Insight July 2020 by Prime Creative Media

INSIGHT JULY

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

CENTURION® ACTIVE SENTRY®with ACTIVE SENTRY® Handpiece

Phaco’s most advanced control centre, at your fingertips*. Centurion

Vision System With ACTIVE SENTRY ™ Handpiece

Unused optical extras to roll over to 2021 and surplus funds to be returned to members.

PROTECTING OUR WORKFORCE Eyecare professionals adopt innovative COVID-19 protocols to mitigate infection risk.

HEALTH FUNDS REACT TO MEMBERSHIP DECLINE

*Based on the range of features available for the Centurion Active Sentry System that are not available with other devices currently on the market. ANZ-ASP-1900013

AN IOL TO ALTER THE CATARACT PARADIGM? Surgeons are talking up a new lens that could push monofocals to the periphery.

INSIGHT JULY

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

HEALTH FUNDS LAY OUT PANDEMIC BLUEPRINT AS THOUSANDS DROP INSURANCE COVERAGE

The private health insurance sector has vowed to return additional funds stemming from the cancellation of services, including for optical and ophthalmic care, as thousands of people dropped their cover as the COVID-19 crisis escalated during the March quarter. The commitment features in a raft of measures from the sector – which also involves a six-month premium freeze and roll over of unused ‘extras’ to 2021 – after many health fund members were temporarily unable to access the services they were paying for. It comes as the Australian Prudential Regulation Authority (APRA) released the March 2020 quarterly figures for private health insurance. It showed the number

of insured people with hospital treatment cover, which includes cataracts and other eye procedures, decreased by 9,760 compared with the December quarter. The largest decrease was 9,565 for people aged between 30 and 34, while the largest net decrease, taking into account movement between age groups, was for the 25 and 29 age group, with a drop of 11,176 people. In terms of general treatment (ancillary) insurance, which includes optical, there was a decrease of 13,894 people with coverage in the same period. The largest net decrease, after accounting for movements across age groups, was 9,888 for people in the 25 to 29 age bracket. Comparatively, last

According to consumer groups, people have been abandoning their private health insurance policies after the coronavirus pandemic left health funds charging people for services many could no longer use. The majority of cancellations were in younger age brackets.

year’s March quarter saw an overall increase of 11,634 people covered. Additionally, there was a 10.4% reduction in optical ‘episodes’ from December to March to 3.3 million, with $252 million in benefits paid. There were 82,920 ‘episodes’ for ophthalmic (prosthesis) services in this year’s March quarter, a reduction of 11.5% over threemonth period.

This was largely due to a monthlong suspension on non-urgent elective surgery. Some routine services like eyecare were also cancelled or difficult to access, as practices prioritised urgent cases or shut down entirely. Mr Dean Price, health campaigner at consumer group CHOICE, said the impact of COVID-19 on health insurance coverage would be seen more fully in the next quarter. “Policies that were poor value before COVID-19 have only become continued page 6

AGED CARE POLICIES MAJOR BARRIER FOR PATIENTS Blanket policies in aged-care facilities, including complete lockdowns and two-week quarantines for residents seeking external medical treatment, have been a significant barrier for patients needing anti-VEGF treatments, the Macular Disease Foundation Australia (MDFA) has revealed. The organisation told Insight it has made several individual representations on behalf of residents and their families to federal ministers, aged care peak bodies and several aged care providers, as a result of the stringent measures. It comes after ophthalmologists reported an initial 30% drop in scheduled intravitreal injection visits early in the health crisis

in March. This, according to the MDFA, was due to a disconnect between Australian Government guidelines and the community’s understanding of what constituted ‘essential care’, leading many to cancel their appointments. While numbers have improved since restrictions were eased, MDFA CEO Ms Dee Hopkins said some patients living in aged care facilities remained dependent on the individual policies of providers. “In the early stages and even in recent weeks, several families and ophthalmologists approached MDFA outlining concerns about aged care residents who were unable or unwilling to attend scheduled sight saving treatment

due to confusion about their provider’s policies,” she said on 5 June. “While aged care providers understandably were concerned about safeguarding residents’ health and wellbeing, blanket policies were often unnecessary where there were no cases of the virus. As providers are responsible for setting their own policies, policies varied from provider to provider and each state and territory had different COVID-19 containment stages.” Hopkins said policies included complete lockdowns so residents couldn't go outside the facility, while others who attended external medical treatment were asked to continued page 6

