Insight June 2024

A tailor-made progressive lens for clarity at any distance.

Hoyalux iD MySelf. Our most premium and personalised progressive lens.

TRAINING WORK-READY GRADUATES

Are clinical placements preparing student optometrists for real-world practice?

24

TAKING OWNERSHIP OF YOUR CAREER The opportunities available to entrepreneurial eyecare professionals in Australia

43

CARING FOR OUR KIDS

Overcoming the nation's chronic paediatric ophthalmology shortage

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

If you want to work for a company that’s passionate about supporting our people to be the best they can be and building a culture where all team members can thrive and everyone feels welcome, valued and proud to belong, you’ll shine at Specsavers. spectrum-anz.com/careersat-specsavers/

SIMULATIONS AND VIRTUAL CARE: FUTURE OF OPTOMETRY STUDENT PLACEMENTS UNDER REVIEW

The quality of optometry clinical placements in Australia – alongside opportunities to perform simulation-based learning and equipping students for the future of remote optometry consultations – is in the spotlight as part of an Ahpra review.

A special committee is seeking industry feedback on its draft guidance on embedding good practice in clinical placements, simulation-based learning and virtual care in “initial student health practitioner education” across various health professions, including optometry.

“These activities enable students to develop the capabilities they need for contemporary practice, and to safely and competently deliver patient-centred care,” committee chair Professor Andrew Wilson said.

Students studying optometry have various clinical placement opportunities, depending on the university they are studying at, which intensify in duration and patient involvement as they near final-year graduation. The review’s focus on virtual care exposure comes at a vital juncture, as optometry networks begin rolling out remote optometry services to regional patients with limited access to primary eyecare. OPSM and Specsavers are among those piloting this model, supported by high tech equipment.

According to Ahpra’s Accreditation Committee, evidence on the value of clinical placements for student learning is mixed, with a lack of studies reporting objective, quantifiable learning outcomes. However, studies have found students can develop their clinical as well as non-clinical

skills on placements. The data also demonstrates several factors influence student learning outcomes from placements, including learning activities that prepare students for practise in the real-world and experiences requiring students to actively participate. Placements in diverse settings, adopting a model that suits the work context, and longer, more continuous placements may

GENDER DIFFERENCES IN TRAINEE EXPERIENCE

Ophthalmology trainees report differences in their experience of medical training based on their gender, a further analysis of the 2023 Medical Training Survey (MTS) has revealed.

The survey results were originally published in December 2023 and included several interesting findings for RANZCO trainees including a higher-than-average working week (53.3 hours), but a generally positive attitude towards passing their course, securing employment, and sticking to a career in medicine.

But more recently, the Medical Board of Australia published a further breakdown of the 2023 MTS results, detailing experiences by gender.

Insight accessed a further

breakdown for RANZCO trainees and found significant differences in the experiences of female and males when it came to workplace environment and culture. The survey only included results where more than 10 people answered. In the situations below, roughly 23 females answered compared to around 30 males.

When asked during the past 12 months whether they had experienced bullying, harassment and/or discrimination, 43% of females ophthalmology trainees said they had, while just 3% of males answered yes.

Bullying was the most prevalent issue, with 33% of female respondents saying they had experienced it followed by

harassment (14%), discrimination (5%) and racism (5%). Meanwhile, for males the numbers were <1% for bullying, harassment and discrimination, and 5% for racism.

The national data across all disciplines showed variations in doctors’ access to research, the quality of orientation and payment for overtime between trainees, according to gender.

For RANZCO trainees, some other gender differences included the average weekly hours worked: 57.2 for females and 51 for males. Also, unpaid overtime adversely affected the well being of 35% of female RANZCO trainees, while for males this was 24%.

also enhance the learning experience. Universities contacted by Insight revealed an appetite for virtual care experiences and even virtual reality simulation to build confidence. They also highlighted some issues with the current framework, including out-of-pocket expense of attending placements.

As part of its 3.5-year optometry course, Deakin University, based in Victoria, runs mock telehealth consults for history taking, examination and planning/ management discussions in practical classes with actor patients.

“These run across second- and third-year classes throughout each year, starting with history taking in year two and building up to the actor patient classes in year three,” Deakin’s

Accommodation disorders

With accommodative dysfunctions, LAURA DeANGELIS and TIM FRICKE say understanding these conditions can improve patient outcomes, alleviate symptoms and enhance visual comfort and efficiency (0.5 CPD).

One of the most effective ways to bridge the gap between theoretical knowledge and practical skills is through clinical placements.

AU: 1300 365 470

CIRRUS 6000

At 100,000 scans per second, ZEISS CIRRUS 6000 is the next-generation OCT delivering high-speed image capture with wider field of view and HD imaging detail.

Maximise patient throughput with performance OCT, proven analytics and patient-first design.

IN THIS ISSUE

If you’ve just sat down to indulge in the latest edition of Insight magazine, there are two articles I implore you to read, highlighting exceptional people that call our industry theirs.

As if providing eyecare to his own community isn’t enough, Sydney optometrist Mr Shaun Chang details the sobering moment he viewed a bag of suboptimal specs that constituted the eye clinic within a Nepalese hospital. It was an experience that spurred him into establishing Eyes4Everest.

15 21

Higher calling

Shocked by Himalayan eye health services, a Sydney optometrist took action.

Analytical advantage

How independents are accessing business data on a scale never seen previously.

Lease on life

Optometrists prescribing new migraine lenses provide a path to normalcy for sufferers.

Differentiating factor

Perth’s Angelo Street Optical is fiercely independent, especially with its frames range.

During the past 10 years, he’s been visiting communities around Mt Everest – which he has summited himself – to provide eye health and vision care, culminating in life-altering outcomes for the severely disadvantaged. The power of correctly prescribed spectacles is incredible. But there’s also been some heartbreak along the journey, which he details on page 15, motivating him to expand the service.

What I love about this story is Chang’s motivation to enact change with real action. It sits in contrast to a world burdened with false compassion and tokenism. He saw a problem and, realising he wouldn’t receive the support as hoped, he found a way around the problem.

This edition we also shine a light on the valuable work of orthoptists as part of Orthoptics Awareness Week (3-7 June). On page 48, readers can find three examples of orthoptists leaving an indelible mark on their communities by pushing the limits of their scope.

Vision Australia’s Mr Cem Oztan is one of them. He is a ‘classifier’ for Paralympic and Blind sport, allowing the vision impaired to fulfil their athletic potential. Meanwhile, Ms Natalia Kelly’s passion for neurological vision impairment has helped children with cerebral visual impairment roll for the first time, recognise and respond to Auslan and write their name. Her work with a stroke client also helped them regain their ability to read magazines and move around their home without dizziness related to vestibular-ocular dysfunction. There’s also Ms Navdeep Kaur who has shown through her work at the Royal Children’s Hospital, Melbourne, that orthoptist-led care models can allow for timely, safe and cost-efficient care.

It’s a privilege uncovering gems like this in our industry; ordinary people doing extraordinary things, and often we’re only just scratching the surface. Now, go read those articles.

MYLES HUME Editor

Just as Insight went to print, OV/SA has welcomed a substantial injection of $6.8 million to expand the Glasses for Kids program over the next three years. "We applaud the Victorian Government for prioritising children's eyecare and recognising the importance of ensuring children have access to regular eye care," said Mr Timothy Lo, president of Optometry Victoria South Australia. "We need to be doing more to ensure all kids have regular eye examinations throughout childhood. This funding boost

UPFRONT STAT

WEIRD

University of Rochester researchers investigating blinking have found it isn’t just a mechanism to lubricate the ocular surface. It also has an important role in allowing the brain to process visual information. “By modulating the visual input to the retina, blinks effectively reformat visual information, yielding luminance signals that differ drastically from those normally experienced when we look at a point in the scene,” Prof Michele Rucci said.

WONDERFUL

From 2025, World Rugby guidelines to prevent kit clashes that make it difficult for colour blind people to watch matches will become policy. Teams that wear red and green are among those that will need to wear an alternative kit when playing one another. The body has worked with not-for-profit Colour Blind Awareness on the initiative.

WACKY

Academics at the University of California have discovered profound similarities and surprising differences between humans and insects in the production of the critical light-absorbing molecule of the retina, 11-cis-retinal, also known as the visual chromophore. The findings deepen understanding of how mutations in the RPE65 enzyme cause retinal diseases, especially the devastating childhood eye disease, Leber congenital amaurosis.

represents a step in the right direction.” IN OTHER NEWS, CRISPR-based therapy has been shown to be safe and effective for inherited retinal diseases.

The "landmark" BRILLIANCE phase 1/2 trial by US genome editing company Editas Medicines showed 11 out of 14 participants experienced improvements in vision and quality-of-life measures.

"To hear from several participants how thrilled they were they could finally see the food on their plates – that is a big deal. These were individuals who could not read any lines on an eye chart and who had no treatment options," principal investigator Dr Eric

Pierce said. FINALLY, a study has detected micro-plastics (MPs) in the human vitreous humour. Published in ScienceDirect, it involved 49 patients with either macular hole, macular epiretinal membrane, retinopathy and rhegmatogenous retinal detachment.

Of the 1,745 plastic particles identified, most were smaller than 50 μm.

Published by:

Paediatric paucity

A 2021 RANZCO survey of public ophthalmology departments revealed 39% of them did not provide paediatric services. Page 43

WHAT'S

ON

THIS MONTH ASO SKILLS EXPO 2024 1 – 2 June

The event is an opportunity to gather with ophthalmology peers to share the latest in best practice, knowledge and cutting-edge medical technology. sandra@asoeye.org

Complete calendar page 56.

“Correlations were observed between MP levels and key ocular health parameters, particularly IOP and ... aqueous humour opacities. Intriguingly, individuals afflicted with retinopathy demonstrated heightened ocular health risks associated with MPs." NEXT MONTH AUSCRS 24 – 27 July

The popular Australian Society of Cataract and Refractive Surgeons conference is heading to Hamilton Island, an ideal winter get away for attendees. office@auscrs.org.au

379 Docklands Drive, Docklands VIC 3008

T: 03 9690 8766

www.primecreative.com.au

Chief Operating Officer

Christine Clancy

christine.clancy@primecreative.com.au

Publisher

Sarah Baker sarah.baker@primecreative.com.au

Editor

Myles Hume myles.hume@primecreative.com.au

Journalist

April Hawksworth april.hawksworth@primecreative.com.au

Commissioning Editor, Healthcare Education

Jeff Megahan

Business Development Manager

Luke Ronca luke.ronca@primecreative.com.au

Client Success Manager

Salma Kennedy

salma.kennedy@primecreative.com.au

Design Production Manager

Michelle Weston

michelle.weston@primecreative.com.au

Head of Design

Blake Storey

Art Director

Bea Barthelson

Subscriptions T: 03 9690 8766

subscriptions@primecreative.com.au

The Publisher reserves the right to alter or omit any article or advertisement submitted and requires indemnity from the advertisers and contributors against damages or liabilities that arise from material published. © Copyright –No part of this publication can be reproduced, stored in a retrieval system or transmitted in any means electronic, mechanical, photocopying, recording or otherwise without the permission of the publisher.

PLACEMENTS DEVELOP 'WORK-READY GRADUATES'

continued from page 3

head of optometric clinical placements Ms Heather Connor said.

Held over 10 consecutive trimesters, Deakin’s optometry program is described as Australia’s only accelerated Bachelor of Vision Science/Master of Optometry course. Placements vary from half a day or full day for optometry and ophthalmology, to four days a week in practice during the clinical residential placement. Students also attend the Australian College of Optometry for one week twice a trimester.

Simulation-based learning is also incorporated into the program. Connor said these were held in the pre-clinical phase and allowed students to learn in a low stakes environment without inconveniencing real patients.

These simulations include working with 3D printed models, augmented reality applications, structured communication and clinical reasoning tasks, and virtual international grand rounds with optometry students from India and Malawi, and with UK and Swedish students soon.

“Each course in Australia runs their own placements with individual frameworks. At Deakin, we have a structured progression to placement, starting with observations and gradually scaffolding increasing amounts of clinical work until students begin their final residential placement which is modelled on the longitudinal integrated clerkships that many successful medical programs employ,” she said.

“There are pros and cons of all models, but research we have undertaken supports

the longer-term placement structure as it allows students to really integrate into the practice and to work collaboratively with the optometrists and other practice staff.”

Connor added: “There is definitely a place for virtual simulation in training optometry students as it offers us ways to prepare our students to make the most of the clinical placements which are so vital for their development as optometry professionals. We review this process continually and are always looking for feedback and ways to improve the experience for students and clinical partners.”

Addressing 'placement poverty'

Professor Lisa Keay, head of the UNSW School of Optometry and Vision Science, said clinical placements were designed to reflect the full range of modes of practice, so could include remote optometry consultations in future.

Currently, UNSW graduates spend the equivalent of one year in face-to-face clinical training by the end of their Masters in Clinical Optometry, in a range of practice settings and locations. This includes its internal UNSW Optometry Clinic providing more than 5000 student-led consultations annually, alongside experiences at the Centre for Eye Health, Australian College of Optometry, Guide Dogs Low Vision Clinic, rural and metropolitan optometry practices, and opportunities for international placement and working in Aboriginal and Torres Strait Islander communities.

Students also observe ophthalmologists across multiple placement settings, and the university supports students to experience

“THERE IS DEFINITELY A PLACE FOR VIRTUAL SIMULATION IN TRAINING OPTOMETRY STUDENTS AS IT OFFERS US WAYS TO PREPARE OUR STUDENTS TO MAKE THE MOST OF THE CLINICAL PLACEMENTS.”

HEATHER

CONNOR, DEAKIN UNIVERSITY

hospital optometry placements at Prince of Wales and Royal Hobart Hospitals.

When considering the clinical placement framework in optometry, Prof Keay said one challenge is balancing the best placement opportunities against out-of-pocket costs to students. She said the recent Universities Accord highlighted some students have significant financial hardship while meeting requirements for work-integrated learning using the phrase “placement poverty”.

“The government has not yet responded to the many recommendations from the Accord, including recommendation of financial support for placements,” she said.

“We are working with our student cohort to understand financial hardship and respond with a range of supportive measures including a small number of grants for equipment purchase and placement bursaries. We acknowledge the generous annual donation from Young Optometrists since 2022 to support equipment purchase for students in need. We also see tremendous goodwill from our placement hosts and industry partners who enable and support clinical training for our students.”

She said placements provided critical skills in developing work-ready graduates from improving clinical skills, understanding organisational/work requirements and dealing with communication, as well as understanding the social context surrounding healthcare practice.

“Our training enables development of competencies from pre-clinical laboratories, simulated learning before independent practice in a supportive environment,” she said.

CULTURAL ISSUES REQUIRE URGENT ATTENTION, MBA SAYS

Of the more than 23,000 doctors in training who participated in the 2023 Medical Training Survey, 18,000 participants answered the question about their gender.

Of these, more than 9,000 trainees identified as female, 8,000 as male and 67 as non-binary. Among RANZCO trainees, 38% are female, 55% male and 7% preferred not to say.

For all medical trainees, those who identified as non-binary reported the highest rates of experiencing bullying, harassment, discrimination and/or racism (no RANZCO trainees identified as non-binary).

According to the report, non-binary trainees reported witnessing bullying, harassment, discrimination and racism at nearly double the rate reported by both male and female trainees. There were smaller variations in reported rates of witnessing these behaviours between male and female trainees.

The source of the behaviour varied across genders.

The reasons trainees did not report an incident they had experienced also differed across genders. Non-binary trainees indicated they did not report incidents because they believed nothing would be done and/or there was a lack of support, while male and female trainees indicated concern about repercussions.

Male and female trainees identified senior medical staff as the primary source, and non-binary trainees identified medical colleagues (registrars and other doctors in training) and other health practitioners as mostly responsible for the behaviours.

Medical Board chair Dr Anne Tonkin said the established link between poor culture and increased risk to both patient safety and doctors’ wellbeing required urgent attention.

“This detailed data exposes the impact of gender on doctors’ experience of medical training. With this knowledge, must come action,” she said.

Female trainees reported higher rates of bullying, harassment, and discrimination.

Image:

Image: Deakin.

FIVE AUSSIE OPHTHALMOLOGISTS MAKE 2024 POWER LIST

Five Australians have been recognised among the top 100 ophthalmologists globally in the 2024 Power List, compiled by The Ophthalmologist magazine, with Centre for Eye Research Australia (CERA) managing director Professor Keith Martin ranking fifth overall.

He joined CERA colleague Professor Robyn Guymer, the institution’s deputy director and head of macular research, as well as Adelaide’s Dr Ben LaHood, Sydney’s Professor Stephanie Watson and Western Australian Professor David Mackey. New Zealander Dr Helen Danesh-Meyer, a Professor of Ophthalmology at the University of Auckalnd, also made the list.

The Power List highlights the excellence and impact of the most influential people in ophthalmology globally.

“As usual, the task of selecting and ranking the Top 100 ophthalmologists was a burden shouldered by our panel of judges – all internationally renowned experts in the field themselves,” the publication said.

“And once again, the insights and observations provided by our 100 chosen influencers throw a light on the cutting-edge

issues and trends that are driving and shaping ophthalmology right now – as well as letting us in on some lesser-known aspects of their backgrounds and interests.”

The 2024 list was topped by US ophthalmologist Professor Ike Ahmed who is recognised as one of the most experienced complex eye surgeons globally – particularly in glaucoma and surgical complications.

Rounding out the top five were, renowned US cataract surgeon Professor David Chang, fellow Americans Professor Felipe Medeiros and Professor Joel Schuman, both leading glaucoma experts, and CERA’s Prof Martin.

Prof Martin – who is also a Professor and head of Ophthalmology at the University of Melbourne, and Honorary Senior Research Fellow at University of Cambridge, UK, said he believed there would be a move beyond intraocular pressure lowering as the only treatment for glaucoma.

“I think gene therapy will find increasing applications in ophthalmology, not just in inherited eye disease, but also in glaucoma, macular degeneration, and diabetic retinopathy,” he said.

Dr LaHood, who is affiliated with Adelaide

Eye and Laser Centre, The Queen Elizabeth Hospital and The University of Adelaide, revealed he is in the final stages of releasing a cosmetic product to protect eyelid skin as well as provide anti-ageing properties.

Prof Watson – head of the Save Sight Institute’s Corneal Research Group at the University of Sydney, head of the Corneal Unit at Sydney Eye Hospital, chair of Australian Vision Research, and vice chair of RANZCO NSW – hoped to see research become a part of the everyday practice in ophthalmology.

“This would include the routine collection and analysis of patient reported outcomes. With this, ophthalmologists would soon become leaders in healthcare as they would see real-time outcomes of treatments, have a deeper understanding of the patient perspective, and take on the task of ensuring equitable delivery of eyecare.”

Struggling with discomfort and blurry vision?

Tokai CCP/CCP400

* Targeted light filtra�on

* Reducing glare while maintaining efficient brightness

* Improving vision especially for those with specific eye condi�ons

Martin (from left), Prof Robyn Guymer, Prof Stephanie Watson, Dr Ben LaHood, Prof David Mackey. Images: Supplied.

IN BRIEF

ETHICAL EYEWEAR

Sustainable Australian eyewear brand Project Green has strengthened its partnership with ONE TREE PLANTED after recently planting a further 2,318 trees as part of the Forest Fire Recovery project. For every frame sold, the award-winning eyewear label – supplied by Eyes Right Optical – plants a tree through ONE TREE PLANTED. Since the launching in September 2023 at O=MEGA23, Project Green has planted more than 3,500 trees globally, with 1,203 trees planted in the Amazon rainforest in October 2023. For the latest efforts, Project Green has had trees strategically planted in areas of Canada such as British Columbia and Alberta, regions heavily affected by record-setting fires. This initiative not only aims to reforest damaged lands but supports the rehabilitation of habitats for iconic biodiversity.

