGRESS OF OPTOMETRY
Melbourne, Australia
8 – 10 September omega-event.org
EUROPEAN SOCIETY OF CATARACT & REFRACTIVE SURGEONS CONGRESS
Vienna, Austria
8 – 12 September congress.escrs.org/
INTERNATIONAL VISION EXPO WEST
Las Vegas, US 14 – 17 September west.visionexpo.com
SILMO PARIS
Paris, France
29 September – 2 October event.silmoparis.com/2023/en/
To list an event in our calendar email: myles.hume@primecreative.com.au
RANZCO SCIENTIFIC CONGRESS
Perth, Australia 20 – 24 October ranzco.edu/events
ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE
Perth, Australia 21 – 24 October orthoptics.org.au
EYECARE PLUS BOOTCAMP AND AGM
Sydney, Australia 27 – 28 October y.safier@eyecareplus.com.au
SILMO INSTANBUL
Istanbul, Turkey 23 – 26 November silmoistanbul.com/en
$30k Sign-on bonus Optometrist opportunities across Australia
2023 is shaping up to be another year of nextlevel growth for Specsavers, with 4 new stores already opened and many more scheduled to come. This growth is creating more opportunities for optometrists like you to join us. We offer flexible rosters to support work/life balance, access to the latest technology (including OCT in every store free for every patient) and extremely attractive salaries – with $30k sign-on bonuses in selected locations. We will also provide you with excellent opportunities for career development – including pathway to Partnership, outreach opportunities and the chance to mentor new graduates. There is no better time to join!
In the south – west of New South Wales, at the heart of the vast Murrumbidgee irrigation area is Griffith. With fertile land particularly well suited to vineyards, Griffith is a popular food and wine destination. There are more than a dozen wineries in the district with world famous names. Specsavers Griffith is well positioned within Griffith Central Shopping Centre, attracting high volumes of foot traffic. The store opened in 2018, and contains 3 Optical testing rooms, a dedicated Audiology room, 5 dispense points, over 1100 frames on display and state of the art equipment including OCT and HVF analyser.
Specsavers ACT Locum Opportunities
Specsavers have locum block bookings opportunities across ACT where we will look after your travel arrangements including flights accommodation and car hire along with attractive hourly rates. Whether new to specsavers or if you are Specsavers experienced there are endless opportunities for you.
The Specsavers Graduate Recruitment Team currently have over 120+ regional stores who are looking for new graduates to join and start their career.
Whether it be for a new challenge or relocating for different lifestyles - this could be your first step in opening doors for your professional career. Providing generous bonus’ along with a competitive salary and relocation package, all Specsavers stores are equipped with the latest optometry catering for your diverse patient base. Specsavers are the largest employer of Graduate Optometrists across Australia and New Zealand and we have continued to develop our comprehensive two-year Graduate Program which provides newly qualified Optometrists with a dedicated Mentor, support network and structured program to assist you in your development.
LET’S
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 opportunities enquiries: Kimberley Forbes on +61 (0) 429 566 846 or E kimberley.forbes@specsavers.com
Australia Optometrist employment enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134
Locum employment enquiries: Matthew Cooney matthew.cooney@specsavers.com or 0447 276 483
New Zealand employment enquiries: Chris Rickard –Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499
Graduate employment enquiries: apac.graduateteam@specsavers.com
All Specsavers stores now with OCT
serving in roles including Product Manager - Retina and Glaucoma for five years, and Product Specialist - Ophthalmic Systems for five years.
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The biggest eye care and eyewear fair in Australia combines with the most credentialed and largest annual optometry Clinical Conference in the Southern Hemisphere - the 2023 program will run in partnership with the 4th World Congress of Optometry in an exciting international event that should not be missed. Our diverse and unique program includes accredited CPD sessions.
Uncover Australia’s breathtaking scenery and unique wildlife, as well as Melbourne’s iconic cultural scene and world-renowned eateries! We are excited to welcome you to Melbourne, Australia.
HOSTED BY: omega-event@arinex.com.au www.omega-event.org
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