HYGIENE REIGNS SUPREME IN RETURN TO PRACTICE The days of casually leaning on the reception desk at medical clinics are gone, replaced instead with plastic screens, hand sanitiser and non-contact thermometers. page 25

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

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

UPFRONT Just as Insight went to print, QUEEN’S BIRTHDAY HONOURS were awarded to four professionals in recognition of their service to eye health causes. RANZCO Fellows Dr Harold Spiro and Dr Arthur Briner, both from Queensland, were awarded the Medal of the Order of Australia (OAM) for contributions to paediatric ophthalmology, and services to the Jewish community and ophthalmology, respectively. Sydney optometrist Dr William Trinh became an OAM recipient for service to international

WEIRD

humanitarian medical programs and optometry. Victorian theatre nurse Mrs Alison Plain was recognised for her service to Indonesia through eye health programs. IN OTHER NEWS, Centre for Eye Research Australia PhD graduate Dr Joshua Foreman has been awarded the University of Melbourne’s 2019 Chancellor’s Prize for his role in the National Eye Health Survey, the country’s first nationally representative survey of eye health. His findings have been used extensively by the eye health sector and have played a key role in driving changes in policy and service delivery. “I hope to develop screening programs and behavioural interventions that can be

adapted cross-culturally to meaningfully reduce the burden of preventable vision impairment, particularly from diabetic retinopathy,” he said. FINALLY, The Fred Hollows Foundation will redirect funds from a comprehensive eyecare project to supply five Bangladesh hospitals with personal protective equipment (PPE) and increase health messaging amid COVID-19. The foundation announced it had support from the Australian NGO Cooperation Program (ANCP) to repurpose funding that will assist nearly 100 eyecare professionals in Bangladesh. It is also anticipated to benefit 20,000 people in accessing eye health services and raise health awareness.

WACKY

Kiwi researchers have found the temperature of a sheep’s eye is linked to stress levels using thermal imaging technology. “Once you have the tools to measure stress levels in animals, you can then look at what situations or circumstances are causing more stress for the animals, and how you can adapt farming practices to enhance their welfare,” they told NZ Herald.

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

christine.clancy@primecreative.com.au

Editor Myles Hume myles.hume@primecreative.com.au Journalist Rhiannon Bowman rhiannon.bowman@primecreative.com.au

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

Client Success Manager Justine Nardone

WONDERFUL

A retinal surgeon who just ended his shift stepped in to save a UK man who tore his retina during a sneezing fit triggered by hayfever. According to KentOnline, his vision was blurred with dark spots and a ‘cobweb effect’. After a specialist failed to repair the tear with a laser procedure, the ophthalmologist worked overtime to perform the sight-saving surgery.

Published by:

Publisher Christine Clancy

STAT

Researchers at the University of Sussex found that zebrafish are able to use a single photoreceptor to spot their tiny prey. They have what’s known as an ‘acute zone’, an evolutionary forerunner to the human fovea where visual acuity is at its highest. The findings may provide insights as to how animals, including humans, process tiny details. n

insightnews.com.au

justine.nardone@primecreative.com.au

Design Production Manager Michelle Weston michelle.weston@primecreative.com.au

CATARACT BACKLOG Cataract surgery is the most common elective surgical procedure in Australia, accounting for 245,797 hospitalisations in 2014-15. Full report page 30.