DRY EYE REPORT

Dr Alex Hui, Adjunct Associate Professor at the UNSW optometry school, has detailed the emerging pipeline of dry eye therapies with “important clinical potential”, in the latest Contact Lens Update online report. Developed by the Centre for Ocular Research & Education, the report is published six times a year and provides eyecare professionals with clinical insights grounded in current research. In his editorial, Dr Hui provided an overview of recently approved treatments such as a short-term corticosteroid to treat acute periods of worsened dry eye, a preservative-free ophthalmic solution that slows tear evaporation, and investigational products that either target inflammation or stimulate receptors on the ocular surface to increase the production of tears.

ORDERING PORTAL

OptiMed has launched a new online ordering portal to streamline the customer experience. Eyecare professionals can now purchase pharmaceuticals and consumables, and ancillary products such as trial frames, occluders, foreign body instrumentation and ocular lenses via the portal. National product manager Mr John Larkin said the portal had been developed for the benefit of customers and convenience. The inclusion of ancillary products via this ordering method has also been described as an Australian industry first. “The new online ordering streamlines the whole process for both customer and OptiMed,” he said. “The customer needs to register and confirm their account details on OptiMed website before using. They will then have full visibility on past orders, be able to replicate orders. They can pay directly or use place order on their account.”

ESSILORLUXOTTICA360 UNVEILED FOR INDEPENDENTS

EssilorLuxottica has launched a new partnership program –EssilorLuxottica360 – for its independent practice customers, focusing on differentiation, an enhanced patient experience and improved profitability.

During the past two years, EssilorLuxottica ANZ has been evolving as an integrated company. A new chapter recently started with Mr Matteo Accornero, previously general manager retail ANZ, extending the scope of his responsibilities to lead the EssilorLuxottica ANZ business strategy across both Professional Solutions (wholesale) and Direct-to-Consumer (retail) distribution channels.

The company said this new business organisation provided independent customers with better access to all the group had to offer, while maintaining differentiation in the market.

As part of this, EssilorLuxottica said the ANZ Professional Solutions business is continuing to support independent optometry with EssilorLuxottica360, a recently launched partnership program.

As a frame and lens partner, independents can access tailored services, expert guidance and exclusive

access to EssilorLuxottica’s products and iconic brands, the company said. This new level of partnership aims to:

• D ifferentiate and elevate each practice with enhanced visibility and the introduction of innovative technology such as digital windows and a customised calendar of activities across frame and lens to elevate the practice and drive traffic.

• Enhance the patients’ experience with tools and services that will drive a more engaging patient journey .

• I mprove practice profitability through enablers that boost productivity and drive value, including access to special financing options for instruments and practice development funds to invest in business growth.

“Eligibility for this exclusive program is based on committed spend and growth across the frame and lens business. There are two levels of partnership and as one increases the partnership, the practice unlocks additional benefits,” the company stated.

“ EssilorLuxottica is excited to be launching this program with i ndependents across Australia throughout 2024.”

ROBOTIC-ASSISTED

CATARACT SURGERY MAKES DEBUT

Cataract surgeon Dr David Chang has debuted a novel robotic cataract surgery procedure on a porcine eye at the American Society of Cataract and Refractive Surgery (ASCRS).

The technique – on display in April 2024 – uses ForSight Robotics’ Oryom platform which is being developed to amplify surgeons’ skills and to increase patient access to sight-saving surgery worldwide.

During his lecture, Dr Chang discussed his experience using the robotics platform to perform a complete, remote cataract procedure. He presented a video of the procedure and discussed the future potential for the ‘groundbreaking’ technology.

“This is the first time I’m showing a video of me operating on an animal eye, doing

the entire procedure with robotic arms, while sitting at a workstation located 20 ft. (6.1m) away from the eye. The robotic arms were precisely mirroring what my hands were doing,” Dr Chang said.

Utilising AI-based algorithms, robotics, and advanced computer vision, the Oryom platform has already completed dozens of full robotic cataract procedures on an animal eye model.

“This was an exciting milestone for us – debuting a cataract procedure that has not yet been presented in a public conference forum,” ForSight co-founder, president and chief medical officer Dr Joseph Nathan said.

“With the expertise and support of world-renowned cataract surgeons like Dr Chang, we are seeking to transform the future of sight-saving eye surgery.”

Dr David Chang performed the surgery 6m away from the model eye. Image: University of California.

The program intends to elevate independent practice. Image: EssilorLuxottica.

Are you ready to unlock the potential of shared vision? At The Optical Company, we understand that a successful partial or full sale depends on the right outcome for you. Our journey to success is not solitary; it’s a collective venture with you and us.

Whether you’re considering a partial or full sale, we’re here to help you realise your vision. If you are interested in starting the conversation about your future, let’s work together to establish a mutually beneficial arrangement. We are actively seeking practices

Email: vision@theopticalco.com.au

BAUSCH + LOMB LAUNCHING DRY EYE SUPPLEMENT AFTER FAVOURABLE FINDINGS

Global ophthalmic company Bausch + Lomb (B+L) has achieved statistically significant results from a trial evaluating the efficacy and safety of its novel daily nutritional supplement for dry eye disease. After published the findings in Frontiers in Ophthalmology on 24 April 2024, the company now expects to launch the supplement – featuring a proprietary blend of ingredients including lutein, zeaxanthin isomers, curcumin and vitamin D3 – under the brand name Blink NutriTears early in the third quarter of 2024 in the US.

The clinical study met both primary endpoints, which were:

• Daily NutriTears consumption showed significant improvements in tear production, as measured by change in Schirmer’s test scores from baseline compared to placebo to day 56.

• By day 14, total Ocular Surface Disease Index (OSDI) scores, as well as symptoms and vision domains of the OSDI significantly improved from baseline for participants consuming the

daily NutriTears versus placebo.

Interestingly, the trial subjects were allowed to use artificial tears throughout the study, with no difference between groups for artificial tear usage reported.

“These data suggest consumption of this new once-daily nutritional supplement may help restore tear film homeostasis by addressing the key root causes of dry eyes,” said Dr Neda Gioia, founder of Integrative Vision, president of the Ocular Wellness & Nutrition Society, and Blink NutriTears investigator.

were achieved and included significant improvements in ocular surface staining, participant reported symptoms, and the inflammatory marker MMP-9 in participants consuming the daily NutriTears compared to placebo were seen at day 56. By day 56, participants consuming the daily NutriTears had significantly improved TBUT and tear osmolarity, versus placebo. They also had significant improvements in corneal and conjunctival staining, and inflammation, as assessed by presence of MMP-9, by day 56.

The prospective, randomised, double-blind, parallel, placebo-controlled study evaluated the efficacy and safety of NutriTears in 155 adult participants with mild dry eye symptoms (aged 18 to 65; median age 42).

Participants were randomised to receive one NutriTears (77 people) or placebo capsule (78 people) per day over eight weeks, and artificial tear use was captured. In addition to meeting both primary endpoints, key secondary endpoints

Significant improvements in participant-reported ocular symptoms of dry eyes and participant experience of the frequency and severity of dry eye symptoms, as assessed by a SPEED questionnaire, were noted by day 14 for participants consuming the daily NutriTears versus placebo and maintained to day 56.

NutriTears was found to be well-tolerated. No serious adverse events were reported during the study period, B+L stated.

Blink NutriTears met both primary endpoints. Image: engagestock/ Shutterstock.com.

FULL CIRCLE PROGRAM EXPANDED FOR INDEPENDENTS

into Safilo frames, in a move offering prompt delivery of personalised eyewear without compromising quality, the companies say.

The Full Circle Program has been described as a pioneering collaboration between CR and Safilo Australia.

In addition to the newly announced frames, it also offers independent practices access to eyewear from Carrera, Kate Spade New York and Privé Revaux, fitted with CR lenses.

“The Full Circle Program reinforces its commitment to providing independent optometrists with unparalleled tools to excel in the industry,” Safilo Australia senior commercial manager Ms Shiva Taghvaei said.

popular within the store, it happened to be paired with CR Labs who have the most amazing service,” she said.

“One of the best reasons for the Full Circle program is the ability to keep stock on the shelves and not have to spend time re-ordering and re-entering stock into the system. It is a huge time saver and the ordering system through CR Labs is extremely easy to navigate."

CR Labs CEO Mr Adam Fletcher said Full Circle was a game-changing program for independent optometry.

“[It] sets a new benchmark in the industry, offering an environmentally responsible supply model that drives significant savings in time and better margins,” he said.

ZEISS ACQUIRES EVA NEXUS PLATFORM

ZEISS has completed the acquisition of D.O.R.C. (Dutch Ophthalmic Research Center) that includes the EVA NEXUS platform, one of the ophthalmology market’s most advanced dual-function systems.

On 4 April 2024, ZEISS confirmed it had purchased D.O.R.C. from the French investment firm Eurazeo SE, following regulatory clearances.

“With D.O.R.C., we have an incredible opportunity to serve ophthalmologists around the world with more complete workflows and solutions than ever before,” said Mr Euan Thomson, president of ophthalmology and head of the Digital Business Unit for ZEISS Medical Technology.

PROVISION CALCULATOR HELPS PRACTICE GROW REVENUE BY $60K

ProVision business coach Mr Jim Colley has leveraged the organisation’s practice growth calculator to help increase revenue in one practice by $60,000 annually.

The calculator –developed for independent optometry businesses part of the network – has been described as the first of its kind, and free to use.

It operates by analysing six key performance indicators from systems such as Sunix or Optomate, including total sales, number of patients, average sale per patient, conversion, average consultation value, and multi-pairs. The calculator then projects the financial outcomes when each metric is adjusted incrementally.

“For instance, adding just one consultation per day could boost a practice’s annual revenue by approximately $120,000, based on an average revenue of $399 per consultation over 300 working days,” Colley said.

A ProVision business coach then collaborates with the practice owner to implement strategies to realise this goal including enhancing marketing efforts, optimising appointment scheduling, expanding consultation hours, or refining procedures.

“The ProVision practice growth calculator is a gateway to strategic growth and enhanced profitability, facilitated by expert coaching and robust, actionable insights.”

Recently, Colley used the calculator with a practice which revealed an opportunity whereby increasing the revenue per patient by $20, resulted in an additional $60,000 annually.

With D.O.R.C. considered a leader in the retina surgical devices and consumables, ZEISS expects to bring a portfolio of market-leading technologies to ophthalmologists, including an expanded digitally-connected Retina Surgery Workflow from ZEISS.

The companies’ portfolios are complementary, exemplified through

the EVA NEXUS platform from D.O.R.C. featuring alongside ZEISS’ range of visualisation, diagnostic and therapeutic devices, and surgical instruments and consumables, all connected to a digital ecosystem.

EVA NEXUS is at the core of a D.O.R.C.’s portfolio, comprising a full range of accessories, instruments and liquids for vitreoretinal and combined cataract procedures.

To achieve this, Colley and the practice team reassessed technological fees, standardised charges for various services, and revamped the lens dispensing approach.

“We set this as a tangible target and developed a comprehensive strategy to achieve it,” he said.

“By aligning and training the entire team towards this goal, we’re on track to not only meet but exceed our target, potentially increasing revenue by $35 per patient.”

Toni Hotker, Simply Spectacles. Image: Safilo

The D.O.R.C. EVA Nexus cataract and vitreo-retinal system. Image: D.O.R.C.

The calculator projects financial outcomes to determine potential. Image: ProVision.

The Eye and Ear’s $317M facelift

Australia’s only eye, ear, nose, and throat hospital has undergone a multi-million-dollar transformation, offering a world-class facility for ophthalmologists to work in and a greater service for Victorians.

The fullstop has been put on The Royal Victorian Eye and Ear Hospital’s $317.6 million redevelopment, with the capacity to now treat an additional 7,000 patients each year.

Victorian Minister for Health and Health Infrastructure, Ms Mary-Anne Thomas, officiated the opening of the redeveloped world class specialist health, research and education facility, unveiling a plaque commemorating the occasion.

“The Royal Victorian Eye and Ear Hospital has a long history of delivering world-renowned care, treatment and research – this redevelopment will help them continue this groundbreaking work,” Thomas said.

“More Victorians will now be able to get the specialist eye and ear, nose and throat public health care they need with the hospital upgrade expanding its capacity.”

The upgrade – which supported more than 2,500 jobs – boasts a new 13-cubicle 24-hour emergency department (ED), ED Short Stay Unit with four 24-hour beds, perioperative suite with eight upgraded operating theatres and 14 recovery spaces, as well as a further 37 same-day beds and 42 consulting rooms.

There is an additional inpatient ward with 24 beds, and a dedicated floor for clinics, offering more than 90 specialist services.

Improved teaching, training and research facilities are now on upper levels, with patient services located on the first three floors of the buildings to improve navigation across the hospital. The redevelopment also delivered a new Central Sterile Services Department and a full upgrade of the hospital’s engineering infrastructure and central plant,

making the facility safer and more efficient.

Thomas revealed the Victorian Government invested $144.7 million toward the project, with the Commonwealth providing $100 million, and the hospital an additional $72.9 million.

'A NEW CHAPTER IN OUR 161-YEAR HISTORY'

The hospital delivered more than 130,500 ophthalmology services in the 2022/23 financial year, including 28,180 emergency department presentations, 12,580 inpatient admissions and 95,072 seen in specialist clinics.

The hospital’s CEO Mr Brendon Gardner said he looked forward to seeing the impact the redeveloped hospital would have on metropolitan, regional and rural patients.

“As Australia’s only eye, ear, nose, and throat hospital, this signifies a new chapter in our 161-year history,” he said. “As Victoria’s third oldest public hospital, our specialist knowledge and expertise position us well to continue to provide the best care for Victorians over the next 160 years and beyond.”

Established in 1863, the Eye and Ear was instrumental in developing the world-leading bionic ear, which later became the groundbreaking Cochlear implant. It is Victoria’s leading provider of eye and ear health, integrating clinical care, research and education to optimise innovation and provide advanced treatments for vision and hearing loss.

Mr John Desmond recently became a patient after sustaining a traumatic eye injury while chopping wood at his home. A large wood chip struck his left eye causing blunt trauma. After presenting at the local ED in Mansfield, he was advised to travel to the Eye and Ear.

His treating surgeon, Associate Professor Penelope Allen and head of the Eye and Ear’s Vitreoretinal Surgical Unit, had to remove his lens and the treat extensive bleeding.

“Treating traumatic eye injuries like John’s require additional years of training and skills on top of general ophthalmologist training. We see several eye injuries per week through our Emergency Department and collaborative management from subspeciality units is very beneficial for their care,” she said.

The Eye and Ear is nationally and internationally renowned for teaching, training and research since its founding in 1863.

“The Eye and Ear was built on three pillars; care, training and research,” Dr Allen added.

“What is most profound to me is that we are all still upholding these principles today. The Eye and Ear is the leading trainer of ophthalmologists in Victoria through RANZCO. Doctors from all over the world come to train at the hospital in ophthalmology and otolaryngology, to learn from leaders in the industry, colleagues, renowned here and internationally. Our dedication to research and improving patient’s lives now and in the future is something I know we constantly strive for.”

Images: Eye and Ear.

At the opening, (from left) Prof Stephen O’Leary, Prof Keith Martin, Dr Sherene Devanesen, Sinead Cucanic, Dr Jacqueline Beltz, and MP Mary-Anne Thomas.

Aerial of the hospital from Victoria Parade.

Transforming eyecare

in the Himalayas

Australian optometrist SHAUN CHANG wanted to ensure the view from the top of world could be enjoyed by all. So, he established Eyes4Everest to deliver much needed eyecare services to the people of Everest National Park each year.

When Sydney optometrist Mr Shaun Chang stumbled across a bag of broken frames, and a trial lens kit with mismatched lenses dating back to the 1960s, he was shocked to find this was the extent of the Everest National Park communities’ optometry services, in the Himalayas of eastern Nepal.

From this, he established volunteer organisation Eyes4Everest. The organisation has serviced the primary eyecare needs of local communities annually since 2014 and is set to return to Everest and Langtang on 20 October 2024. Momentum behind the project for the past decade has also culminated in a permanent eye clinic to offer a more sustainable service.

A frequent trekker of Mt Everest, Chang was forced to turn back during a climb in February 2013, with heavy snowfall and poor weather conditions threatening him with frostbite.

During his downtime, he visited the local hospital in Khunde built by Sir Edmund Hillary – a New Zealander and the first person recorded to have reached Everest’s summit – where he was given a tour of the facilities by local staff.

“When they showed me the eyecare facilities they had at the hospital, I thought: ‘That just won’t do’,” Chang says.

In the eye clinic, he came across three bags of donated spectacles and a trial lens set with lenses out of order. Although he spent an afternoon teaching hospital staff how to organise them with a vertometer, he knew more had to be done to meet the basic needs of the community.

Up until that point, the extent of eyecare in the region involved patients sifting through bags of donated spectacles and choosing one that best suited their vision needs.

When establishing eyecare services for the Everest communities, Chang’s intention was to go through the regular avenues of philanthropy and partner with large, well-established organisations. However, the

organisations would only service regions with a greater population, and thus more of an eyecare need.

“My friend told me, if anything was going to happen, it was up to me to get it going,” he says.

The charity had some support from sponsors such as Melbourne-based lens manufacturer CR Labs and Australian-owned optical lens and equipment supplier Opticare, which was enough to kickstart operations.

Later, Eyes4Everest would partner with charitable organisation, the Himalayan Trust Nepal which was first established by Sir Hillary in the 1960s. It provides Nepalese communities with access to safe water, healthcare and education.

During the initial trip – Chang and a small team of two optometrists spent three days at the hospital. The first day was dedicated to teaching staff

Image: Shaun Chang.

Eyes4Everest has travelled to Everest National Park each year since 2014, with two upcoming trips in October this year.

Prescription glasses are made to order, with information sent to a dispensary in Kathmandu.

Image: Shaun Chang.

about the mission. The next two days they spent screening patients – 152 in total with 32 pairs of spectacles prescribed.

Although an impressive number, Chang recalls the patients that did not make the cut.

“We were exhausted, but there were still people waiting outside that we had to turn back,” he says.

“The patients – including kids – had walked three or four hours from other villages. Which meant they had to walk home in the dark when we couldn’t service them. It was very tragic, and heartbreaking for us. So, we decided that during the next trip, we’re going to travel to those villages rather than have them come to us.”

Chang realised that this too would be beneficial for those who were so visually impaired they could not leave their villages to trek to the hospital.

EYECARE HEROES

I ntegral to the operations in Everest National Park is Nepalese optometrist Mr Rickchen Sherpa.

Sherpa – who has recently relocated to Sydney from Nepal and is now working at Eyecare Plus Chullora – discovered Eyes4Everest through a Facebook ad in 2019 when the organisation advertised the need for a locally-based optometrist.

And when COVID meant the Australian contingent couldn’t travel to Nepal, Sherpa and a team of local team of optometrists ran the operations. For the volunteers, it is fulfilling to see the impact of their efforts on the local communities. Sherpa himself relishes the role and what he can do for his people.

He describes a case with a patient who had cataract surgery many years before and was wearing +11.00 D lenses. However, the nose bridge of his frames was broken, with one half of the frame holding the lens in place and the other held in place by a rope.

“I was really emotional seeing someone in that condition, and was so happy to see the impact that providing him with new glasses had,” Sherpa says.