Art Director Blake Storey Graphic Design Jo De Bono Subscriptions T: 03 9690 8766 subscriptions@primecreative.com.au

WHAT’S ON THIS MONTH

NEXT MONTH

The Publisher reserves the right to alter

PAEDIATRIC MEETING

WA CPD EVENING

or omit any article or advertisement

JULY 10

AUGUST 3

damages or liabilities that July arise

The RANZCO 2020 Paediatric Special Interest Group Annual Scientific Meeting will take place via Zoom.

The event is Optometry Western Australia’s regional CPD evening. Venue to be confirmed.

ranzco.edu

optometry.org.au

submitted and requires indemnity from the advertisers and contributors against from material published. © Copyright – No part of this publication July be reproduced, stored in a retrieval system or transmitted in any means electronic, mechanical, photocopying, recording or otherwise without the permission of the publisher.

INSIGHT July 2020 5

NEWS

ECONOMICS OF SURGERY COVERAGE 'MARGINAL' continued from page 3

worse value as the industry dithers on returning their unexpected windfalls back to their customers,” he said. Dr Rachel David, CEO of peak industry body Private Healthcare Australia (PHA), said savings from a reduction of services would look to be passed on to members, but this could take some time. “Health funds have given a commitment that any additional funds resulting from COVID-19 related restrictions causing cancellation of some elective surgery and some allied health services will be returned to members,” she said. “This is a continuing process and health funds will be regularly reviewing their financial position in coming months to provide as much support as possible to members. Given the constantly changing circumstances resulting from the pandemic, it is not possible to calculate this amount in advance. It can only be done retrospectively, once claims data has been submitted to regulators.” David added that “estimates of huge windfall gains by some so-called experts have proven to be excessive". This was due to the success of the Australian Government’s COVID-19 strategy, resulting in an earlier than expected recovery from a short period of

service reduction. Elective surgery for most urgent and semi-urgent cases has resumed, and cancelled cases have been rebooked, she said.

president Dr Peter Sumich, a cataract and refractive surgeon, said the economics of holding private insurance for ophthalmic surgery were marginal.

To ease pressure on consumers in the short term, David said insurers had postponed the April 1 premium increase for six months and provided premium relief for thousands of Australians. They also secured regulatory approval to roll over unused ‘extras’ benefits, including optical, to 2021, which is now available to all health funds.

Because eye surgery is a relatively commoditised service with high volumes and efficient services, he said the actual cost of an episode was not much more than an annual insurance premium.

Overall, the private health insurance sector anticipated a decline in member claims due to COVID-19 restrictions. “We expect APRA’s next quarterly report, reflecting data from April and May, to show some reduction in hospital claims, however with the lifting of the ban on elective surgery, this will be followed by a surge in claims in coming months," David said.

"ESTIMATES OF HUGE WINDFALL GAINS BY SOME SO-CALLED EXPERTS HAVE PROVEN TO BE EXCESSIVE" RACHEL DAVID, PRIVATE HEALTHCARE AUSTRALIA

“More patients are now paying directly for their surgery and saving on their health insurance by not paying for top cover. This is due to the failure of private insurers to keep up with medical inflation,” he said. “In fact, the private rebate refunded to patients for cataract surgery in 2020 is approximately the same as in 2008. The new requirement for patients to buy Gold Cover to pay for cataract surgery means that many are happy to forgo Gold, settle for Silver and pay their own way.” Specsavers director of communications Mr Charles Hornor said the overall figures demonstrated all sectors have been affected during COVID-19.

“Members with private health insurance will have access to timely care in the private system. This compares to the public system where wait times are expected to exceed 1.5 years for common elective procedures. It has never been more important for people to hang on to their private health insurance.”

"All of optometry will no doubt welcome the rollover of unused extras cover into 2021 – not only will it maintain and highlight value for health fund members, but also it will come as a much needed boost to optometrists whose businesses have been so sorely impacted." n

Australian Society of Ophthalmologists

TWO-WEEK QUARANTINE UNNECESSARY AND UNFAIR continued from page 3

be allowed to attend treatment without fear of quarantine.

quarantine in their room for two weeks.

“This week [5 June], we received a response from a large national aged care provider who have now relaxed their restrictions. We think it will take some time for all providers to follow accordingly,” Hopkins said.

“The 14-day quarantine became a major barrier for aged care residents to attend their treatment despite knowing that missed appointments could compromise their vision,” Hopkins said. “In one case a 92-year old aged care resident insisted on attending this scheduled appointment but on each occasion, he had to quarantine in his room with his wife for 14 days. He felt this was totally unnecessary and unfair as there had been no cases of the virus in the facility.” As a result, MDFA approached federal ministers, aged care peak bodies and providers with the request that – where no COVID-19 cases are present – residents

INSIGHT July 2020

Meanwhile, at the beginning of the health crisis, MDFA’s national research advisor Professor Paul Mitchell reported an initial drop of 30% of scheduled injection appointments while others reported varying reductions of between 5-10%. MDFA initiated a public campaign to ensure people kept attending their appointments. “Since the campaigns have run, Professor Mitchell reports that there

has definitely been an improvement in attendance. Each week the numbers improve and some patients who cancelled earlier are now attending,” Hopkins said. “Other ophthalmologists have reported similar improvements.” Dee Hopkins, MDFA.

In terms of quantifying the impact of COVID-19, the MDFA launched the inaugural longitudinal Macular Disease Social Impact study while Australia was in the initial stages of the pandemic restrictions. Prior to print, it added an open-ended question directly relating to COVID-19 and the impact this was having on the macular disease community. “We are currently collating this data and will be able to share patient insights in the not too distant future,” Hopkins said. n

NEWS

TGA WARNING OVER ‘MACULAR DEGENERATION’ REFERENCE A review of 13 medicines mentioning macular degeneration in Australia found all had inappropriately referenced the disease, prompting the health regulator to urge suppliers of listed medicines with eye health indications to reassess their compliance. The Therapeutic Goods Administration (TGA) recently announced the findings from its targeted compliance review, which began in 2017, after consumers and industry figures signalled that some listed medicines indicated for eye health did not meet regulatory requirements. This, according to the authority, was due to inappropriate referencing of macular degeneration and there being insufficient scientific evidence to support the indications. Macular degeneration is a ‘restricted representation’, a reference to a serious form of a disease. As such, reference to a ‘restricted representation’ in advertising requires a formal application to the TGA’s Delegate of the Secretary. Two of the 13 medicines were cancelled at the request of the sponsor after receiving a TGA request for information. The sponsors of both medicines stated they had been discontinued and no longer manufactured. The remaining 11 progressed to review. During the process, one medicine was cancelled before the review was completed. The remaining 10 were assessed and found to be non-compliant. In total, the TGA stated five of the 10 medicines reviewed referred to the restricted representation of macular degeneration either directly or indirectly, included indications that were not sufficiently supported by the evidence held by the sponsor and advertised indications that were not included on the Australian Register of Therapeutic Goods (ARTG). As a result, one of those was cancelled by the sponsor after they were informed of the issues. The labels and/or websites for the four other medicines were revised by the sponsors to remove restricted representations, any unsupported indications, and indications made about the medicine that were not included on the ARTG. The remaining five of the 10 medicines reviewed did not refer to the restricted representation of macular degeneration,

but included indications that were not sufficiently supported by the evidence held by the sponsor. Subsequently, three of those were cancelled by the sponsor after they were informed of the issues with their medicine. The labels and/or websites for two medicines were revised by the sponsors to remove any unsupported indications relating to eye health. In its public alert, the TGA noted a large study called the Age-Related Eye Disease Study (AREDS), which was followed by another called AREDS2. The studies examined the effect of a number of different antioxidants and other nutritional supplements on the progression of age-related macular degeneration and cataracts. “These studies recruited participants who were known to have eye disease, including early or advanced macular degeneration, which is considered a serious disease. Any reference to these studies in listed medicines is also considered a restricted representation,” the TGA stated. “In addition, these studies and any others that are not performed on healthy individuals are not appropriate evidence to support claims made about listed medicines.” Following the review, the TGA advised sponsors of listed medicines with indications relating to the eye, and in particular the macula, to re-assess their ARTG entry, label and advertising material and ensure their compliance with regulatory obligations. The agency said suppliers should ensure appropriate evidence to support all indications for the medicine. They should also secure prior approval from the TGA for reference to restricted references in the advertising materials. n