In totality, trips normally take three weeks. They are slow, as volunteers must acclimatise to the high altitude.

The team conducts comprehensive eye exams, with the camp separated into stations. First, patient history and visual acuity testing is conducted, followed by binocular vision testing, and then by refraction and ocular health where the team determines whether ophthalmology intervention is required. In the final station, glasses are dispensed.

Chang stresses prescription glasses are made to order with the information for prescriptions sent to dispensaries in Kathmandu. Frames are fit in the clinic, with patients given the choice of single vision, bifocal, and multifocal lenses, among others.

He also ensures there’s a good choice of frames for patients, no matter how remote they are.

“I don’t like the idea of a bag of donated glasses with patients having to find one that works. It’s a lot of weight to carry and you’re not giving that person what they want style-wise and what they need vision-wise,” he says.

A unique problem to Himalayan communities and isolated villages in this region is the increasing prevalence of myopia. Chang noted that these communities are using their smartphones more frequently and so there has been myopic progression – which was virtually unheard of in the region in previous eras.

In response to this need for primary eyecare – and looking for a more permanent solution – Chang and Sherpa have set up a permanent eye clinic in Khunde – an addition to Khunde Hospital – which is the main hub for several villages in the region.

In collaboration with the Himalayan Trust Nepal, Eyes4Everest established the permanent base to service the primary eyecare needs of the area.

It joins a general ward, laboratory and dental clinic and officially opened on 17 November 2023 – 10 years after Chang’s first visit to the hospital.

“We successfully built a clinic that provides primary level of eyecare with an ophthalmic assistant servicing the villages,” Sherpa says.

To enquire, donate or get involved, visit eyes4everest.org.au

Shaun Chang.

Rickchen Sherpa.

Image: Shaun Chang.

Image: Rickchen Sherpa.

Image: Eyes4Everest.

Chang and Sherpa have set up a permanent eye clinic in Khunde in collaboration with the Himalayan Trust Nepal.

MiYOSMART Chameleon

Photochromic spectacle lenses that slow myopia progression

MiYOSMART Chameleon lenses adapt to sunlight, offering children continuous protection18,22* against harmful rays, without needing to switch glasses outdoors.

MiYOSMART Sunbird

Polarised spectacle lenses that slow myopia progression

MiYOSMART Sunbird provides sun and glare protection1,18 , ideal for photophobic children managing myopia with atropine drops. It preserves vibrant colours and contrast for outdoor 23 enjoyment.

No longer going with your gut

Based on decades of business intelligence know-how, ProVision has launched ProIntel –offering elevated business analysis capabilities for individual independent practices.

Optometrist Mr Stephen Lucas from Somerville & Merrin Optometrists in Tooowoomba, Queensland, was among the 50 initial practices piloting ProVision’s new ProIntel system and says it has helped him visualise and track business data on a scale he hasn’t been able to before.

The program, unveiled in May 2024 at O-SHOW24, performs practice performance reporting and benchmarking that independents part of the network can leverage to identify strengths and weaknesses within their business.

Typical collation of data such as KPIs, categorising sales based on product type, consultations and visualising business progression since the previous year, was a lengthy process for Lucas. Now, he can view dashboard reports, filter and organise information as he wishes – with 24/7 mobile access.

Systems of this calibre and nature are commonplace in corporate optometry, but ProVision has embraced the challenge to create a system that its practices – each with unique ways of operating – can leverage as well for a data-driven business strategy.

“It’s such a useful way to visualise the data. Before, it would take me a very long time to sit down and drill into the data, whereas now, it can literally be done in minutes,” Lucas says.

He says ProIntel has been easily integrated with his current Optomate Touch system – which transferred the plethora of data his practice had accumulated over the span of 24 years. Today, he can look at different facets of the business from several angles and at an unprecedented speed.

The system also protects patient information as it’s based on de-identified

data only. Moreover, Lucas has found utility in appointment hotspotting across his practice’s two locations, where he can analyse trends in consultations and patient demographics – something he wasn’t easily able to do before.

“We’ve looked at what our fill rates are like and our appointments across days, months, weeks, years. We can see what percentage of our available appointments are taken up,” Lucas says.

“You can see where your patients are coming from via postcode and track your patient demographics so you can see the age group of the patients. We’ve got two practices so we can compare one to the other,” he says.

The data can also be drilled down to individual optometrists, to identify patient demographics that each practitioner tends to see – which has also proven useful to Lucas with multiple optometrists across different locations.

FACT-BASED DECISION MAKING

ProVision business systems manager, Mr Andrew Parker, has been accountable for delivering the ProIntel project. He says the tool was born out of an industry need for the system.

“One of the big things we’re seeing is that we have a huge amount of data that’s living at an individual practice level,” Parker says.

“Therefore, we can give that tool to our practices so they can start to analyse their information and make fact-based decisions as opposed to gut-feeling decisions.”

Parker understands that business acumen may not come naturally to some, so ProIntel can bridge these knowledge gaps and guide practices through these learning curves.

“Over the years, ProIntel will grow and continue to improve based on member feedback and what they want out of a business intelligence system,” he says.

The underlying motive for ProVision is to provide business leadership and support for its practices – which it has embodied in ProIntel.

“From a marketing perspective we can analyse sales by postcodes, and combine this with age group and gender, and so we can start to analyse information combining a whole raft of relevant data dimensions. Ultimately, that’s the beauty of business intelligence,” he says.

CLEAR SALES PROGRESSION

For Lucas, ProIntel will allow him to identify areas of weakness and opportunity within his practices. This information can be extracted from product trends and seeing what works for patients.

“For example, ProIntel can help us when trying to promote contact lenses in the practice because we can gauge over time whether certain types of contact lenses or certain modalities of contact lenses are worn more than others,” he says.

“You can track the brand, the type of contact lens and even the package size of the lenses if you want.”

Beyond product, opportunities can also be found by breaking down appointments and identifying what services patients are mostly using.

“Over time, you can track whether patients are making use of extra scans

“We can give that tool to our practices so they can start to analyse their information and make fact-based decisions as opposed to gut-feeling decisions.”

Andrew Parker ProVision

Image: ProVision & Josep Suria/Shutterstock.com.

Image: ProVision.

for example, so it provides a lot more flexibility to drill down into the data in a way that we haven’t had access to in the past.”

Although this information has always been available to Lucas, it has not been readily accessible. Prior to ProIntel, he would have needed to dedicate hours to extract any meaningful data from previous practice management software.

Visualisation of data is key for Lucas as he can clearly see sales progression in graphical format.

ProIntel offers users nuanced visualisation – as opposed to basic sales figures – and the ability to deconstruct figures into specific groups or categories to create a personalised business analysis.

Patients can also be organised into age brackets, postcodes, new versus existing, health funds and more. Users can combine multiple dimensions which are then cross examined with sales.

ProIntel also plugs into the other ProVision services – such as Business Coaching. This can be described as a “hand-in-glove” relationship between information data and the Business Coaches. These coaches can provide guidance and leadership around how to take the practice from where it is currently, to where the owners want it to be.

Currently, the pilot program is being used as a sales performance reporting system so practices can visualise their sales history, appointments and inventory.

But performance benchmarking is soon to follow. Unlike traditional benchmarking initiatives that are run infrequently and can take considerable resources to deliver, ProIntel will provide a daily view of comparable groupings, allowing practices to see changes in real time with real market feedback to gauge their relative performance.

“Our Business Coach’s role is to try and help us improve as a business and with more access to more data and more benchmarking that just allows for better comparisons between practices,” Lucas says.

TARGETED ENERGY TO TREAT DRY EYES AND INFLAMMATION

“It gives you confidence that you’re moving in the right direction and confirmation that what you’re doing is actually working.”

Stephen Lucas Somerville & Merrin Optometrists Image: Stephen Lucas.

“It shows us trends and gives us encouragement or ideas as to how to improve on business based on the benchmarking of us versus others.”

Benchmarking will also show the identified groupings of practices to be able to see how the rest of the population went when it comes to sales trends. This may include looking at specific areas within the practices, such as billing, or the trends in mixed billing between Medicare and private health insurance.

Although in the preliminary stages of system use, Lucas is eager to see how benchmarking will elevate the practice.

“It gives you confidence that you’re moving in the right direction and confirmation that what you’re doing is actually working,” he says.

Parker adds: “Rational, fact-based decision making coupled with industry leading Business Coaching allows ProVision independent practices to tap into similar capabilities that large scale organisations use to build their strategic goals and measure their progress.”

“They can track progress using ProIntel and continuously adapt and improve along the journey.”

IS COMING N THING

from the darkness Emerging

For most, opening the blinds and heading into their day trouble-free is a privilege taken for granted. Yet for people living with migraine, this is all they want. Avulux – the first clinically proven lens that Australian optometrists are now prescribing for migraine and light sensitivity – is providing a gateway to a normal life for wearers.

or Ms Simone Dow of the Australian progressive metal band Voyager – and Australia’s entry into the 2022-23 Eurovision Song Contest – light is one of her biggest migraine triggers, but the new Avulux lens for migraine and sensitivity has given her career a new lease of life –

“As you can imagine, being a musician, you are assaulted with lights on

“But people don’t realise that you wear a variety of different hats as a musician. You’re also doing a lot of the business administration behind the scenes as well, so you’re on computers and screens and that can be

She now wears Avulux lenses nearly all the time – during gigs but also when she’s shopping, reading, watching TV, or working on the computer.

“The difference has just been remarkable,” she says. “I’m finding most days my symptoms for light sensitivity are at such a manageable level now just from wearing them regularly. I don’t know how I dealt without them; now

Dow is among patients across Australia who can now access Avulux. The lenses are the first to have been tested in a clinical trial and received FDA confirmation of classification to be marketed as general wellness tools, which may, as part of a healthy lifestyle, help people living with migraine. It has been available in the Australian market since 2020– exclusively through Melbourne-based lens manufacturer CR Labs – which is making it available

According to the World Health Organization (WHO), migraine ranks among the top 20 most disabling medical conditions, with a significant impact on quality-of-life and productivity and is three times more common in women than men. What can be a devastating neurological disease, it affects approximately 15% of the world’s population – and studies show 80%-90%

of people with migraine have light sensitivity.

A research team from the University of Utah in the US, comprising Avulux CEO and co-founder Dr Charles Posternack, noted that light at very specific wavelengths appeared to both worsen light sensitivity and overall discomfort in patients with migraine.

Described as a first for any optical lens, Avulux was able to meet the highest standard of scientific evidence, by proving it was both clinically and statistically better than a placebo, in managing both light sensitivity and light induced pain in subjects with migraine. This occurred after an independently run, randomised, double-masked clinical trial in 2020 comparing the Avulux precision optical filter versus a placebo lens.

From this patented approach, the Avulux precision optical filter was created.

“Using Avulux lenses can be like having their own portable dark room, allowing them to get back to living their life.”

Dr Charles Posternack Avulux

Image: Avulux.

ABOVE: Simone Dow, of Australian metal band Voyager, says the Avulux lens for migraine and sensitivity has given her career a new lease of life.

Wavelengths (circled red) of blue and amber light that are filtered by the Avulux lens, while soothing green light (circled green) is allowed through. Transmission curves (dotted lines) for FL-41, blue light and sunglasses lenses are shown in contrast to Avulux.

Source: Avulux.

Dr Posternack says his own motivation behind developing the lens was personal. After a long career as a practising physician and senior healthcare executive, he co-founded Avulux to provide his two daughters – who suffer from light sensitivity and migraine – an option that would help them.

Until 2019, options available to people with light sensitivity were scarce – these included dark sunglasses, which could result in chronic dark adaptation, meaning eyes become adapted to darkness and may become even more sensitive to light if used continuously.

“Today, my daughters are two of the many Avulux success stories from around the world,” he says. “Real-world experience shows that 90% of Avulux users find they can resume their daily activities while using Avulux lenses to manage the impact of light. It’s my goal that countless others who suffer from migraine and light sensitivity will enjoy similar life-changing benefits.”

CHANGING LIVES

Avulux made its debut in the Australian market when the company expressed interest in working with a local and independent lens lab, according to CR Labs’ professional service manager, Dr Fiona Om.

“CR Labs was excited to collaborate with Avulux to spread awareness about migraine and light sensitivity and to offer a product which provides a point of difference in the independent market,” she says.

Now, CR Labs is an exclusive lens supplier in Australia that offer Avulux in plano and prescription form.

Prior to the introduction of Avulux, eyecare professionals had few, if any, clinically proven lenses to recommend to patients with photophobia, which is why Lakeview Eyecare, in Melbourne’s southeast, had one patient leaving with three pairs.

The practice is among a handful of Australian independents prescribing the Avulux lens to patients who suffer from migraine or are photophobic – with many even reporting they are now medication free.

Lakeview Eyecare practice manager and optical dispenser Ms Belinda Clarey, and optometrist Mr Robert McQualter, say the response has been overwhelmingly positive. Patients are offered an easy to execute trial period and can decide for or against the lens. McQualter says most opt for it. Often, he says the relief for patients is instant and sometimes has the dual benefits of working as a preventative (if light acts as a migraine trigger) and symptom reliever. McQualter says the lens can be worn continually if the patient lives with chronic migraine or experiences continuous light sensitivity. It can also be worn during any trigger activities such as screen

time or under harsh lighting, at the onset of a migraine attack or aura and when experiencing light sensitivity.

Meanwhile, at Fresh Vision Optometrists in Queensland, Mr Brett Jenkinson’s patient was able to go to work once again after debilitating migraines. While the concept of ‘work’ is a bane to many, for Jenkinson’s patient, it meant she could participate in life. She could open her blinds, and leave the house; trivial things, the rest often take for granted, he says.

As a health practitioner, Jenkinson is no stranger to improving peoples’ lives. But with the Avulux lens, it gives him an additional and unique avenue to achieve this.

“It’s great to know my patient can leave the house more frequently and can now have a more normal existence instead of being regularly debilitated by migraine,” he adds.

Prescribing is simple – the only prerequisite for patients is a migraine diagnosis. They then complete a questionnaire by Avulux.

McQualter says: “The majority of patients that do go through a trial period are happy at the end, compared to those who aren’t – it actually makes a big difference to their day-to-day life.”

Overall, Dr Om says Avulux has received a positive response from optometrists and other allied healthcare professionals across the country.

“In particular, optometrists specialising in behavioural optometry who regularly encounter patients with migraine have embraced the product with open arms. They’ve prescribed Avulux and have reported significant success among their patients, to the extent where some have needed less frequent and lower doses of migraine medication,” she says.

BREAKTHROUGH LENS DESIGN

Research shows that specific blue, amber and red wavelengths of light can increase migraine headache pain while green light can soothe it.

The Avulux lens uses a patented nano-molecular technology to selectively filter harmful wavelengths of light while allowing soothing, green light through. This precise filtration targets wavelengths that induce melanopsin activation.

Melanopsin is a photopigment that is released when cells at the back of the eye, called intrinsically photosensitive retinal ganglion cells (ipRGCs), are exposed to light in the upper blue and amber range. Research in 2010 linked melanopsin-secreting ipRGCs to pain in people with migraine.

The filtration technology also targets wavelengths that generate larger electrical signals that can lead to pain via the optic nerve.

“People who experience light sensitivity and migraine often find they must retreat to a dark room when symptoms begin,” Dr Posternack says. “This takes them away from their families, friends, work and all the things they love. Using Avulux lenses can be like having their own portable dark room, allowing them to get back to living their life.”

Avulux lenses are exclusively available in the Australian market through CR Labs.

Image: Avulux.

Comparable high levels of UCDVA § and CDVA

Similar dysphotopsia profile with lower incidence of optical side effects

High degree of patient satisfaction for daily life activities

Enhanced spectacle independence from far to intermediate distances

Through the toughest of times, optometry has proven its resilience, making it attractive for prospective business owners and partners. There are various models for entrepreneurial eyecare professionals to consider, depending on their career aspirations. Here, Insight provides a cross-section of what's available across the Australian landscape, sprinkled with some wisdom from seasoned campaigners.

What are your options?

YOUNG INDEPENDENT FINDS STABILITY TO BECOME THRIVING OWNER

At the age of 24 – and only two years out of university – Ms Emma Slinger became an independent practice owner. She had no real business management knowledge and made some mistakes along the way, but between these and advice from Eyecare Plus – from both National Office staff and other members – she’s accumulated valuable knowledge to ultimately lead a thriving business.

Initially she joined the independent network – with 120 practices – because the practice, Eyecare Plus Karalee, was already Eyecare Plus-branded. With the practice going through ownership changes, she wanted

while learning how to hold the reins. Two years in she even did her due diligence, exploring other options.

“But I stayed because the value to membership with Eyecare Plus couldn’t be beaten. I had access to mentors who had seen it all before, marketing support and business operation support to help me grow my business,” she says.

Slinger says Eyecare Plus’ licence fees are reasonable at 0.7% of turnover. But in her 10 years as a member, she’s never paid the full licence fee due to it being offset by the Strategic Partner usage incentives and advertising support.

“Most of the time, Eyecare Plus has essentially been paying me money to be a member as my incentives have been greater than the licence fees,” she says.

Eyecare Plus allows her to “have my cake and eat it too”, receiving the benefits of clinical autonomy but the power of a joint brand and access to better discounts and extra support from suppliers.

“One of the best services available at Eyecare Plus is the done-for-you marketing included with your licence fees. Eyecare Plus National Office manages and funds the website with a customisable page for each practice, funds SEO marketing and even location specific Google Ads to help each practice generate more patients without having to lift a finger.”

For a small additional contribution, she says members can also access Meta (Facebook and Instagram) and catch-up TV advertising, something that is difficult for a standalone independent to achieve. “This is all possible because we have a joint brand,” she adds.

For optometrists considering ownership, she advises taking time and obtaining firsthand experiences and advice from colleagues who have done the same thing.

“There are so many costly mistakes I could’ve avoided if I had reached out to others first. Also, ensure that you seek the advice from other professionals such as an accountant and solicitor before making the purchase,” she adds.

Images: Eyecare Plus.

Emma Slinger became the owner of Eyecare Plus Karalee early in her career.

FIERCELY INDEPENDENT WHILE REMAINING ULTRA COMPETITIVE

Mr Mark DePaola’s entire professional life has been spent at Graham Hill Eyecare in Shepparton, Victoria – initially as an employee optometrist, a business partner and now as a business owner. His long tenure can be attributed to being part of a large, independent, passionate and professional team. The practice, a member of the ProVision network with 440 practices, employs six optometrists complementing one another with varying clinical interests.

With the clinical side supported by a suite of advanced technology, Graham Hill Eyecare has also achieved commercial recognition. It’s been awarded a Shepparton Chamber of Commerce Hall of Fame Award for 50 years of service to the Greater Shepparton region.

Being part of the ProVision network has been a “tremendous resource”.

The business can leverage the network’s buying power, business

coaching, practice management systems, networking opportunities and more.

“My business coach Julius Maloney provides an outside and industry wide view of our business offering. He provides great insights to improve our business model, culture and team structure. The buying power and particularly ProVision’s ProSupply ordering system make a great difference to us in stock control and value,” he says.

“We also utilise ProVision’s marketing campaigns, especially the end-of-year health fund campaigns, to provide professional and effective marketing messaging – it also saves me time and is efficient financially. ProVision makes it easier to ensure our business can continue providing our own special brand of individual and holistic eyecare while remaining cost competitive.”

After an extended period with the practice, DePaola was inspired to contribute at a higher level. By 2010, it became clear that for Graham Hill Eyecare to continue being an autonomous business without corporate influence, a succession plan to facilitate ownership transfer from Mr Graham Hill to himself would be key.