IN BRIEF “THESE STUDIES AND ANY OTHERS THAT ARE NOT PERFORMED ON HEALTHY INDIVIDUALS ARE NOT APPROPRIATE EVIDENCE TO SUPPORT CLAIMS” THERAPEUTIC GOODS ADMINISTRATION

ZEISS FINANCIALS

Zeiss Meditec generated revenue of €714.9m (AU1.16 billion) in the first six months of 2019/20. It represents an increase of 7.2% compared with the same period of the prior year. “Our revenue growth in the first six months of the year is the result of basically solid demand for our products and solutions,” Dr Ludwin Monz, president and CEO of Zeiss Meditec, said. “However, we, too, were significantly impacted by the effects of the COVID-19 pandemic during the second quarter, which was initially evident in the Asia/Pacific region and was then also abundantly clear in Europe and North America in March.” Revenue in the ophthalmic devices strategic business unit increased by 5.5% in the first six months to €517.7 million.

AAO CONDEMNATION

The American Academy of Ophthalmology has condemned US law enforcement after peaceful protesters were blinded by rubber bullets. “These life-altering eye injuries are a common result of urban warfare, rioting and crowd dispersion. We have seen it around the world, and we now see it in the United States,” it stated. Following numerous serious injuries over a two-week period after the death of Mr George Floyd, the academy called on officials to immediately end the use of rubber bullets to control or disperse crowds of protesters. The academy also asked physicians, public health officials and the public to condemn the practice.

VERACITY QUESTIONED

An article that found hydroxychloroquine increases the risk of death in coronavirus patients has been retracted due to doubts over its veracity. The drug, which can cause retinal toxicity and irreversible blindness, was the subject of a study in The Lancet involving 96,000 coronavirus patients across 671 hospitals worldwide. Its findings led the World Health Organization to suspend its testing on the anti-malaria drug. Three of the study’s authors said they could no longer vouch for its veracity because Surgisphere, a healthcare firm behind the data, would not allow an independent review of its dataset.

INSIGHT July 2020 7

NEWS

NOVARTIS CONTINUES PBS PURSUIT FOR BEOVU Novartis’s new drug anti-VEGF therapy Beovu will be reconsidered for listing on the Pharmaceutical Benefits Scheme (PBS) this month. The therapy, which was registered by the Therapeutics Goods Administration in January, went before the Pharmaceutical Benefits Advisory Committee (PBAC) in November and March, however the independent advisory panel is yet to recommend it for the subsidised medicines program. Novartis believes that Beovu (brolucizumab) represents an important treatment option for patients with neovascular AMD and says the twin Hawk and Harrier studies, in which it was compared head-to-head with Eylea (aflibercept), have demonstrated Beovu’s safety and efficacy. The therapy has now been approved in more than 30 countries, including all major markets. In its latest decision from the March meeting, the PBAC said it considered the claim of non-inferior efficacy compared with aflibercept was reasonable, a finding consistent at an initial hearing in November. However, the PBAC considered the claim of non-inferior safety was not adequately supported due to the higher incidence of ocular serious adverse events reported for Beovu in clinical studies. “The PBAC noted the American

Society of Retinal Specialists (ASRS) had received anecdotal reports of retinal artery occlusion and intraocular inflammation following approval in the United States and considered this increased the uncertainty regarding comparative safety,” a decision outcome statement said.