“Graham and I had always worked very well together, so the potentially daunting prospect of being ‘joined at the financial hip’ was made easy by our strong, long-term relationship and common goals,” he says.

“Business ownership can be incredibly rewarding as well as challenging at times. However, delivering the best eyecare experience is made all the easier by the brilliant and passionate team around me. Encouraging each employees’ strengths, training aspirations and personal goals to flourish has resulted in great team retention, business culture and continued growth in patient numbers.”

He says prospective owners should consider a workplace environment that will invigorate them long-term, supported by mentors and groups like ProVision.

“It may be a greenfield practice, or if it’s taking over from a current owner, an important ingredient to a successful ownership is to find a business partner or team you feel wholly comfortable with to share the good times, the challenging times and the vision of a bright future.”

RETIRING ON YOUR OWN TERMS WITH YOUR PRACTICE INTACT

The proudest aspect of Mr Ian Brigden’s optometry career is simple – his longevity. He’s been practising for 45 years and there aren’t many professions these days where one can say that.

But he’s also proud of having built his Nelson Bay practice, in the Port Stephens local government area north of Newcastle, NSW, from “almost nothing” in 1980 to what it is today. For most of its existence, Brigden’s practice has been independent, but in recent years he sought a transition to retirement.

That’s when he came across George & Matilda (G&M) Eyecare. Since its foundation in 2016, the network has partnered with several practices with owner optometrists, like Brigden, near the end of their careers. Now serving more than 100 communities, many of these practices are part of the fabric of their local area, so G&M has also made it a priority to find suitable, long-term successors, and is now offering buy-in partner opportunities.

“When I retire from fulltime practice next year, I will be 68, but will want to continue dabbling in optometry while enjoying some travel, fly fishing and improving my golf handicap,” he says.

“I knew others who had joined G&M and they all had good things to say and great experiences. I didn’t want to walk out and close the door, I have built this practice since 1980 and want to see the support I provide to the community continue.”

Since joining G&M in March 2023, Brigden says his consulting practices haven’t changed.

“I still see patients the way I always have. Clinical freedom was very important to me because I didn’t want to be told to do 15-to-20-minute appointments, or to have others trying to influence my prescribing habits – this doesn’t happen at G&M,” he says.

“Long term patients have been surprised when they come back in that everything seems the same and I am still here. G&M’s marketing is driving a lot of patients back to the practice. Our books are filled two weeks in advance, which can at times create its own challenges.”

Looking ahead, Brigden says G&M is already helping find a successor for the practice whom he will work alongside before pulling back.

“Anyone thinking of being a partner or selling their business should talk to G&M and they will probably be surprised. I haven’t had any regrets,” he says.

“I also recommend any early- tomid-career optometrists to consider regional areas. They have cheaper housing, better lifestyles, you are respected in the community, and can practise community-based optometry. Regional roles allow you to practise a wide scope of optometry and build good relationships with other medical professionals in your area.”

Since his practice joined G&M, Ian Brigden says his consulting practices haven’t changed.

Image: George & Matilda.

Image: Graham Hill Eyecare.

Mark DePaola says business ownership is most rewarding when a positive business philosophy is created to invigorate owners and team members.

‘IT

TAKES DEDICATION, BUT THE REWARD IS UNDOUBTEDLY WORTH IT’

meant she could lead a team she already knew and loved.

“The ability to continue to grow and develop beyond a clinical career, especially in terms of being a leader, has been a highlight,” she says.

“Helping develop early career optometrists from starting out to partaking in the partnership training program has been hugely rewarding for me, knowing that my contributions have impacted others in reaching their goals.”

For others considering partnership, she says it offers a career that’s rewarding and sustainable.

“Being able to work as a clinical optometrist who has also developed a set of skills around business literacy and leadership means you can constantly develop without a feeling of stagnancy – life as an optometrist can be repetitive, but in partnership no two days are the same,” she says.

“Your contributions to developing a team and making a store successful provides visible outcomes which you can take a lot of satisfaction from. The role takes a lot of dedication, but the reward is undoubtedly worth it.”

INDEPENDENT FINDS IDEAL CUSTODIAN

When university mates Mr Edward Kosmac and Mr Ian Clemens completed their optometry degrees together in 1989 and became housemates in their first year out –working for opposing independent practices in Bendigo – they began hatching a plan.

“Sharing our experiences we spent many a night talking about how we could provide a quality optometry service if only given the chance,” he recalls.

“That chance came when we opened our first practice in the rural town of Kyneton in January 1992. Along with help from friends and family we fitted the rooms out and took our first phone call on an old dial phone the previous tenants had left behind.”

Over the course of 30 years, Kosmac & Clemens Optometrists grew to six practices in regional Victoria, adding a third partner Mr Arthur Stevens along the way. In 2023, the practice joined The Optical Company (TOC) now with a 60-practice network.

TOC is part of Healthia – a major allied health group that itself was acquired in December 2023 by Pacific Equity Partners. TOC remains as the Eyes & Ears division of Healthia, offering independents various options, including an immediate or phased exit plan, as well as full or partial sale.

In Edward Kosmac’s case – creating a group practice over three decades – the energy to sustain the business was depleting. Three years of COVID trading stress and Arthur Stevens approaching retirement meant it was time for an energetic organisation to take over that was willing to preserve the legacy.

“At no stage did we ever feel comfortable having the business rebranded to be completely consumed by a corporate machine,” he says.

“Consequently, we were impressed with TOC’s approach which aligned with our general ethos; to behave and be seen as an independent group

FOR HIS BUSINESS LEGACY

“They were a delight to deal with during the negotiation process. Even after the acquisition we feel they are completely approachable for any operational concerns. In general, they’ve been extremely supportive of our desire to improve as a practice and entrench the Kosmac & Clemens brand within our communities,” he says.

Now working as an employee optometrist, rather than a director, Edward Kosmac says the practice feels as it always has with no perceivable change to his consulting experience.

“The main pro is that I can now focus all of my attention on practising optometry; it's a real privilege to provide my clients with the best of my skills as I enter the autumn years as a consultant,” he says.

TOC says it is in active discussion with several prospective additions to the business as the network’s growth continues. It welcomes new contact by interested independents.

Images:

TOC.

Edward Kosmac established Kosmac & Clemens Optometrist in 1992.

Images: Specsavers.

Christina Pizzuto is the optometrist partner at Specsavers Broadmeadows.

Dry eye: Patient identification, product formulation and therapy escalation

LEIGH PLOWMAN explores dry eye disease from a patient-identification perspective, discussing management options and highlighting the role of immunomodulators like topical ciclosporin in treatment escalation.

DABOUT THE AUTHOR:

LEARNING OBJECTIVES:

At the completion of this article, the reader should be able to improve their management of patients requiring treatment for dry eye disease (DED), including:

• Understand what a dry eye patient looks like, and how DED is often a combination of physical symptoms and environmental conditions, including recreational activities, that c an lead to DED and/or exacerbation of the condition

• Understand what to look for in terms of management options and how formulation matters when it comes to suitability for the ocular surface

• Understand when and how to elevate DED treatment if artificial tears are not enough

• Understand and manage DED patient expectations.

ry eye disease (DED) is a common condition worldwide, with estimates ranging from 5% to 50% of the population, depending on location.1 It’s a complex, multifactorial disease related to disrupted tear film homeostasis accompanied by ocular symptoms such as itch, blurring and discomfort.2 In addition to its complex pathophysiology, DED can be a symptom of numerous diseases, and can also be a consequence of systemic medications.

Making matters more complex, DED is commonly self-treated, often sub-optimally, before the sufferer presents to an eyecare professional. This delay in professional diagnosis and treatment can have a significant impact on patient outcomes, including patient mental health.3

Once diagnosed, determining the optimal management for each individual patient can also be difficult. In this article, we will explore DED from a patient-identification perspective, offer advice on the management options available, identify when and how to escalate treatment, and explore a case study to provide a practical example of the treatment of DED.

IDENTIFYING A DED PATIENT: SIGNS AND SYMPTOMS

The Tear Film and Ocular Surface Society (TFOS) launched the Dry Eye Workshop II (DEWS II) in 2015, bringing together 150 of the world’s foremost experts in the field of dry eye. Their objective: to provide a deeper understanding of DED and how to treat it.

As a result of this massive undertaking, the seminal TFOS DEWS II report was published, offering practical advice and an algorithm to aid with patient identification.4 Essentially, the TFOS DEWS II report explains that diagnosis of DED depends on a sequence of three areas of investigation following the presentation of a patient with a dry eye complaint: 1. triaging questions to determine differential diagnosis and potential comorbidities (and exclude conditions that can mimic DED)

2. risk factor analysis to determine likelihood of DED 3. diagnostic tests to confirm (Figure 1)

TRIAGING QUESTIONS

The TFOS DEWS II Diagnostic Methodology Report5 details the types of triaging questions that should be asked, and the basis for them, but in general, it’s important to explore the nature of the signs and symptoms presented to understand the likelihood of DED. For instance: assessing the presence, and level

DIAGNOSTIC PATHWAY FOR DED

Dry eye complaint

Triaging questions: e.g. Severity? Duration? Effect(s) on vision? Co-morbidities/medications

Analyse risk factors: e.g. age; gender; ethnicity; environment; medications

Diagnostic tests: quantitative (TBUT; OSS; osmolarity) and qualitative (OSDI, DEQ-5)

Figure 1: Sequential pathway for the diagnosis of DED. Based on the findings of TFOS DEWS II.4

or duration, of pain may uncover underlying trauma, infection or ulceration that could explain symptoms that otherwise may be deemed to be DED. Knowing the types of questions to ask, and how to investigate the responses to them, will do a lot of the initial heavy lifting when trying to diagnose DED.

RISK FACTOR ANALYSIS

Once satisfied that the symptoms presented are likely due to DED, the next step is to examine the patient’s risk factor profile. Broadly speaking, the risk factors can be broken into two groups: non-modifiable risk factors – such as age and gender – and modifiable risk factors, which include lifestyle, environment and current medications. Knowing the risk factors – women are significantly more prone to suffering from DED than men, for example6 – can again go a long way in confirming the presence of DED before any testing is even done.

DIAGNOSTIC TESTS

The final step, according to TFOS DEWS II, in diagnosing DED is the use of validated diagnostic tests. These tests take the form of both quantitative and qualitative methodologies that, together, can confirm a diagnosis of DED. Qualitative tests include the validated DEQ-5 (Dry Eye Questionnaire) and OSDI (Ocular Surface Disease Index) questionnaires, while quantitative options include Ocular Surface Staining (OSS) and Tear Break Up Time (TBUT). An example of the criteria for each of these tests is in Figure 2.

QUALITATIVE DIAGNOSTIC TESTS FOR DED

Symptomology screening (choose 1):

Ocular Surface Disease Index (OSDI) OSDI score ≥ 13

Dry Eye Questionnaire (DEQ-5) DEQ-5 score ≥ 6

QUANTITATIVE DIAGNOSTIC TESTS FOR DED

Homeostasis Marker (choose 1):

Ocular Surface Staining

Tear Break Up time (TBUT) < 10 seconds

Osmolarity

mOsm/L interocular difference

Figure 2: Diagnostic tests for DED and the baseline results required to determine the presence of DED. Based on the findings of TFOS DEWS II.7

TREATMENT OPTIONS FOR DED

Treatment follows diagnosis, of course, and the options available will depend on numerous factors, including DED subtype, the presence of inflammation, severity and impact of disease and past treatments.

Subtypes of DED

There are three types of DED, each requiring a different approach to treatment.

• Evaporative dry eye (EDE), characterised by excessive evaporation from the tear film

• Aqueous-deficient dry eye (ADDE), characterised by reduced secretion of tears

• Mixed dry eye (MDE), a combination of both EDE and ADDE2

While 86% of patients with DED suffer from increased evaporation,8 it is important to address all layers of the tear film, which will have a significant

treat the key physiological issues of DED: increased evaporation and reduced tear secretion, or hydration of the ocular surface.1

Careful and diligent use of ATs can break the deleterious cycle of DED and prevent exacerbation of the condition or further damage of the ocular surface, but key to this is determining the correct choice of AT for the subset of DED.

Not all artificial tears are the same; some may be oil-based and lack an aqueous component, which will be suitable for EDE but does nothing to address the lack of hydration. Conversely, a water-based product may effectively hydrate the ocular surface but may be short-lived if there is no oil component to sit on top of the eye and prevent or reduce evaporation.

WHICH ARTIFICIAL TEAR?

Choosing the right type of AT – especially in such a crowded market – can be tricky, but a simple maxim that may help with this is: consider the formulation. Understanding the necessary features of an AT (namely that it addresses all layers of the tear film) can come from knowing, in very basic terms, the key components in the formulation:

• Does the AT contain a lipid layer stabiliser? (Hyaluronic acid products, for example, often do not).

• Is water and/or hydrating ingredients such as glycerin present?

• Does the formulation interact with the ocular surface in such a way that it will prolong contact time, without increasing viscosity and compromising patient acceptability?

• Is the formulation positively-charged? This important point is often overlooked. The ocular surface is negatively charged, so a positivelycharged formulation has the best chance at remaining on the ocular surface by way of simple

PBS eligibility criteria for Ikervis requires the patient to have: Grading of corneal fluorescein

• a CFS grading of 4 at treatment initiation using the Oxford scale or equivalent;

• an OSDI score of greater than or equal to 23; and

• the condition must not be adequately controlled by monotherapy with a preservative-free AT substitute.

Patient's OSDI score

Patients answer each question on a scale of 0-4, with 4 being 'all of the time' and 0 'none of the time' OSDI is assessed on a scale of 1-100, higher scores representing greater disability

Patients re classed as normal, mild, moderate or severe DED depending on their score

therapy; in the case of inflammation to an anti-inflammatory agent such as topical ciclosporin (CsA).

Knowing when and how to escalate therapy can be tricky; TFOS DEWS II in their four-step DED treatment algorithm recommend topical CsA as a step two option to consider when step one treatment options such as ATs, lifestyle modification and lid hygiene are insufficient.5

Ikervis, a 0.1% CsA, for example is available in Australia and can be prescribed by optometrists and ophthalmologists for the treatment of severe keratitis in adult patients with DED which has not improved despite treatment with ATs. Crucially, there is no universal, clinical definition of severe keratitis and the decision to prescribe relies on the prescriber’s clinical judgement considering both signs (CFS grade), as well as symptoms (impact of DED on quality-of-life).

This is a particularly important point and should hopefully help when prescribers need to ascertain whether escalation to CsA is warranted. Ikervis is available to be prescribed as a PBS authority item for patients who meet specific CFS and OSDI requirements (Figure 3) and can be prescribed privately for patients who do not meet the PBS criteria.

A PATIENT’S DRY EYE JOURNEY

Every individual experiencing dry eye has a distinct narrative and journey, influenced by a variety of factors such as their overall health, medication regimens, environmental conditions and lifestyle.

‘Ben’* first presented to Otway Optical in Colac, Melbourne, in 2018 complaining of a sore right eye following an injury with a fire curtain. He had a central traumatic epithelial defect in the right eye and used eye ointments overnight.

Ben had three episodes of recurrent corneal erosion (RCE) until early 2022. As such, he started using a bandage contact lens alongside a hyaluronic

Ben returned to the clinic in May of 2023 complaining that the right eye often felt gravelly overnight, gritty upon waking, and dry during the day. While RCE was an underlying issue, it was clear that there was also something else contributing to these

Using the TFOS DEWS II algorithm, Ben was first asked triaging questions to determine his history followed by a risk factor analysis.He had a history of dry nose and mouth, hay fever, anterior blepharitis, conjunctivochalasis, ocular rosacea and meibomian gland dysfunction, and he was taking systemic medications for reflux, arthritis and an anti-depressant, the latter of which may have been

Further, Ben is a volunteer with the CFA as a bushfire instructor, renovates homes in his community, and is a target shooter. These risk factors, combined with his history, meant that dry eye was likely. His DEQ-5 score was 12 while TBUT

staining (CFS) - 'oxford scheme'

Figure 3: PBS eligibility criteria for prescribing Ikervis (0.1% CsA). Please refer to PBS Schedule for full information. Image: CSL Seqirus.

was less than 10 seconds, confirming the diagnosis according to TFOS DEWS II Diagnosis Criteria. Ben was then started on Cationorm eye drops, prescribed to instil every three hours.

Within two weeks, Ben felt that his eyes had improved a little yet were still a little dry overnight. Digging deeper, I found that Ben had mild lissamine staining, indicating aqueous-deficient dry eye, but the fact that his dry eye symptoms hadn’t improved adequately with an AT told me that keratitis was an issue.

This was the pivotal moment in Ben’s treatment, and it was clear that treatment needed to be escalated to an immunomodulator. While Ben did not meet the specific criteria for PBS, Ikervis was prescribed privately every evening, alongside Cationorm four times a day.

The key to ensuring compliance with treatment was to educate Ben on the journey; irritation is likely when CsA is being used to treat keratitis, but this is common and usually temporary, and the fact that CsA can be used consistently without the need to limit treatment time (as with steroids) means that treatment can have a lasting positive impact. Managing expectations with patients is one of the most crucial components of successful treatment. By June of 2023, Bens DEQ-5 score had dropped to 9, there was a significant improvement in his nasal lissamine staining and conjunctival hyperaemia

(Figure 4), he hadn’t experienced dryness, grating or gravelly sensations, and had been doing what he loved (renovating and target shooting) without issue. In Ben’s words, “my eyes have never felt so comfortable”.

SUMMARY

As this experience in the clinic shows, it’s hard to overstate the importance of a comprehensive approach to dry eye management – including proper diagnosis, risk factor analysis and patient education. Ben's case demonstrates how escalating treatment to include an immunomodulator, alongside appropriate counselling, led to significant improvement in his symptoms and quality-of-life. By sharing these clinical experiences, I hope to offer some insights into the complexity of dry eye and the importance of individualised treatment plans Ultimately, when a patient is diagnosed with dry eye, a responsibility emerges for the eye care provider, as well as the patient, which requires a dedication to the ongoing monitoring of the condition, and the willingness to adjust the treatment strategies when or if those conditions change.

*Name changed to protect patient confidentiality NOTE: This article was developed with the support of CSL Seqirus. References are available in the online version of this article or upon request.

BEFORE (23 MAY 2023)

AFTER (20 JUNE 2023)

OUR COMMUNITY SUPPORTING YOUR INDEPENDENT LOCAL SUCCESS

Safier | y.safier@eyecareplus.com.au or 0407 224 611

Rose | philip.rose@eyecareplus.com.au or 0416 807 546

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.

Eyecare Plus Mermaid Beach

Eyecare Plus Moss Vale

Eyecare Plus Orange

Eyecare Plus Wagga Wagga

Figure 4: Nasal lissamine staining of Ben’s eyes before and after treatment with Cationorm and Ikervis. Images: Leigh Plowman.

Service turnaround like no other

Experience the CR Labs difference.

Australian College of Optometry, Carlton, Victoria, Australia School of Optometry and Vision Science, UNSW Sydney, NSW, Australia Department of Optometry and Vision Sciences, University of Melbourne, Victoria, Australia Image: ACO.

Accommodation disorders: Recognising, assessing, and managing

When it comes to accommodative dysfunctions, LAURA DeANGELIS and TIM FRICKE say understanding and managing these conditions can help improve patient outcomes, alleviate symptoms and enhance visual comfort and efficiency. Ultimately, early detection and intervention will prevent potential long-term visual issues.

Today’s way of life places a high value on activities requiring close-up vision, such as reading, working at a desk and using computers. However, some people find these tasks challenging due to the requirement for accurate eye alignment and sustained, precise focus. Trying to perform these tasks without these abilities can result in eye strain and tiredness, and affect visual performance.