“WE BELIEVE BEOVU CONTINUES TO REPRESENT AN IMPORTANT TREATMENT OPTION FOR PATIENTS WITH WET AMD, WITH AN OVERALL FAVORABLE BENEFIT-RISK PROFILE” MARCIA KAYATH, NOVARTIS

A Novartis spokesperson told Insight the company was disappointed with the PBAC’s March decision.

marketing cases of severe vision loss, retinal artery occlusion and/or vasculitis with Beovu. On 11 June, the US Food and Drug Administration was among the first to approve the updated label. It includes characterisation of adverse events, retinal vasculitis and retinal vascular occlusion, as part of the spectrum of intraocular inflammation observed in trials and noted in the original prescribing information. "This label update provides clinicians with important information to guide treatment decisions. We believe Beovu continues to represent an important treatment option for patients with wet AMD, with an overall favorable benefit-risk profile,” Dr Marcia Kayath, global head of medical affairs and chief medical officer of Novartis, said. An Australian Therapeutic Goods Administration spokesperson said the agency was aware of reports of retinal vasculitis cases in the US.

“Novartis will continue to work collaboratively with the PBAC, the Department of Health and the Federal Government to ensure that Australians with wet AMD receive access to Beovu through the Pharmaceutical Benefits Scheme at the earliest opportunity,” the spokesperson said.

“We are currently investigating this potential safety signal and working with the sponsor to determine the regulatory response including changes to the Product Information and Consumer Medicines Information as appropriate.

Beovu will now be reconsidered at the PBAC’s next meeting this month.

“Beovu has only recently been registered in Australia and is not listed on the PBS. The TGA has not received any local adverse event reports for Beovu.” n

Elsewhere, Novartis announced an update of Beovu prescribing information worldwide following reported post-

DEPARTMENT OF HEALTH DASHES TELEHEALTH HOPES Efforts to extend Medicare coverage for optometry telehealth services during COVID-19 have taken a blow after the Department of Health advised Optometry Australia (OA) it's unlikely to approve the proposal. Since late March, OA has formed a united front with Specsavers, Luxottica and Diabetes Australia to lobby for telehealth-related modifications to existing Medicare item numbers. The organisations were hopeful of a positive response, but grew increasingly frustrated at delays. Now, after recent discussions with health officials, Brodie said it was unlikely to occur.

INSIGHT July 2020

“Following a recent meeting with the Department of Health, we were disappointed to learn that telehealth optometry services are unlikely to be covered via the temporary Medicare extension during the COVID-19 pandemic,” Brodie told Insight on 5 June. “We will continue to look for opportunities to explore innovative modes of practice that will keep optometrists supporting patients.”

potential exposure to COVID-19, and telehealth can enable them to access the optometric care they need,” she said.

Telehealth provides timely access to care.

“More broadly, the use of telehealth during the COVID-19 pandemic has demonstrated that it can support timely access to care for patients unable to access in-person care.”

Brodie believes tele-optometry still has a role to play in the pandemic, despite most practices retuning to full levels of service since late May.

Brodie said many primary healthcare disciplines are exploring whether telehealth may be able to be used in a more long term way to enhance patient access, especially in rural and remote areas, and complement established systems of care.

“Some patients are still practicing caution with regard to limiting any

“It's appropriate for optometry to also make these considerations,” she said.

Caring Caring for our for our communities communities Throughout the lockdown period we remained Open for Care and as the restrictions have eased we - like so many in our industry - are now making careful inroads into a significant patient backlog.

To find out more about how we are providing optometry, dispensing and audiology care to our local communities - and for some emerging employment opportunities - go to spectrum-anz.com

NEWS

ACCC LAUNCHES PROBE INTO ELLEX-LUMIBIRD DEAL "WE CAN’T SPECULATE ON THE OUTCOMES OF THE ACCC PUBLIC REVIEW, WE JUST HAVE TO LET THE PROCESS RUN"

The Australian competition authority is examining Ellex Medical Lasers’s proposed $100 million sale of its laser and ultrasound business to Lumibird to consider its impact on market competition and the pricing of related ophthalmic devices. On 1 May, a week after Ellex shareholders approved the sale at an extraordinary meeting, the Australian Competition and Consumer Commission (ACCC) advised both companies it would undertake a public review of the acquisition. Lumibird is a French headquartered technology company whose subsidiary, Quantel Medical, develops lasers and ultrasound machines for ophthalmic procedures. Australian supplier Device Technologies distributes the devices locally. According to the ACCC, both Lumibird and Ellex’s lasers and ultrasound business overlap in the supply of several instruments, including low energy pulse lasers for glaucoma, high energy photocoagulation lasers for retinal disease, high energy photodisruption lasers for post cataract scar tissue and vitreous floaters and diagnostic ultrasound devices. “The ACCC’s investigation is focused on the impact on competition. In particular,

we are seeking views on; whether Ellex Lasers and Ultrasound and Lumibird compete closely; the likely impact on prices; alternative suppliers of overlapping products; and the use of other treatment methods for eye conditions treated by lasers,” the government agency stated on its website.

TOM DUTHY, ELLEX

confirmed both Ellex and Lumibird have made submissions to ACCC. “I can’t disclose the contents of those submissions; however, clearly the ACCC is interested in the effects of such a transaction of laser and ultrasound competition in Australia,” he told Insight. “We can’t speculate on the outcomes of the ACCC public review, we just have to let the process run and their determination will be made on 25 June.” The transaction relates to Ellex’s laser and ultrasound business. The company will retain its 2RT therapy for intermediate age-related macular degeneration and glaucoma iTrack therapy. Earlier this year, Ellex shareholders voted in favour selling the business segment for $100 million, seeing the return of approximately $61 million of sale proceeds back to them.

“The legal test which the ACCC applies in considering the proposed acquisition is in section 50 of the Competition and Consumer Act 2010. Section 50 prohibits acquisitions that are likely to have the effect of substantially lessening competition in a market.”

The remaining $39 million will fund the expansion of the iTrack and 2RT business segments, as well as tax liabilities arising from the transaction, closing adjustments and costs associated with the sale.

The ACCC sought submissions on the acquisition, which closed on 15 May. It aimed to release its findings on 25 June, which could either be a final decision or a release of a Statement of Issues.

If the deal proceeds, the Ellex brand will transfer to Lumibird and it will acquire Ellex’s production site in Adelaide and its commercial subsidiaries in Australia, Japan, the US, France and Germany. n

Ellex head of investor relations and corporate development Dr Tom Duthy

RANZCO CONFIRMS DETAILS FOR 2021 ANNUAL CONGRESS RANZCO has announced this year’s postponed 52nd Annual Scientific Congress will take place in November 2021, with Brisbane remaining as the host city. The college revealed the new event details, alongside an extensive list of local and international speakers that include Australia's Professor Alex Hewitt and Professor Graham Barrett, as well as Glaswegian consultant ophthalmologist Dr David Lockington. The 20/21 congress will take place between 19-23 November 2021, at the Brisbane Convention & Exhibition Centre. The new details come after RANZCO announced last month that it would postpone this year’s congress, scheduled for October, due to the

INSIGHT July 2020

and thought-provoking content.”

COVID-19 crisis. It explored turning the event into a virtual meeting, however this was ruled out due to a range of factors. After celebrating its 50th anniversary at the 2019 congress, RANZCO is optimistic about the 2021 event. “Having taken a year off, we believe that the congress in Brisbane will be even more informative and enjoyable for everyone involved. The 2021 congress will be an opportunity to look towards the next 50 years of science, ophthalmology and the college,” RANZCO stated on its new congress website. “The stunning and sunny location of Brisbane is the perfect location to reinvigorate the mind and the senses wherein the congress will provide a robust array of science

The congess will take place in Brisbane.