As society increasingly depends on tasks that demand close-up vision, it becomes more crucial for optometrists to recognise and manage these difficulties.

THE NEAR TRIAD

When a person changes fixation from one target at a given distance to another target at an alternate distance, several ocular systems need to be altered to maintain clear, single binocular vision.

The near triad links increased ocular accommodation, convergence and pupillary constriction when a person’s attention shifts to a near object. Accommodation provides near focus using parasympathetic control of the ciliary body to adjust crystalline lens shape via the zonules.1 Age is obviously a common disruptor of accommodation via lens hardening manifesting as presbyopia.2

LEARNING OBJECTIVES:

At the completion of this article, the reader should be able to ...

• Review the three main techniques to determine Amplitude of Accommodation (AA)

• Review the use of the Monocular Estimated Method (MEM) to determine accommodative posture

• Understand accommodative facility, and the test needed to measure it

• Review the five categories of accommodation disorders.

However, while neurologic or pathologic disruption of accommodation is rare, functional disorders manifesting with symptoms of blurred vision, asthenopia and diplopia are a relatively common finding in children and young people.3

These functional accommodative disorders can affect quality-of-life and might even make school performance worse. That’s why it’s important for optometrists to do the right tests, diagnose the problem and manage it properly to help patients get back to normal vision.4

DIAGNOSTIC TESTING OF ACCOMMODATIVE FUNCTION

A diagnostic assessment of accommodative function generally consists of tests probing some combination of four parameters: amplitude, posture, facility and range. Accommodation and vergence systems interact under binocular viewing

Functional accommodative disorders can affect quality-of-life and might even make school performance worse.

conditions, so dysfunctions of one system may contribute to problems in the other. The interaction also means that monocular and binocular test results may differ – practitioners should be mindful of the potential accommodation cues present in a test situation (proximity, blur, vergence), controlling each as appropriate to generate repeatable results.5

Ideally, testing should be performed in free space with distance correction in place. It is also worthwhile considering that as the system fatigues, for example towards the end of the day, more abnormal findings may reveal themselves.

AMPLITUDE OF ACCOMMODATION

Amplitude of Accommodation (AA) is a measure of the maximum dioptric focus attained by the accommodative system. It can be measured using three main techniques, which vary in test time, skills needed, repeatability and results.6 Practitioners should use the one they are most comfortable with and compare to normative results using the same method.

1. Push-up method

Patient views a target monocularly, starting at a distance appropriate for age (40 cm from the eye for a young person), then the target is slowly moved (at a rate of 0.50D/sec) towards the eye until the first reported sustained blur. It is important to use an accommodative target (letters or words in the smallest resolvable print) under good illumination

Image: ACO.

Amplitude

Posture MEM

Hofstetter, 19449

+0.50DS ± 0.25 Rouse, 198210

Range PRA/NRA +3.00DS/-2.50DS Wajuihian, 201911

Facility Lens Flippers 8cpm at near with ±2.00D flipper McKenzie, 198712

Table 1. Normative results for key diagnostic tests of the accommodative system. Acronyms: AA, Amplitude of Accommodation; MEM, Monocular Estimation Method; PRA, Positive Relative Accommodation; and NRA, Negative Relative Accommodation.

to enhance the patient’s ability to detect blur, and periodically monitor patient response by asking them to read the letters to ensure the target is not blurred. The reciprocal of the ‘near point of accommodation’ (in meters) represents the AA in diopters. Repeated measures can be helpful to observe sustaining ability.7 The ‘pull-away’ method is similar, but starts close enough to be blurred and moves away until reported clear.

2. Minus lens technique

Negative lenses are introduced in front of a monocularly viewed accommodative target in -0.25DS steps with the patient instructed to keep the target clear. The amplitude is measured as the strongest minus lens with which the subject can keep the target clear.6,7

3. Dynamic retinoscopy

With one eye occluded, a near accommodative target should be placed close to the eye and the patient asked to push the target away until it is clear.6 With the target held at this distance, the patient should be instructed to maintain a clear focus of the target while the examiner moves towards them.

Initially an ‘against’ movement is expected; the amplitude can be measured as the inverse of the

Accommodative Insufficiency (AI)

Accommodative Infacility

Accommodative Excess (AE) - commonly presents with convergence insufficiency

Ill-Sustained Accommodation

distance (in meters) at which a neutral reflex is first observed.6 If a ‘with’ movement is observed move the retinoscope away until neutrality is achieved.7

ACCOMMODATIVE POSTURE

Accommodative posture is the difference between the accommodation generated (response) and accommodation stimulus (demand). Patients can have a ‘lag’ or ‘lead’ of accommodation representing either a smaller or greater accommodative response relative to demand, respectively.7,8 Due to depth of focus, the accommodative response can be up to 0.75 D different than stimulus without any appreciation of blur.8

Posture can be measured objectively using the Monocular Estimated Method (MEM). Attach an age-appropriate accommodative target to your retinoscope and instruct your patient to focus on the target. Neutralise the retinoscopy reflex in each eye sequentially by interposing spherical lenses.8

Plus lenses indicate a lag (‘with’ motion) and negative lenses a lead (‘against’ motion). Remember that to minimise the effect of the

• Low AA

Less accommodation than expected for age across ≥2 tests

Difficulty changing focus from distant to near (and vice versa)

More accommodation generated than required OR difficulties relaxing accommodation

Normal AA but deteriorates with repeated testing

• Near blur

• Asthenopia with near work

• Intermittent distance blur after near tasks

• Intermittent near blur when starting near tasks

• Asthenopia with near work

• Intermittent distance blur after near tasks

• Asthenopia with near work

• ± Diplopia at near

• Near blur after time attending to near tasks

• Asthenopia with near work

• Lag on MEM (e.g. +1.50D)

• Fails minus component of facility

• Low PRA

• Fails plus & minus components of facility, both monocularly and binocularly

• Low PRA and NRA

• Variable vision

• Low lag, or lead (e.g. -0.50D)

• Low NRA

• Fails plus component of facility (preference for minus)

• AA decreases with repeated testing

• Low PRA

• Fails minus component of facility, with performance decreasing over time

• Lag on MEM (increasing over time)

Table 2. Key clinical signs and symptoms associated with common types of accommodative dysfunctions.3 Acronyms: AA, Amplitude of Accommodation; PRA, Positive Relative Accommodation; NRA, Negative Relative Accommodation; MEM, Monocular Estimation Method.

neutralising lenses on accommodation, the lenses should remain in front of the eye only briefly.3,7 An alternative to MEM is Nott’s method whereby the fixation target is held at a fixed near point while the retinoscope is moved further or nearer until a neutral reflex is observed.8

ACCOMMODATIVE FACILITY

Accommodative facility measures the ability to increase and relax accommodation in response to blur induced by alternating plus and minus lenses. The dynamics of the accommodative response can be assessed by measuring the number of cycles (one cycle represents the ability to clear one set of plus and minus flipper lenses, either with ±1D or ±2D) that can be cleared within a one-minute period while viewing an accommodative target held at 40 cm.

The test should initially be completed binocularly to give measurement of combined accommodative/vergence response, followed by monocular testing for subjects experiencing difficulties with binocular testing.3 It can also be helpful to note the patient’s preference for plus or minus lenses, and, when testing binocularly to check for suppression.

ACCOMMODATION RANGES

Positive Relative Accommodation (PRA) and Negative Relative Accommodation (NRA) measure the extent that accommodation can change while holding proximity and vergence stable. The patient views an accommodative target at 40 cm through their distance correction. Positive lenses are added binocularly in 0.25 D steps until first sustained blur, giving NRA. Then negative lenses are added to first sustained blur to measure PRA.3

ACCOMMODATION DISORDERS & DIAGNOSES

Accommodative dysfunctions can be grouped using the Duke-Elder classification into five categories: insufficiency; ill-sustained; infacility; spasm and accommodation paresis.13

Learn more

Accommodative insufficiency (AI) is the most frequently diagnosed (80% of accommodative dysfunctions), followed by infacility at 12%.14,15 Accommodation paresis is a rare sudden onset disorder of marked accommodation insufficiency accounting for less than 1% of accommodative dysfunctions and will therefore not be discussed further.

It is important to appreciate that clinical findings may not exactly match those described above. In reality, binocular vision problems may have more than one area affected. In addition, as accommodation and vergence systems are intrinsically linked you should always ensure that your testing and management encompasses both systems.

ACCOMMODATION DISORDERS & MANAGEMENT

Accommodative dysfunction is common, accounting for around 50% of patients diagnosed with binocular vision problems in optometric practice.16 Commonly reported symptoms such as blurred vision, asthenopia, and diplopia can have a marked impact on quality-of-life, and may contribute to diminished school performance and thus appropriate diagnosis and management of these disorders is critical.4

Uncorrected refractive error can cause accommodative problems.3 The first step in evidence-based management of accommodative dysfunction is therefore to consider how a distance refractive correction would impact the problem. If the accommodative dysfunction persists after correcting any significant ametropia, consider a near addition and/or vision therapy to alleviate symptoms and help patients to regain normal visual function.

A near addition should be considered for patients experiencing difficulty generating accommodation – classically, AI. In patients with AI, one study showed significant improvement in symptoms with both +1.00 D and +2.00 D reading glasses for eight weeks, however AA only showed significant improvements in the +1.00 D group.17 While the

keeping near additions lower may achieve better long-term outcomes. The MEM result minus 0.25 D may be a useful guide.

Vision therapy is the other option, and can be used sequentially to refractive correction and near addition, or in place of other options. A literature review up to 1987 concluded that vision therapy was an effective treatment for accommodative deficiencies, but most studies lacked randomisation or control.18 More recently, a large (221 children), well designed (randomised, controlled, and double-masked) study showed that vision therapy can improve both AA and facility significantly more than placebo over a three-month period.19

Vision therapy often works best in older children who can understand and follow directions. It can be performed at home (after in-office instruction), or purely in-office. Either way, compliance is critical to the desired outcome.

When managing any paediatric patient it is vital to clearly communicate your diagnosis, proposed management, including goals for treatment, anticipated timeframe, frequency of reviews, and associated costs to both the patient and their parents/carer. It is also important to discuss with patients the link between accommodative problems and other factors such as fatigue, stress and overwork.

Optometrists should always complete a thorough exam of ocular health especially when faced with potentially neurological symptoms (headache or diplopia) and consider referral if any doubts regarding their final diagnosis. Good communication with caregivers is an essential step for successful treatment.

CONCLUSION

Accommodative dysfunctions are common in children manifesting as clinically significant symptoms such as blurred vision, asthenopia, and diplopia. Their negative effects on quality-of-life and school performance necessitate appropriate clinical investigation, diagnosis and management to help these patients recover normal visual function.

NOTE: References are available in the online version of this article or upon request.

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.

Challenging

the conventional

Eyewear collections that are frequently updated and considered avant-garde – while still selling through the practice – are like gold for independent optometry. Face à Face is a brand that exceeds these requirements, providing a differentiating factor for stockists.

Angelo Street Optical, a high street practice in suburban Perth, has a philosophy that patients leave “looking good and seeing well”. The consulting room is considered the backbone of the business with thorough 30-minute appointments. But it’s eyewear that mostly pays the bills – and the team take pride in finding the ideal frame for each patient.

“In fact, we get disappointed if somebody tries out the first pair of frames, and says ‘that’ll do’, because we always have so much more to show them,” says partner and optical dispenser Mr Barry Telfer.

“We pride ourselves on having a genuine interest in our clients and avoid where possible the heavily corporatised brands, preferring to lean towards brands from independent suppliers.”

It’s fair to say Angelo Street Optical has the hallmarks of a fiercely independent practice. As such, for the almost 20 years it has been in business, Eyes Right Optical has been the practice’s mainstay frames supplier. The family-owned eyewear wholesaler is one of the leading suppliers to the independent optical market in Australia and New Zealand, importing brands from Europe aimed at the mid- to- high end.

Face à Face is one of the key brands – and is a label Angelo Street Optical has stocked since 2010. It fits nicely with the suburban practice’s clientele who have an appreciation for high fashion and beautiful, quality product.

“With Face à Face, we continue to see fresh designs and combinations and we’ve got a number of existing clients with deep trust in the brand. It does tend to attract the mature age wearer who is comfortable not wearing an instantly recognisable brand, but still want to look modern and vibrant,”

Telfer says.

“We also love that Face à Face has consistently stuck with a marvellous variety of exquisite Mazzucchelli acetates that are incredibly well cut and finished, with good joint structures. They’re not cookie cutter shapes and there’s always new models and colour varieties being introduced. I recently went to SILMO and what I saw in Paris was almost immediately available here in Australia – we’re right up there accessing the latest stock and trends.”

Mr Mark Wymond, CEO and managing director of Eyes Right Optical, says Face à Face frames are handmade, with a production and finishing centre in the French Jura region – one of its unique selling points.

“Handmade speaks to the precision hand finishing and polishing at the end of the production, which is evident in the final product. There’s no sharp corners or edges because it’s been meticulously cared for," he says.

First created in 1995, the Face à Face brand grew out of a passion for architecture shared by a small group of eyewear enthusiasts. Among them were Mr Pascal Jaulent and his partner Ms Nadine Roth, who sold the business to Danish eyewear designer and manufacturer Design Eyewear Group, which now counts Face à Face among nine brands in its portfolio.

Wymond says Jaulent and Roth had a close relationship with DEG over the years, and the latter has respected the essence of the brand.

“Face à Face and Eyes Right Optical also have a long history, which started around 1996, and it was one of the brands that put us on the map in Australia,” he says.

“Later, Face à Face became a part of Design Eyewear Group, which really helped professionalise the brand, adding to an already incredibly reliable brand in terms of consistently beautiful releases, with avant-garde style while also paying attention to saleability. It also allowed access to more marketing, video and imagery, availability of stock and creative design.

“For a creative brand, that’s sometimes very hard achieve, but Design Eyewear Group have done this while sticking to the DNA of Face à Face. The strong sales and brand heritage are evident. We’ve never sold more Face à Face than last year.”

Wymond says Face à Face is famous for beautiful colorways and adventurous styles. It’s avant-garde while remaining saleable for largely style-driven and boutique independents.

“The typical wearer is fashion-orientated. They have their own sense of personal style, while always giving equal appreciation to quality and

Images Eyes Right Optical.

Face à Face, famous for beautiful colourways and adventurous styles, on display at SILMO PARIS.

Business partners Wayne McCarthy (left) and Barry Telfer and their Face à Face display within their Perth practice.

comfort,” he says, noting the collections mostly comprise acetate frames, but there are some metal pieces.

“Anything that comes out with a black front with a safari print temple is always a hot seller. The bright pinks and bright blues are popular too, but we find new releases always end up as our bestsellers. It’s very quick moving collection; when the new release drops, there’s always increased interest.”

Wymond adds that Face à Face usually introduces four new collections per year – with the two main releases coinciding with SILMO Paris and MIDO.

A SYMBIOTIC RELATIONSHIP

When Angelo Street Optical first spoke to Eyes Right Optical sales agent Ms Maureen Bradley about stocking Face à Face in 2010, there were some nerves. The practice hadn’t introduced a collection at this price point previously,

“We worked with Maureen to get the right product mix for our practice and from there Face à Face just took off, it was amazing and we have never looked back,” Telfer recalls.

“We have what I’d describe as a symbiotic relationship with Eyes Right Optical. They are a delight to deal with. It doesn’t matter who you’re speaking with, they all have our best interests at heart and that shows. David and Gaye Wymond set the tone when we first opened an account with them, and the next generation, Mark and Lisa Wymond, have certainly continued that ethos. Natalie Alcock, the current WA rep for Face à Face, has also been exceptional helping us maintain our range for the past 10 years.”

Today, Telfer continues to be impressed with Face à Face’s artistic flair, consistency, style and materials. It stands out, so the practice has it on display in a prominent area of the store.

While Face à Face has allowed the practice to elevate its eyewear offering, from a business perspective, it’s also allowed Telfer to focus on high quality dispensing.

“We ensure our price-pointing compared to other stockists with the same product is very competitive. It’s helped define us, and allowed us to work smarter, not harder,” he explains. “As opposed to being known as ‘grumpy, old Barry’ performing 30 buy one, get one free dispenses a day, I’d rather do 10 good dispenses and come out at a similar place financially.”

INSIDE THE CREATIVE PROCESS

While DEG is based in Denmark, Face à Face’s design team remains in the heart of Paris, with the frames hand crafted in France, Italy or Japan, depending on the manufacturing expertise required.

As the design creative manager at DEG, Ms Marianne Desez is one of the key figures bringing Face à Face eyewear to life in the company’s Paris studio. Working alongside fellow designer Ms Claire Ferreira and new junior designer Ms Diane Bliek, she says they act like “colour paparazzis – always catching colour moments in our daily life, morning coffee, art exhibitions or shopping sessions”.

“We are colour hunters mixed with sculptor searchers. Actually, we could say that one of our main activities is ‘sculpturing colour’,” Desez says.

“We like crushy-tasty-intense sensations and our passion is to make it

At Face à Face’s birth in the mid-1990s, Desez says optical frames were mostly considered a medical device. But Ms Alyson Magee’s first Face à Face designs were considered an artistic statement for wearers.

Built on the founding principle to empower individuals with the confidence and conviction that comes from eyewear truly reflecting their essence, Desez says from the outset Face à Face challenged the conventional, bringing to life eyewear that combines avant-garde design, vibrant colours, and surprising shapes. Each collection is described as an invitation to explore new possibilities, to break free from the mundane, and embrace styles wearers dream of.

“With every curve, colour, and line, we strive to embody the spirit of Parisian artistry. Our eyewear is designed for those who see the world differently and who wish to reveal their unique perspective through what they wear. That’s why we say: Wear your vision,” she says.

“In 2014, Face à Face needed more power inside the international landscape and joined Design Eyewear Group. The unique association between French flair and Danish commercial genius gave Face à Face a second birth. Today our brand is distributed in more than 80 countries around the world and benefits from the latest logistical methods to ensure some of the best reliability in the createur eyewear industry. The possibility of combining high creativity and a strong sense of service is something rare and unique.”

Bright pink models are popular among Face à Face collections, as well as frames that are blue, or black with a safari print temple. Image: Eyes Right Optical.

At SILMO Paris, Face à Face NSW sales rep Maxime Peyrot (from left), Design Eyewear Group designers Claire Ferreira and Marianne Desez, and Eyes Right Optical owners Lisa and Mark Wymond.

Image: Eyes Right Optical.

Seeing

the world in a new light

Tokai’s CCP/CC400 lenses have been described as the underdog in absorptive lens design with colour variation that can be selected to suit a plethora of patient needs. The range is not widely known – but optometrists report their patients are pleasantly surprised with the level of visual comfort.

Optometrist Ms Sonia Shin, of Eyecatch Optical in Brisbane, has given Tokai’s CCP/CCP400 absorptive lenses her tick of approval – nothing says endorsement of a product more than getting a prescription yourself. As someone with mild cataracts, Shin says she feels instant relief and a greater degree of comfort.

“I definitely feel much more comfortable wearing the lenses,” Shin says.

After previously relying on sunglasses, a hat and blue-light control lenses to relieve the discomfort that came from glare, she finds the lenses a highly effective alternative or even complementary.

Similarly, her patients with retinal detachment, glaucoma and macular degeneration, among other eye diseases, all experience a similar level of relief.

“All my patients are very happy that I’ve recommended the lenses,” she says. “They’ve also never had any lenses like this before.”

Having established itself in Australia for five years, Tokai Optical Australia has seen a rapid increase in awareness as a high-quality lens manufacturer from Japan, with its range increasingly becoming a staple in many independent practices.

“Tokai lenses are synonymous with premium quality without necessarily carrying a premium price tag,” Tokai Optical Australia managing director Mr Justin Chiang says.

The CCP/CCP400 range utilises a selective light filter designed to enhance vision comfort and clarity, particularly for people with certain eye conditions affected by glare.

The CCP absorptive lenses can suppress 380 to 500 nm blue wavelength light – which is reported to potentially cause damage to the retina and cornea – and offer relief from glare. Meanwhile, products in the CCP400 series offer a wide colour variation to “provide a rich visual environment” and can be used to for all patient lifestyles, both indoors and outdoors.

Chiang says through years of research on the impact of light on vision

– especially for those with cataracts, glaucoma, retinitis pigmentosa, macular degeneration, and light sensitivity – Tokai has found solutions to the way various eye conditions respond to light.

“This research led to the development of the Tokai CCP/CCP400 range, which aims to eliminate or reduce specific light wavelengths for improved comfort and clearer vision for those in need.”

Although the range does not cure eye disorders, it’s designed to significantly improve vision quality and comfort by targeting the light that causes glare while allowing light necessary for clear vision to pass through.

“For instance, someone with glaucoma may experience glare or excessive brightness from computer screens, TVs, or even general lighting conditions, compared to someone with good vision,” Chiang says. “While a person with good vision might use lightly tinted sunglasses to reduce glare for everyday tasks, such lenses can reduce vision clarity for someone with an eye condition.”

In addition to degenerative eye diseases, patients with neurological disorders or light sensitivity find their visual comfort have improved with the lenses.

“The benefits extend beyond those with severe eye conditions. Anyone who experiences light sensitivity can find value in this range.”

Justin Chiang Tokai Optical Australia

Image: Tokai Optical Australia.

allow patients to legally drive in this environment because they are not limited by lighting conditions associated with certain tints.

Phuan says by offering these lenses, she has captured different patient bases. For example, she has patients with seizures referred to her by neurophysiotherapists to check for ocular dysfunction as there are some tints that can improve these symptoms.

“The benefits extend beyond those with severe eye conditions. Anyone who experiences light sensitivity can find value in this range,” Chiang adds.

“These lenses can function as sunglasses, offering a light tint with the effectiveness of darker sunglasses. This provides the advantage of maintaining clear vision when transitioning from bright outdoor environments to indoor spaces or tunnels.”

VISUAL NOISE-CANCELLATION

Optometrist Ms Sandy Phuan of Optical Connect in Queensland has special interests in paediatrics – but is expanding her scope-of-practice to capture neurological conditions as well. These patient profiles have been shown to benefit significantly from the lenses, including those with functional neurological disorder (FND) which is often associated with light sensitivity.

Those with visual snow syndrome – a disease characterised by a continuous visual disturbance that resembles the noise of a detuned analogue television – have also reported benefits when using certain tints.

“They’ve reported that there’s no noise in their vision,” Phuan says. “In this case, the lenses work in a similar way to noise-cancelling headphones.

“Usually, I go through an array of tests to check on the pattern glare and check for their sensitivity to light. We usually go through a number of different colours and see what their preference is and whether it will take off that pattern glare and discomfort with the line plates using the Wilkins Pattern Glare Test,” Phuan says.

Patients are given a trial consisting of a tint overlay to assess their visual comfort.

Relative to other specialty lens tints, Phuan says the CCP/CCP400 range offers a different intensity and more neutral colour options and with a photochromatic function. This protects patients’ eyes from UV rays, while providing full visibility in low light environments.

For driving at night, Phuan says there are a several tint options that

“Some of the tints can improve their ocular motility as well,” Phuan says.

Not a widely known option for light-filtering, Phuan says her patients are often relieved to have an alternative to dark polarised lenses.

“Some of my patients who used to wear dark polarised lenses and then made the switch to the CCP range felt that there was less glare even though the lenses aren’t as dense,” Phuan says.

Chiang adds: “The CCP/CCP400 lenses represent a range that many people are unaware of, yet it offers significant benefits to a broad range of patients.”

Similarly, Shin and Phuan came across the lens range at an O=MEGA conference, never having heard of it or of a similar alternative. They both saw the range as an opportunity to elevate their level of care. “It adds another layer to patient care and comfort,” Shin says.

To ensure patients and eyecare professionals alike are confident in the CCP range, Tokai provides comprehensive support.

Shin says Tokai’s service is unmatched and explains that if patients are unhappy with their prescription, the company is quick to offer its support, analyse the problem and provide a solution. She says this is particularly useful when there’s a learning curve for practice staff when adopting any new type of lens, such as the CCP range.

“It makes things easy for the new dispensers or new receptionist, for example. Tokai’s been very helpful in offering peace of mind to patients for trying something new,” Shin says.

Chiang adds: “While Tokai CCP/CCP400 lenses may not be widely known in the Australian market yet, the O=MEGA exhibition has generated increased awareness and interest. Educating eyecare practitioners about this range is crucial, as a significant portion of the population experiences light sensitivity that CCP/CCP400 lenses can address.”

Educating the public about this product and its potential to improve vision and quality of life is equally important, according to Chiang, as the lens series has a “proven track record of long-term effectiveness”.

ABOVE: The CCP absorptive lenses can suppress 380 to 500 nm blue wavelength light – which is reported to potentially cause damage to the retina and cornea (left); Sonia Shin, Eyecatch Optical.

The CCP/CCP400 range utilises a selective light filter designed to enhance vision comfort and clarity, particularly for people with certain eye conditions affected by glare.

Image: Tokai Optical Australia.

Image: Sonia Shin.

Image: Tokai Optical Australia.

Takagi’s

Transcending transactions

In its business dealings with eyecare professionals, OptiMed seeks to build meaningful relationships and deliver tailored solutions and comprehensive support to solve each practice’s complete puzzle.

Quality is a cornerstone of the OptiMed service. With a concentrated suite of core brands renowned for being the best in class, technical services and operations manager Mr Doug DeLaMare believes this is what has always defined the Australian ophthalmic product distributor.

With a rich background in electronics and optical equipment and a career in the ophthalmic instruments space spanning more than 25 years, DeLaMare knows the turf well. To him, a standout is Japanese-owned Takagi, which has been part of the OptiMed portfolio since 2001.

“In line with OptiMed’s ethos, we sought premium products to expand our range and believed Takagi was a great fit. We respectfully approached them with our strategy for the Australian and New Zealand markets, and 23 years later, the rest is history. We are proud to have such a long-lasting collaborative relationship with Takagi.”

The manufacturer is family-owned, with ophthalmic equipment such as slit lamp microscopes, imaging systems, diagnostic and specialist devices, and ophthalmic furniture, crafted by hand, and exclusively distributed to the Australian and New Zealand market by OptiMed.

“You walk into their factory, and to an extent, it’s like stepping back in time in terms of their hands-on processes, attention to detail and consistently high quality of the product,” DeLaMare says.

“For me, it’s that philosophy of doing things in a manner that produces a high-quality product from traditional methods and the pride of workmanship in their production.”

Although the company remains family-run, the number of employees has increased to 200. Takagi built a new factory in 2018, and production capacity has improved. Mechanisation is used where necessary to be efficient. However, traditional and delicate techniques are still used to make items carefully by hand.

Although there is a transitional process when customers shift from their

standard product choices, they soon appreciate the benefit this will bring.

“It’s a bit of a paradigm shift for eyecare professionals to move away from what they’re used to. But interestingly, once you get over that hurdle and people look at the product objectively, they tend to fall in love with it,” DeLaMare says.

According to DeLaMare, the price point for a premium product isn’t a deterrent. Customers who appreciate quality see the value.

“There is an educational journey to take the customer on when it comes to the level of investment because we are dealing with a high-quality product at the end of the day,” he says. “But then once they’ve experienced that, there is a willingness to continue investing in Takagi products.”

To do the expertly hand-crafted Takagi equipment justice, OptiMed backs this up with second-to-none service.

Essilor instruments manager Mr Mark Stapleton says the company takes this service a step further by transforming customer feedback into modifications, improvements and tangible products.

“We talk to customers and ask if they’re happy with what they’re getting and, if not, how we can improve things for them,” he says.

In one instance, OptiMed collaborated with Takagi to develop an ergonomic piece of equipment that addressed client concerns. With Takagi’s flagship device, the 700GL Slit Lamp, OptiMed’s team played a significant part in redefining an already premium product.

“We go above and beyond; but because of the number of practices that we’ve fit out and worked with, we’ve seen everything, and we know what works and what doesn’t.”

Mark Stapleton

OptiMed

ST-50 Smart Table allows the slit lamp to move up and down for best positioning and retracts neatly when not in use.

Images: OptiMed.

the fingertips of the practitioner  – they don’t have to reach for anything – and it’s great we get to help with this.”

CUSTOMISED SOLUTIONS

Stapleton says many OptiMed employees consider themselves part of the company’s furniture, and they bring an incredible depth and breadth of knowledge.

“We spend time learning about people’s businesses and will work out how we can assist them with increasing their patient flow and their points of difference with other nearby practices. We’ll also work out what products can assist this differentiation,” he says.

“We work hard on that and ensure we build a comfortable and safe environment for the customers.”

Greenfield practices are a case in point. Setting up a location from scratch isn’t just a matter of installing, bidding farewell, and returning to service when needed. OptiMed’s staff includes technicians, biomedical engineers, and electrical engineers, who work in synergy to find the best solution for the practice.

The team can help the practice owner visualise the best solution for the practice, from identifying the customer base to the ideal shop fit-out to which patients would respond best.

Stapleton explains that the team is equipped with expert knowledge, and they can even help practices develop marketing strategies.

“For example, one practice had a unique dry eye program. So, we set up a cross-communication channel between them and other healthcare professionals within the area,” he says.

Stapleton says delivering this level of service—covering all details from the start—ensures long-term satisfaction and an enduring partnership.

“We go above and beyond, and because of the number of practices that we’ve fit out and worked with, we’ve seen just about everything, and we know what works and what doesn’t,” he says.

“We can examine the plans for a new shop or practice and liaise with the architect and designer to find the best solution. We also need to discuss the future with the practice owner and ask them, ‘What do you want to do

now? What do you want to do in the future? Where do you envision business?’"

DeLaMare says the dedication and meticulous planning behind the team’s commitment to exceptional service includes out-of-hours work when suitable, which minimises disruption to clients’ operations.

“This requires careful planning and collaboration with clients, our team, and specialist freight companies. Our team strives to achieve high standards, ensuring installations are safe, effective, and aesthetically pleasing for our clients.”

DeLaMare emphasises realistic expectations for product performance and installation timelines. Honesty, transparency, and delivering on promises are fundamental when someone’s business is at stake.

“At our core, we are committed to exceeding client expectations,” he says. “This means being upfront about what our products can deliver and ensuring we follow through on our commitments.”

Central to this philosophy is the collaboration between technical and sales teams, ensuring that everybody is aligned and all the processes are working like a well-oiled machine, with the customers reaping the benefits.

Furthermore, DeLaMare says the company’s comprehensive product range positions OptiMed as a “one-stop shop” for clients’ requirements. Coupled with timely delivery and professional installation, he believes this approach helps build customer trust and loyalty.

This underscores OptiMed’s dedication to building lasting partnerships with its clientele.

Stapleton adds: “There’s no point just selling something and walking away.

“We will provide initial training and follow-up training in the weeks thereafter. We’ll still be available in the months and years after this, often customising configuration to meet customer needs.

Doug DeLaMare, technical services and operations manager.

Takagi’s flagship device –the 700GL – was upgraded to accommodate larger patients, with input from OptiMed customers.

spectrum-anz.com/careers-at-specsavers/

A looming

workforce crisis

A national strain on paediatric ophthalmology services is a symptom of greater systemic issues and funding uncertainty in public eye health. Industry figures discuss what’s needed to strengthen the subspecialty and why there’s still hope.

The paediatric ophthalmology workforce shortage has been described as a complex issue. But what’s clear is that it’s an issue exacerbated by limited training posts, government funding uncertainty, and a lack of incentives.

RANZCO describes it as an “impending critical shortage of paediatric ophthalmologists” in its ‘Vision for Australian Eye Healthcare to 2030 and Beyond’ report.

So how did we get here? In this report, the college outlines the current shortfalls within paediatric ophthalmology, including the maldistribution of ophthalmologists across urban and regional locations, a critical shortage of paediatric subspecialists, and a lack of funded training positions in the public sector. A 2021 RANZCO survey of public ophthalmology departments revealed 39% of them did not provide paediatric services.

RANZCO CEO Mr Mark Carmichael, they drew attention to the “worsening shortage” of paediatric ophthalmologists, caused in part by a “chronic” lack of funding in the NSW ophthalmic public health sector.

A COMPLICATED ISSUE

It’s not a new issue. In 2012, it was reported the critical workforce issue facing ophthalmology is the small number of paediatric subspecialists in Australia – a mere 20 full-time equivalents. It was noted this workforce is nearing retirement, which will affect training supervision capacity – a vicious cycle.

More recently, the NSW Government’s inquiry into healthcare, launched in August 2023, sought to identify ways to improve healthcare distribution in the state. RANZCO didn’t miss the chance to highlight the steps required for equitable access to ophthalmology services.

Authored by NSW branch chair Associate Professor Ashish Agar and

“These

are kids at the beginning of their lives who have everything going for them. And yet, we don’t have the systems or the funding in place to ensure that they’re able to have a decent high level of eyecare in the first critical months of their lives.”

A/Prof Ashish

Agar

RANZCO NSW & ASO

Dr Anu Mathew, paediatric ophthalmologist and director of ophthalmology at the Royal Children’s Hospital in Melbourne, says the workforce shortage is multifaceted – one facet being the subspecialty failing to appeal to new cohorts of medical students and ophthalmology registrars.

The treatment of children is relatively complex as specialists must be equipped with a unique combination of skills. Building rapport with children is challenging, as is ensuring their cooperation. Therefore, creativity is key to working with a child.

“When you examine a baby, you might need to do so while breastfeeding, while showing them a video, while singing a silly song or you might have to engage a toddler by talking about the colour of their shoes,” Dr Mathew says.

“There’s just an entirely different set of skills involved with examining paediatric patients that only comes through experience. It’s something you can’t learn in a lecture or a textbook.”

Dr Caroline Catt, paediatric ophthalmologist, and chair of the Australian and New Zealand Paediatric Ophthalmology Society (ANZPOS), says paediatric ophthalmology is an intellectually stimulating, complex area of ophthalmology that requires sound clinical knowledge, excellent communication skills, intuition and compassion.

To attract more trainees and registrars, she suggests increasing their initial exposure to the subspecialty. With a typical paediatric training rotation lasting three-months for an ophthalmology registrar, she says this is insufficient to develop the interest – or skills – required to practise in the subspeciality.

Image: Ashish Agar.

Image: Svitlana Hulko/Shutterstock.com.

Source: NSW Special Commission of Inquiry into Healthcare Funding, RANZCO, 2023.

“Exposing trainees to the subspecialty through a minimum of six months would go a long way to expanding and future-proofing our excellent, dedicated and hard-working current workforce,” she says.

Dr Mathew concurs: “The longer exposure means that they’ll be more comfortable with these skills and therefore more likely to enjoy it.”

For Dr Mathew, training does not necessarily have to be in one block but can be two three-month rotations.

“In Victoria, we’ve had a few registrars come in and do their training during their early years and then come back later,” she says. “Those registrars have found that highly useful because they’re building on their knowledge. They go away to reflect on their training, and come back with more experience. They’re well-equipped to learn more the second time around.”

Dr Catt says the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) has explored increasing the length of training and has found early exposure to the subspeciality coupled with good mentorship are essential to attracting more trainees.

“In Australia, RANZCO supports a minimum of six months of paediatric ophthalmology training in the five-year training program and are working towards making this opportunity available for all trainees.”

Dr Mathew adds that shortages extend to fellowship opportunities, with funding, space and a lack of interest straining the subspeciality.

“We should have at least two fellows in Victoria, ideally at both children’s hospitals.”

Dr Catt adds: “At The Children’s Hospital at Westmead, we have one paid fulltime fellowship position. For several years, this position was filled but unpaid, which is illustrative of the passion and dedication that paediatric ophthalmologists have for their subspecialty and their patients.”

To incentivise uptake of paediatric ophthalmology in Victoria, Dr Mathew says there is a non-training registrar position available for junior doctors at the Royal Children’s Hospital. The post, which sees them practise paediatric ophthalmology for a year, gives the junior doctor initial exposure to subspeciality before they begin the ophthalmology training program.

Beyond a lack of exposure, Dr Catt says funding limitations for public hospital positions on both a senior and training level, in addition to a preference for working with adults, are also driving the shortage.

Dr Mathew agrees, stating the paediatric subspecialty sometimes may not be appealing as others such as corneal or vitreoretinal surgery that have more cutting-edge treatments available.

Source: NSW Special Commission of Inquiry into Healthcare Funding, RANZCO, 2023.

The nature of the subspeciality means children will take more time than adult patients. Thus, Dr Catt says dedicated government funding would attract more trainees to paediatric ophthalmology.

“Expanding public hospital funding and resourcing would allow for the employment of more senior clinicians, opening of more public hospital outpatient clinics and operating theatre lists, and funding of more trainee positions would support an increased training rotation,” she says.

In 2014, RANZCO with the support of the Australian Society of Ophthalmologists (ASO), successfully lobbied for an increase to the paediatric ophthalmology patient rebate – which saw it rise 50%. However, this increase does not cover review appointments, which still take considerably longer than adult appointments.

“We get more Medicare rebates for new patients – we get paid one and a half times as compared to an adult patient. However, for review appointments, you get paid the same amount as an adult patient, but a paediatric appointment always takes longer,” Dr Mathew says.

Despite this step in the right direction 10 years ago, there have not been many developments in this space since, adds A/Prof Agar, now vice president of the ASO.

“The college was able to convince the government that if they don’t value a service, it’s going to be difficult for people to provide that service. The government accepted that argument and those changes were made.”

Ultimately, A/Prof Agar says the shortage is not merely a workforce problem but is part of greater systemic issues because of funding uncertainty in public ophthalmology. He says the workforce is not part of a system that supports and accommodates them, with the lack of funding resulting in scarce equipment and dedicated eye clinics in hospitals.

“If you have the right number of people trained, you still need funding for equipment and treatment devices. And you also have nowhere for them to be practising if the public hospital they would work at doesn’t have an eye clinic,” he says.

Similarly, Dr Mathew says if paediatric ophthalmology were to attract enough people to the workforce, healthcare facilities do not have the space to cater for an increased workforce as the subspecialty is typically competing for rooms.

“Even if we had paediatric ophthalmologists keen to work in the public sector now, we still need funding, clinic rooms, and theatre lists to be able to create a job,” she says.

NO INCENTIVE FOR RURAL PRACTISE

With maldistribution of ophthalmologists in rural locations, general ophthalmologists with a broad skillset are in high demand for these communities. However, Dr Mathew says they may not feel comfortable seeing children because they’re not frequently flexing their paediatric muscle.

Dr Catt says that anecdotally there is a disparity between urban and regional workforce, but this data is not accurately reported.

Currently there is no atlas to show what services should be delivered, and

“Exposing trainees to the subspecialty through a minimum of six months would go a long way to expanding and future-proofing our excellent, dedicated and hard-working current workforce.”

Dr Caroline Catt ANZPOS

each jurisdiction which would inform where the workforce needs to be distributed,” she says.

There’s also often a gap in resources required to provide paediatric ophthalmology. For example, a specialist anaesthetist and specialist theatre support are required because most surgeries are completed under general anaesthetic rather than day surgery. Often these resources are not available in regional centres.

Some of Dr Mathew’s colleagues have had to refer children under the age of one back to the city to be operated on because they didn’t have the regional resources and support to manage younger children.

“When there’s such a huge demand for ophthalmologists in regional parts of Australia, you must be a jack-of-all-trades and a great general ophthalmologist. This might sometimes dilute your paediatric skills, and unless you specifically try to see more paediatric patients, then the less comfortable you will feel treating them. Which means you’re less likely to see paediatric patients,” she says.

“They have to make a certain effort to keep up their paediatric skills.”

A/Prof Agar explains the regional situation is complex and aggravated by rigid government policy around length of service – or lack of – for the subspecialists.

Current regulations mean that there are regional centres where specialists can’t work at a particular location beyond a six-month period before having to reapply for a Medicare provider number.

This discourages subspecialists to settle regionally due to long-term employmen uncertainty.

A/Prof Agar, along with the ASO, has been attempting for many years

Image: Caroline Catt.

Dr Anu Mathew, director of ophthalmology at the Royal Children’s Hospital in Melbourne.

Image: Anu Mathew.

to support paediatric ophthalmologists who are already practising in regional centres to be able to remain and practise there.

“We know of a major regional centre where Medicare has been unable to give a paediatric ophthalmologist more than six months at a time. So, every six months their future is under a cloud, and this is an area of regional New South Wales where there’s not another paediatric ophthalmologist for hundreds of kilometres,” he says.

He has attributed this employment uncertainty to inflexibility of the system as the rules that define the current system were developed decades ago. He describes these parameters as “a huge beast you can only nudge incrementally”.

IT’S A PRIORITY

Despite the workforce shortage, paediatric patients continue to receive high-quality care in Australia.

The workforce shortage means that care is centralised, with children and their families having to travel to major population centres to receive their care. They often have to wait longer than they wish in some settings with waitlists blowing out to three months.

“It is important to note that high quality, urgent and emergent care is freely available through public hospital emergency departments all around the country. The workforce we have is highly trained and skilled and delivers care to children in the public and private sectors,” Dr Catt says.

Dr Mathew says paediatric departments do well in prioritising sight-threatening conditions, but those who cannot get an appointment are forced into the private sector which they may not be able to afford and also suffers from long waitlists.

“Despite our long waiting lists, we have a team that is constantly triaging

the list to make sure that no child goes blind while waiting,” she says.

“However, there’s a huge number of non-sight-threatening conditions where patients may not get an appointment or are unlikely to get an appointment in a timely manner.”

Dr Catt says one of the biggest challenges in solving the workforce shortage is driving innovative solutions.

For example, in NSW, RANZCO is collaborating with the Agency for Clinical Innovation (ACI) and Neonatology, and NSW’s chief paediatrician to advocate to NSW Health for digital screening of babies and placement of digital camera remote screening in NSW NICUs. This would streamline retinopathy of prematurity screening services and limit the need to transfer babies from one unit to another for screening purposes.

Meanwhile, A/Prof Agar says paediatric ophthalmology needs to be a publicly funded system, with no disparity between public and private services.

“These are kids at the beginning of their lives who have everything going for them. And yet, we don’t have the systems or the funding in place to ensure that they’re able to have a decent high level of eyecare in the first critical months of their lives,” he says.

Even though the sector has a mountain to climb, many are hopeful for the future of the subspeciality.

“This is a good example of the whole sector working together, making it more likely for real progress to occur. We know it’s going to take a lot of advocacy and a lot of work,” A/Prof Agar says.

“But it’s not as though we don’t know how to diagnose or fix or the problem. We simply need the powers that be to say, ‘Yes: A child’s eyesight is a priority, and we’re going to support a public system that enables doctors to save their vision’. If you do that, then everything will fall into place.”

VF2000 NEOPORTABLE VISUAL FIELD ANALYZER

The New Standard in Visual Field Testing

V irtual Reality Visual Field device - incorporates complete Visual Field analysis.

Detailed progression analysis and the most versatile & efficient vision screening technology. Latest technology provides the same reliability and reports as the “gold standard”.

Supplied complete with a Tablet PC –BlueTooth interface with the VF2000 NEO.

Compact/Space-saving/Portable - can be used anywhere, no need for a darkened room.

Active eye tracking –enhances reliability.

Full and Fast Thresholds VF Testing plus Neuro, Kinetic, Ptosis and Estermann tests FDT Testing

Acuity and Contrast Sensitivity Colour Testing (Ishihara, D15 and Advanced Colour Tests) Eye Mobility and Strabismus

Unleashing the potential of orthoptists

For Orthoptics Awareness Week 2024 (3-7 June), Australia’s peak body for the profession is drawing attention to the expanded role orthoptists can play to contribute even more effectively to a strained eye health system.

BY AMANDA FRENCH

Orthoptists are a crucial part of the eye health care workforce in Australia, working to screen, triage, diagnose and therapeutically manage a range of eye conditions, both independently and as part of the collaborative eye care team. Orthoptists also have particular expertise in the therapeutic management of amblyopia, strabismus and ocular motility conditions, and provide visual rehabilitation services.

In celebration of Orthoptics Awareness Week 2024, Orthoptics Australia is highlighting the positive impact of orthoptists working to their full scopeof-practice across a range of settings and practice areas.

The collection of articles compiled in this feature for Insight demonstrate the varied roles and settings in which orthoptists work, as well as emphasise the positive impact of orthoptic work on eye health outcomes.

- Ms Navdeep Kaur’s cost-benefit analysis of an orthoptist-led versus consultant-led optic pathway glioma screening clinic for children with neurofibromatosis type 1 at The Royal Children’s Hospital, Melbourne shows significant benefits of orthoptist-led paediatric service delivery, with improved patient experience, reduced cost and reduced wait times.

- Ms Natalia Kelly’s private Vision Matters clinic provides a great example of innovative therapeutic management provided in autonomous orthoptic practice. The positive impact of visual rehabilitation strategies such as eccentric viewing training for improving quality-of-life for those with low vision is of particular note.

Amanda French, Orthoptics Australia president.

- Mr Cem Oztan discusses the application of his clinical skills as an orthoptist at Vision Australia at the top-of-scope of practice to a role as a ‘classifier’ for Paralympic and Blind sport. Such work supports participation of athletes with visual impairment in elite sports, allowing them to perform to their full potential.

It’s a timely topic, given the government’s ‘Unleashing the Potential of our Health Workforce’ Scope of Practice Review is well under way – and Orthoptics Australia has made its voice heard through subsequent rounds of consultation.

Orthoptics Australia is also undertaking work to further define current orthoptic scope-of-practice including, advanced and extended practice, and promoting the importance of facilitating orthoptic work at top-of-scope to foster effective and efficient eye health service delivery across Australia.

Unfortunately, there is much work to be done, with several barriers to orthoptists routinely working to the top of scope-of-practice. This includes, varied state and territory legislation, limited recognition of self-regulated health professionals within legislation, lack of awareness of orthoptic expertise and competencies, funding models for allied health and workplace culture.

This series of articles puts into focus the significant benefits of orthoptists utilising their clinical expertise at the highest levels including improved patient satisfaction and quality-of-life, more timely access to eye health care and more cost-effective service delivery.

There is so much to be gained from addressing current barriers and unleashing the potential of orthoptists.

REALISING AND HARNESSING THE POWER OF ORTHOPTIST-LED CLINICS

Traditionally, the neurofibromatosis type 1 (NF1) ophthalmic care model was incorporated into general consultant-led clinics to screen for an optic pathway glioma (OPG) at The Royal Children’s Hospital (RCH), Melbourne. Following a presentation about the lack of uniformity in NF1 OPG screening at an international conference, RCH chief orthoptist Ms Cathy Lewis was inspired to implement a new NF1 eye screening clinic at the RCH. This was an opportunity to explore a different model of care adopting an orthoptist-led workflow. Using evidence-based research and collaboration with the hospital’s ophthalmology and neurology teams, a strict assessment protocol was developed for an orthoptist-led screening clinic for children diagnosed with NF1 and no known OPGs in 2016. During the past 20 years, two factors have driven increased economic evaluations within healthcare. Firstly, the pressure on healthcare budgets has shifted the focus from only assessing clinical effectiveness to incorporating cost-effectiveness. Secondly, data collected from economic evaluations has been integral to funding, reimbursement and decision-making within healthcare. At RCH, we conducted a cost-benefit analysis to assess if an orthoptist-led clinic was more cost-efficient than a consultant-led clinic for OPG screening in patients with NF1. Alternative models have been introduced across the allied health and nursing disciplines to increase patient access, manage long waiting lists, increase clinical efficiency and reduce unnecessary visits and costs. Although multiple studies have assessed the clinical effectiveness of an alternative care model, they lacked a costing component where monetary difference is assessed. We aimed to assist evidence-based policy change with the allocation of ophthalmology screening resources and therefore promote future orthoptist-led models. Our research demonstrated the cost-effectiveness of the orthoptist-led OPG clinic for NF1. From a hospital perspective, it significantly reduced appointment-associated costs. The orthoptist-led clinic resulted in a mean reduction of approximately $64 per appointment compared to the consultant-led clinic. Moreover, it reduced the patient’s overall time spent in the clinic without

whether an orthoptist-led clinic was more cost-efficient than consultant-led for optic pathway glioma screening in neurofibromatosis type 1 cases.

through reduced wait times/clinical interactions – and with no dilating eye drops. For the average patient, the total mean time reduction between the traditional care model and the orthoptist-led clinic was approximately 20 minutes, excluding waiting times. These findings underscore the potential of this service to lower healthcare costs, particularly in settings where resources may be limited. Healthcare comes at a significant expense for societies, so our findings can help inform future policy regarding the allocation of ophthalmic screening resources and the promotion of orthoptist-led clinics. An increase in orthoptist-led models of care will allow timely, cost-efficient care without compromising patient outcomes.

Reference: Kaur, N., Lewis, C., Staffieri, S., Ruddle, J., Goranitis, I., Stiles, J., & Dabscheck, G. (2023). Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics. The British and Irish orthoptic journal, 19(1), 26–34. https://doi.org/10.22599/bioj.288.

HELPING VISION IMPAIRED ATHLETES REALISE THEIR POTENTIAL

I have been involved with classification of vision impaired and blind athletes nationally since 2007 and internationally since 2011. Low vision services are delivered by a broad range of disciplines and social systems throughout the globe, with the primary focus of improving the patient’s use and rehabilitation of their residual vision, or use of other senses in the case of blindness.

Low vision is an important scope in the continuum of care in eye health outcomes and orthoptists play a pivotal role. Numerous studies on the impact of low vision and blindness have identified many findings; reduced quality-of-life, dependence, mobility and falls, fractures, subsequent injuries, mental health, cognition, hearing impairment, mortality, amplified effects of other conditions, and complications in the management of other conditions. Also, other conditions affect the management of eye disease.

Recent studies are finding people with vision impairment and blindness with sports participation show improvement to general health, social inclusion, balance, motor skills, communication, teamwork and positive relationships within all domains of quality-of-life.

Paralympic and Blind sports offers opportunities for all athletes who are blind or have significant vision impairment to compete in various levels of competition. It exists to provide opportunities for athletes who have a competitive disadvantage in non-Paralympic sport.

To determine an athlete’s eligibility for Paralympic and Blind sport, a group of officials, known as classifiers (traditionally ophthalmologists and now includes orthoptists), assess athletes to determine how their impairment influences their sport ability, regardless of their level of training or development. Classification is used to group athletes with similar levels of impairment into classes for equivalent competition. In this way, classification ensures that winning is determined by athletic

Sports classification is used to group athletes with similar levels of impairment into classes for equivalent competition.

Images: Orthoptics Australia.

Cem Oztan.

Images: Orthoptics Australia.

Navdeep Kaur.

Senior orthoptist Navdeep Kaur and colleagues at The Royal Children’s Hospital, Melbourne compared

ORTHOPTIST’S EXPERTISE TRANSLATES INTO POWERFUL REAL-LIFE MOMENTS

Vision Matters is a private orthoptic practice in Melbourne. We offer innovative services at the forefront of low vision care and vision rehabilitation. Our focus is on optimising the visual and ocular motor systems to improve quality-of-life in those who experience vision difficulties.

We work with clients of all ages with visual challenges including binocular vision dysfunction, ocular and neurological vision impairment, vestibular disorders and deafblindness.

At Vision Matters, we specialise in extended evidence-based orthoptic practice across three divisions including, biofeedback training, neuro-orthoptic intervention and learning difficulties. Our orthoptic-specific interventions include restorative techniques (including eccentric and null point training, prisms, etc.) and compensatory approaches (including visual field awareness, sensory integration, etc.) which is complemented by assistive technology, when required. Each client has a carefully considered, tailored intervention program curated for their needs.

To support patients with retinal pathologies, I developed a novel approach to eccentric viewing (EV) training. EV is a technique that enables a person with central vision loss to look off centre to view an object. My advanced EV training program combines visual and auditory biofeedback technology with home exercises. A retrospective study was conducted looking at the effectiveness of this program. The recently published outcomes showed all participants had significant improvements in distance and near acuity, contrast sensitivity and fixation stability. Additionally, clients who underwent this training reported reduced symptoms of depression and improved participation in hobbies and social activities.

My passion for neurological vision impairment inspired me to offer neuro-orthoptic services. When supporting clients with complex needs, I work collaboratively with families and other professionals to ensure there is a cohesive approach to achieving common goals. During therapy sessions, I’ve had the privilege to witness children

with cerebral visual impairment (CVI) roll for the first time, recognise and respond to Auslan and write their name. Additionally, my work with a stroke client has helped them regain their ability to read gardening magazines and move around their home without experiencing dizziness related to vestibular-ocular dysfunction.

More recently, we started supporting children with autism, ADHD and non-specific learning difficulties. These clients commonly present with visual processing difficulties, reduced binocular functions and atypical ocular movements. These visual challenges obstruct their ability to access their vision for learning. Implementation of simple vision strategies has made a difference to the child’s ability to use their vision for learning. Additionally, educating teachers and parents/guardians in how the student can access their vision for academic learning has been essential in creating pathways for accessible learning.

My work at Vision Matters is unbelievably rewarding and I’m fortunate to work in the vision rehabilitation space. My orthoptic training, experience and skills have armed me with a unique perspective to make a positive impact on individuals experiencing vision difficulties.

FASTER & CLEARER

ColorMatic® X fades from its maximum absorption to full clarity faster than any previous ColorMatic® generation – more specifically it is 54% faster than the previous generation. Whether commuting, working inside or doing free-time activities outside, our lenses provide protection, convenience and comfort – faster and clearer than ever before. For more information, speak to your Rodenstock Account Manager.

Image: Orthoptics Australia.

Natalia Kelly.

Natalia Kelly has interests in neurological vision impairment, neurodiversity and biofeedback therapy, is a Vision Matters founder, La Trobe academic, CVI-Community Australia co-founder and Paediatric Vision Impairment Alliance Australia founding member.

WHEN SOMEONE TAKES A CHANCE ON YOU

DISPENSER DETAILS

Name: Lucija Valentic

Position: Director Location: Base Curve

Optical, Victoria Years in industry: 17

1. What initially attracted you to a career in optical dispensing?

I’ve been wearing glasses since the age of five so as early as I can remember I’ve been surrounded by optics. Growing up in Germany, I always thought optics was a little out of my reach, so it took until my early 30s (now in Australia) until I was given a chance to step into optical industry. I will forever be grateful to my mentor and a guy that took a chance on me, Mr Chris McDonald. He is retired now but we keep in touch and every now and then he pops into my practice to say hello.

2. What are your main career highlights?

Opening my own practice, Base Curve Optical, in February 2019. This is located in Sandringham, Victoria. Also, winning the Outstanding Practice Owner Award at the recent 2024 ODA National Excellence Awards in Melbourne.

3. What are your strengths as an optical dispenser?

My strengths are product knowledge and having an innate ability to pick the most appropriate frames for my clients. I have a little check list in my head and when all boxes are ticked, I’m happy and my clients are happy. What excites me about my job is dispensing for children and helping them navigate the news of having to wear glasses or contact lenses, and dispensing for all their sporting needs. I am huge on sports eyewear, being sporty my entire life, I know how important it is to have great fitting glasses or goggles.

4. If you could provide advice to yourself at the beginning of your optical career, what would you say?

I should’ve done it sooner because I love everything about it. But there’s no regrets. I fell

into it when the time was right for me and fell in love with it. So as the saying goes: do what you love and you’ll never work a day in your life. That’s how I feel about it.

5. What are the opportunities and challenges facing optical dispensing in Australia?

I think optical dispensing is rewarding on so many levels. The challenges we face are probably the depth of training and number of trainees.

I feel there’s a shortage of skilled optical dispensers. The optical industry should think of some great incentives to entice more people into optical dispensing.

On another front, dry eye disease (DED) is emerging as a problem for many people and this is what prompted me to incorporate a dedicated dry eye treatment clinic within my practice. I suffer from it, and so does my mum, and we have some great success stories from our clients and their DED management.

6. How do you ensure your skills and knowledge stay up to date?

I try to attend as many seminars and new launch products as I can, be it in person or online. Over the years I’ve developed strong relationships with many product development

managers, and they keep me in the loop. I follow fashion trends in Europe and try to stay relevant with my product.

7. Why did you become a member of ODA?

I am grateful that ODA exists, and that it represents optical dispensers within the industry. I like to network and ODA is the perfect place where I can find other likeminded people – plus there is always a chance to learn something new. I also believe in the importance of giving back, and ODA is certainly doing that with its expedition to Fiji and probably other places in the future.

8. What did it mean to win the Outstanding Practice Owner Award at the 2024 ODA National Excellence Awards?

It meant validation of all the hard work I’ve put into building my own practice (greenfield). It was tough because the world stopped for two years due to the pandemic but somehow Base Curve Optical stayed afloat.

9. What would you say to others thinking of joining ODA?

Just do it, it’s a no brainer. The more members we have, the more voices we have.

Lucija Valentic’s Base Curve Optical is a greenfield independent optometry practice she opened in Sandringham, Victoria, in 2019.

TECHNIQUES FROM A BYGONE ERA

CHRIS SAVAGE has been taking optical dispensers, optometrists, and support staff back to the roots of eyewear production, in an experience he hopes will permanently influence their careers.

"NOT ONLY IS IT A STEP TOWARDS DEMYSTIFYING THE PROCESS OF EYEWEAR CREATION AND MAKING IT MORE PERSONAL AND ACCESSIBLE, BUT IT’S A VALUABLE LEARNING AND TEAM BONDING EXPERIENCE."

Having been an optical dispenser for 20 years, I had always noticed how little many in our industry knew about the manufacturing of spectacle frames. For the past 10 years I have rented a studio where I handcraft eyewear in a mixed creative arts space and saw the willingness of other creatives to share their craft and knowledge.

I thought it would be great to develop a workshop where optical industry figures could come and spend the day making their own pair. I also realised it would be an invaluable learning experience for optical dispensers to lean on when talking to their clients about the difference between mass-produced frames and handmade frames.

The latest workshop was held in collaboration with Optical Dispensers Australia (ODA) in Melbourne, directly after the organisation’s gala event in March. The collaboration came about after conversations with CEO Ms April Petrusma when ODA first launched in January 2022. I thought it would be a wonderful and unique workshop to support their mission, offering a one-of-a-kind experience, along with a great way for dispensers, optometrists, and support staff to bond and learn.

The latest workshop saw a diverse group of attendees, from optical dispensers working in and running independent practices to corporate training managers and graduating Cert IV students. I was thrilled to teach the art of frame making to such an enthusiastic group of budding frame makers, which would not have been possible without the support of ODA and Tokai Optical. Attendees were guided through a comprehensive, yet simplified, process of making a frame from start to finish. The day began with choosing from eight classic frame shapes and a plethora of colourful acetates. After the fun of selecting their style and colours, I guided them through the process of cutting out their selected shape using traditional artisan skills and a jeweller’s saw to rough out the shape of their frame. Following this, the students refined their shape by cutting them on a special acetate trimming machine designed

jeweller’s saw and to match the shape of their template. They then took turns using a mini router to create the groove in the frame to hold their lenses in place.

After some filing and sanding, everybody then got to fit metal nose pad arms along with their metal temples on to their acetate frame fronts before gently heating and curving the front to create the face form.

The workshop is a very hands-on day where, regardless of your experience, everybody can make a frame from start to finish.

No set of frames would be complete without a set of lenses in them. The team at Tokai Optical was gracious to offer everyone the choice of single vision, occupational, and EasyOne progressive lenses, in their choice of clear or tinted.

Ms Kylie Sargent from Tokai helped attendees to select their complimentary pair of Tokai lenses. I loved helping people select the colours for their sunglasses.

I am always excited to see the wide range of tint colours available and how well they complement some of the bold acetate colours included in the workshop.

For some, this was a chance to try Tokai’s 1.76 double aspheric high index

lens. The feedback from the workshop was overwhelmingly positive. Participants appreciated the hands-on approach and the opportunity to learn about eyewear design and production from industry experts. Many expressed satisfaction with their custom frames, highlighting the uniqueness and personal connection to their creations. One attendee commented: “I was in my element. Making your own frames, understanding what goes into making a frame – what’s not to love?”

I believe this workshop sets a precedent for more interactive and educational experiences in the eyewear industry. Not only is it a step towards demystifying the process of eyewear creation and making it more personal and accessible, but it’s a valuable learning and team bonding experience. With such good feedback we are already scheduling future workshops for 2024 and 2025 so keep an eye on the ODA events page, www.odamembers.com. au/events

ABOUT THE AUTHOR: Chris Savage has been an optical dispenser for 22 years, with 17 of those spent crafting bespoke frames for his brand, By Chris Savage. He then started his Make Your Own Glasses Workshops.

Attendees of the recent workshop cut out their selected shape using traditional artisan skills and a jeweller’s saw to rough out the shape of their frame.

Images: Chris Savage.

CLAIMS AND COMPLAINTS AGAINST OPHTHALMOLOGISTS

While patient complaints are an unfortunate part of providing eyecare, it can also shine a light on areas for refinement. Here’s what one medical defence organisation discovered.

"IN ALMOST TWO THIRDS OF CLAIMS AND COMPLAINTS (63%), THE CARE PROVIDED WAS ASSESSED BY EXPERTS AND/ OR REGULATORS TO HAVE MET THE STANDARD OF

In the ever-evolving healthcare landscape, it is important for all optometrists and ophthalmologists to understand and manage risk appropriately.

One way to explore your individual risk profile is to analyse previous medico-legal claims and complaints faced by peers and identify trends or common themes.

As Australia’s largest provider of medical indemnity insurance, Avant is uniquely placed to offer such insights. Using our extensive database, we have recently updated this analysis for ophthalmologists available on our website.

FREQUENCY

Our data shows that over the five years from FY2019 to FY2023, an

another type of matter about the provision of their care each year. By comparison, this was one in nine in our previous analysis.

TYPES OF MATTERS

Types of matters refers to the proportion of matters that are compensation claims, regulatory complaints, coronial matters or employment disputes or other types such as Medicare.

We found the majority of matters related to regulatory complaints with claims for compensation the second most prevalent.

COMMON COMPLAINTS BREAKDOWN

We analysed the data further to identify the types of medico-legal risks associated with compensation claims and regulatory complaints.

We found that the vast majority of complaints related to procedural/ surgical matters. While this is unchanged from the previous analysis, the new data shows claims and complaints relating to procedural/surgical increased by 19% while claims related to diagnosis and consent decreased by 6% each.

STANDARD OF CARE

COMMON THEMES IN PROCEDURAL/SURGICAL ISSUES

Phacoemulsification or other extraction/ replacement of crystalline lens – 55% Cataract

Plastic procedures on eyelid, brow – 10% Ptosis, blepharochalasis

Refractive or other keratoplasty – 7% Myopia, astigmatism

· Allegations of poor surgical performance/ skill or competence (e.g. deterioration of vision after surgery)

· Allegations of failure, misuse or improper insertion of lens

· Allegations of poor surgical performance/ skill or competence (e.g. poor outcome including damage to tissue or disfigurement)

· Allegations of poor surgical performance/ skill or competence (e.g. poor outcome)

Table 1: The following procedures were found to be common themes in the procedural/surgical complaints.

Our data showed that in almost two thirds of claims and complaints (63%), the care provided was assessed by experts and/or regulators to have met the standard of care.

INSIGHTS FROM THE DATA

The data from the most recent claims insights highlights procedural and surgical matters as being most associated with medico-legal risk. Below are some possible ways in which to help mitigate this risk.

R egularly review your surgical techniques to ensure they are in line with current best practice

Engage patients in a discussion about their condition, requirements, preferences and expectations –recognising that each patient is unique, and their expectations

2: The new data shows claims and complaints relating to procedural/surgical increased by 19%.

about results may not be realistic

• Following the consent discussion, check your patient’s understanding by asking them to explain in their own words what will happen

• D ocument your discussions –contemporaneous notes are crucial in continuity of care and when investigating any claim or complaint. Integrating these steps into your practice will help manage your risk while delivering patient-centred care and building a strong therapeutic relationship. Finally, receiving a patient complaint can be stressful and it is important to take care of yourself and seek support if needed. See Avant’s health and wellbeing resources or contact your medical defence organisation for further advice.

Figure 1: The majority of ophthalmology matters related to regulatory complaints with claims for compensation the second most prevalent.

Figure

THE UNKNOWNS OF IOP IN CHILDREN

BY PROF DAVID MACKEY & DR SAMANTHA LEE

M easuring intraocular pressure (IOP) in children can be a challenge particularly if repeated measurements are required.

Children with congenital glaucoma, congenital cataracts, anterior segment dysgeneses, aniridia, Sturge Weber syndrome, uveitis or those on steroid eye drops need to have repeated IOP measurements.

The gold standard for IOP measurement is the Goldmann applanation tonometer and a variant of this method, the handheld Perkins tonometer, was widely used in paediatric ophthalmology. This improved with the Tonopen, however, many children were uncooperative and examination needed to be performed under general anaesthesia. The anaesthetic drugs or mask/ ventilation could affect the IOP reading leading to high but often lower readings.

This challenge of paediatric IOP measurement was revolutionised by the advent of the rebound tonometer from iCare. This has

anaesthesia just for IOP.1

There are numerous studies that have compared the different devices, usually in clinic patients, with variable levels of correlation and often noting that the iCare may over-estimate IOP. 2

There was little data on the range of IOP measured by iCare in the general population and very little data on repeated measures over time. As the iCare is now widely used measure of IOP in paediatric practice, it is important to establish the normal range of IOP in children measured with the iCare and to assess the repeatability over time for this measurement.

Although we can now provide a newborn baby their genetic risk for developing glaucoma in adult life, we do not know when we need to initiate examination or intervention in at-risk individuals.

With the 2023 Quinlivan Research Grant from Glaucoma Australia, we are now evaluating the third generation of the Raine study in Western Australia. We had previously examined parents in generation two for numerous eye diseases and related biometry including IOP. 3

This study, also involving co-investigator and Postdoctoral Research Fellow Dr Samantha Lee, will examine IOP using the iCare in 200 children every six months for a total of three years.

The results of this research will be a population distribution of iCare IOP in children as well as a measure of how constant this is over time.

We will also examine young adults to determine IOP pressure changes through early adult life and whether genetic risk influences pressure at a young age.

This will enable never-before-possible research into the genetic, ifestyle and intergenerational aspects of IOP, as well as the creation of an IOP reference range for children. It will also improve our ability to monitor children and young adults at high risk of developing glaucoma and allow more timely intervention with the aim of decreasing glaucoma blindness. For more information on the Raine Study, visit rainestudy.org.au/ and rainestudy.org.au/second-leading-cause-of-blindness/

References:

1. Grigorian F et al. The use of the iCare tonometer reduced the need for anesthesia to measure intraocular pressure in children. J AAPOS 2012;16:508-510

2. Julia D, Tan S. Intraocular pressure measurements in paediatric glaucoma: A narrative review on accuracy, tolerability, and ease of use. Med J Malaysia. 2024;79:206-211.

3. Lee SS et al. Rationale and protocol for the 7- and 8-year longitudinal assessments of eye health in a cohort of young adults in the Raine Study. BMJ Open. 2020 Mar 25;10(3):e033440.

Names: Prof David A Mackey; Dr Samantha Lee

Qualifications: MD FRANZCO; PhD

Affiliations: University of Western Australia, Lions Eye Institute Perth (both)

Location: Perth (both)

Years in industry: 35; 7

THIS WILL ENABLE NEVER-BEFORE-POSSIBLE RESEARCH INTO THE GENETIC, LIFESTYLE AND INTERGENERATIONAL ASPECTS OF IOP, AS WELL AS THE CREATION OF AN IOP REFERENCE RANGE FOR CHILDREN.

Dr Samantha Lee.

Images: Lions Eye Institute.

Prof David Mackey.

JUNE 2024

CALENDAR EVENTS

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

THE ART OF OCULAR IMAGING (AOI) CONFERENCE 2024

Sydney, Australia 8 – 9 June artofocularimaging.com.au

GENEYE 2024

Melbourne, Australia 19 – 21 June geneye.org.au

JULY 2024

NORTH QUEENSLAND VISION CONFERENCE 2024

Cairns, Australia 6 – 7 July optometryqldnt.org.au/nqv

AUSCRS 2024

Hamilton Island, Australia 24 – 27 July auscrs.org.au

AUGUST 2024

The three-day ProVision National Conference, happening in Perth in from 30 August, will feature a trade show.

TASMANIA’S LIFESTYLE CONGRESS

Tasmania, Australia 17 – 18 August taslifestylecongress.com.au/

OPHTHALMOLOGY UPDATES!

Sydney, Australia 24 – 25 August ophthalmologyupdates.com

PROVISION NATIONAL CONFERENCE

AUSTRALIAN SOCIETY OF OPHTHALMOLOGISTS SKILLS EXPO

Sydney, Australia

1 – 2 June asoeye.org

EUROSCOLE AUSTRALIA

Melbourne, Australia 3 – 4 August euroscole.com

Perth, Australia 30 August – 1 September icmsmeetings.eventsair.com/provision-2024

SEPTEMBER 2024

SPECSAVERS CLINICAL CONFERENCE (SCC) 2024

Gold Coast, Australia 14 – 15 September specsaversclinicalconference.com.au

OCTOBER 2024

EYECARE PLUS NATIONAL CONFERENCE & AGM

Sydney, Australia 18 – 19 October eyecareplus.com.au/conference/

NOVEMBER 2024

RANZCO CONGRESS 2024

Adelaide, Australia 1 – 4 November ranzco2024.com

Last year’s RANZCO Congress featured glaucoma expert Prof Tina Wong (pictured), and will feature an equally powerful speaker line up at the 2024 edition in Adelaide.

Image: ProVision.

In June 2024, the Royal Victorian Eye and Ear Hospital will again host GENEYE, a fully immersive training event for both trainee and current ophthalmologists to strive for excellence in their field.

CHANGING LIVES THROUGH BETTER SIGHT AND HEARING

SPECSAVERS STORIES: HAMMILL PRASAWAT

WHY DID YOU PURSUE AN

OPTOMETRY CAREER?

Being around optometrists my whole life meant there was a natural curiosity about eyes. A profession that is dynamic and rewarding also meant optometry was in my crosshairs from a young age. It was my first preference coming out of high school, followed by engineering and actuarial studies. I still remember googling the ATAR and UMAT cut-offs and stressing in Year 12, hoping my marks were good enough.

HOW DID YOU COME TO WORK AT SPECSAVERS?

I started dispensing at an independent practice. A friend eventually recommended Specsavers and it resonated due to its mission to provide affordable eyecare and eyewear to all demographics. After a quick interview with Dylan – the retail director and my future mentor – I was suddenly spending my weekends at Specsavers. It was higher volume and faster paced than independent optometry, which I enjoyed.

WHAT WAS YOUR FIRST ROLE WITHIN THE BUSINESS?

I started out as a casual dispenser at a busy Sydney store during university. Working the shop floor taught me the dispensing side but moving into the clinic coordinator role developed my understanding of the levers driving the business and how the retail floor at Specsavers functions.

WHAT GROWTH OPPORTUNITIES HAVE PRESENTED THEMSELVES?

I was fortunate during COVID to secure a metro Sydney graduate role. Moving through the two-year Graduate Program meant developing my own clinical skills with mentorship but also growth opportunities outside of the testing room. This included travelling to work in regional areas, mentoring final year students/graduates, an outreach trip with The Fred Hollows Foundation, in-store projects, plus more. This

Specsavers

LET’S TALK!

In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today:

Joint Venture Partnership opportunities enquiries: Carly Parkinson on +61 (0) 478 201 057 or carly.parkinson@specsavers.com

Australia 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

culminated in the Pathway Program where I learnt more deeply about myself, the business model and my leadership skills. The biggest growth opportunity came with moving into designate partnership in another state, where I apply what I’ve learned and continue to build as a leader in a thriving business.

WHAT ARE YOUR CAREER HIGHLIGHTS SINCE JOINING SPECSAVERS?

Due to the partnership between Specsavers and Fred Hollows, a highlight was seeing first-hand see how optometry and ophthalmology were delivered in underserviced, remote and vulnerable communities. Travelling hours into remote land, being hands-on and seeing what’s outside my four walls opened my perspective of eyecare delivery as a whole.

WHAT IS YOUR MOST INTERESTING CLINICAL CASE?

A more memorable case occurred as a fresh graduate involving a patient with a sore red eye. It was a textbook case of angle closure. I clearly remember looking through the slit lamp and buying myself time, mentally ticking off all the signs and symptoms in my head, trying to remember the exact treatment protocol. On top of this, I had to whip out a Perkins tonometer which I hadn’t touched for months. I remember panicking in my mind and stepped outside to give my mentor at the time, Merna, a ring to seek advice. In the heat of the moment, it had slipped my mind exactly what to do, but the support of Merna meant the patient got the right treatment quickly.

WHAT EXCITES YOU MOST ABOUT TURNING UP FOR WORK EACH DAY?

No two days are the same – seeing patients, overseeing and managing a team, business planning, problem solving etc. Coming to work to a fresh challenge, developing myself and creating wins for others makes work exciting and creates a sense of purpose.

ALL SPECSAVERS STORES NOW WITH OCT

Optometrist Joint Venture Partnership Opportunity – Karratha, WA

We are currently on the lookout for expressions of interest for an Optometrist to join Specsavers as a Joint Venture Partner in our brand-new store opening in Karratha, Western Australia. Karratha is a seaside gem capturing the essence of coastal charm and natural beauty. With its stunning natural landscapes, including breathtaking coastlines and pristine beaches, Karratha boasts a picturesque backdrop for all who live there. If you are seeking a laid-back coastal lifestyle, with an array of outdoor recreational activities, a warm climate, and a welcoming community – look no further than Karratha!

Full-Time Optometrist Opportunity – Specsavers Woden, ACT

Join our vibrant Specsavers Woden team, located in Canberra! We’re seeking a full-time experienced optometrist, however, part-time applicants are also welcome to apply. Enjoy a competitive base salary of $130,000, a $10,000 sign-on bonus, relocation allowance, and superannuation. Work in a thriving 4-test room store with a clinical focus on Myopia control and pathology, serving a predominantly middle-aged demographic. Specsavers is committed to providing extensive support, development, and ongoing career growth, including pathway to partnership. Take the next step in your career and make a difference today!

Optometrist opportunity – Specsavers Invercargill, NZ

Seeking a talented optometrist to join our extraordinary team at Specsavers Invercargill. We offer cutting-edge technology, a friendly environment, and a commitment to professional growth. Embrace the relaxed pace of life and enjoy a perfect work-life balance. Explore stunning coastal views and enjoy a fantastic outdoor lifestyle. Don’t miss this incredible opportunity to be part of Specsavers Invercargill.

Graduate Opportunities

Thinking about getting out of the city with your friends? Specsavers have a number of exciting opportunities throughout regional Australia. In addition to the generous regional salary and relocation package, we are offering a ‘Go With A Friend’ bonus for select regional locations. Specsavers continue to be the largest employer of Graduate Optometrists across Australia and New Zealand with our industry leading two-year Graduate Program.

Specsavers Warwick Rose City Locum Opportunities

Specsavers Warwick Rose City are seeking locum support on Fridays & Saturdays throughout 2024. This is a great opportunity to secure ongoing work supported by highly motivated and passionate teams who work with you allowing you to deliver optimum patient care and the best customer experience that Specsavers is known for. With great rates available and accommodation & travel provided if required, this won’t last long, get in touch now to secure your booking.

People on the move

Dr Eve Hsing has joined OKKO Eye Specialist Centre in Queensland. She is a comprehensive ophthalmologist specialising in medical retinal conditions including macular degeneration, diabetic eye disease and vascular occlusion, as well as general eye conditions such as cataracts and pterygium surgery. Dr Hsing graduated from the QUT Optometry program with honours before completing her medical degree in her home state of Queensland. She is now available to see patients at both Auchenflower and Mt Gravatt locations.

Brisbane-based Dr Paul Gifford, a research scientist and industry innovator, and director of Myopia Profile.com, is also on the ZEISS Myopia Advisory Board. He will work alongside Sydney-based Professor Padmaja Sankaridurg who is heading up the advisory board. Ultimately, it’s hoped Gifford and other experts will enable ZEISS to incorporate a wide range of myopia management aspects into business-relevant decisions, to eventually offer holistic solutions that consider myopes of all ages.

Dr John Han has been appointed to the role of Vice President, Medical Affairs at Opthea, effective 9 April 2024. Dr Han brings more than 20 years of experience building medical affairs programs and partnering across organisations to lead pre- and post-launch initiatives for medicines in ophthalmology and retinal disease. Over the course of his career, he has served in senior leadership positions in medical and scientific affairs at leading biopharmaceutical companies.

knowledge will support the company’s innovations in myopia management. Among the 14-strong panel is Professor Craig Woods, Adjunct Professor at the executive manager of educational development for International Association for Contact Lens Education Contact Lens Research.

Dr Sotiris Plainis (UK), Dr Hema Radhakrishnan (UK),

renowned for his leadership in retina, including as a past president of the American Society of Retina. “It is an honour to join Apellis in its mission to deliver life-changing treatments for patients living with serious diseases,” he said. “I was an early adopter of SYFOVRE and have realised first-hand how impactful this treatment is for GA patients. I look forward to working closely with … this tremendously talented team to advance care for patients with this devastating disease.”

MELBOURNE BIOTECH FINDS NEW V.P. OF

CHOOSE TO SPECIALISE IN THE FIELD YOU LOVE

Join the home of some of the best optometrists in the business. With our experience and support, we offer the freedom to practice full-scope optometry or choose a specific area of interest.

Accelerate your career aspirations with OPSM. Visit opsm.com.au/careers today.