Alongside Hewitt (Dame Ida Mann Memorial Lecture) and Barrett (Sir Norman Gregg Lecture), other local and international speakers include; Dr Catherine Green (Fred Hollows Lecture); Dr Clare Fraser (Council Lecture); Dr Lynn Gordon (Neuro Ophthalmology Update Lecture); Dr David Lockington (Cataract Update Lecture); Dr Anita Agarwal (Retina Update Lecture); Dr Pradeep Ramulu (Glacuoma Update Lecture); and Dr Damien Gatinel (Refractive Update Lecture). In addition, there will be a range of concurrent symposia, courses, papers, posters, films and rapid-fire sessions. The congress will also include a social program that will allow time to network with colleagues. n

IT’S TIME FOR A CHANGE! Upgrade your PureVision® patients to the latest technology Bausch + Lomb Ultra® or PureVision® 2 HD contact lenses and they will receive a $30 Coles Group & Myer Gift Card.

Innovation that makes the world look better. For more information and T&Cs of the promotion please contact your Bausch + Lomb Territory Manager or Customer Service 1800 251 150 or visit www.bauschswitch.com.au. Please be advised that from March 31st 2020, PureVision® Toric 2.25 cyl and all plus power parameters have been discontinued. All other PureVision® Toric parameters will discontinue in Q1 2021.

An eye exam may be necessary before upgrading to ULTRA® or PureVision® 2 HD. This promotion does not cover the cost of fitting the lenses. Offer valid to 31 March 2021. †Coles Group & Myer Gift Card: Conditions and exclusions apply. For full Terms of Use visit giftcards.com.au or phone 1300 304 990. © 2020 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Other product names/brand names are trademarks of their respective owners. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150). ZUS.0033.AU.20.

NEWS

PROTOTYPE TO TEST DRIVER VISION AT THE ROADSIDE "THE BIGGEST COMPLIMENT FOR AN INVENTOR IS WHEN SOMEONE SAYS, ‘SURELY THAT EXISTS SOMEWHERE’ BUT IT DOESN’T"

Hobart optometrist Mr Ben Armitage can now add “inventor” to his resume with the creation of Acuidrive, a hand-held device to test driver vision at the roadside. Armitage recognised a need for a roadside vision test due to an alarming disparity between Tasmania’s licensing laws and visual acuity for its driving population. He hopes the novel device will one day create safer roads for drivers across Australia, and around the world. Described as a simple, fast and accurate solution, Acuidrive uses a lens system to replicate a traditional sixmetre eye testing chart within a handheld instrument. It allows the tester, nominally police, to rapidly assess drivers' vision by requiring them to read five letters, which in the event of error can be changed to doublecheck results. Armitage said the statistics on drivers who know they should wear vision correction to drive, but don’t, corresponds with his patients’ anecdotes. “I regularly have conversations with my patients who refuse to stop driving or wear their glasses to drive but Tasmania doesn’t have mandatory reporting laws,

The hand-held device uses a lens system to replicate a traditional six-metre eye testing chart.

BEN ARMITAGE, ACUIDRIVE INVENTOR

so I can’t tell the licensing authorities that a patient is not legally fit to drive,” he said. Currently in Tasmania, drivers have their vision checked for their first licence at 16 years of age, and then again when they reach 75.

local optometrist for an eye test. From his initial idea, Armitage approached Tricycle Developments, a product design team based in Melbourne that specialise in industrial design, product engineering and design for manufacture. He also sought support from Innovic (the Victorian Innovation Centre), a not-for-profit organisation to help startups turn new inventions into viable products and businesses. After developing a proof-of-concept and seeking feedback from friends in the police force, Armitage patented his design and approached Queensland University of Technology for the next phase in development, which involves further research with the current working prototype. With testing, costing and potential legislation still ahead, Armitage cannot estimate when Acuidrive might come to market.

Armitage said that in the interim 59 years, drivers could potentially have sub-standard vision and not be aware of it. With police unequipped to test vision on the side of the road, drivers who don’t meet the legal requirements to drive, whether they’re aware of it or not, are potentially putting others at risk.

There is also no precedent elsewhere of a similar product. “The biggest compliment for an inventor is when someone says: 'surely that exists somewhere’, but it doesn’t exist anywhere else. That’s the case with Acuidrive,” he said. n

Armitage, who studied optometry in the UK, hopes Acuidrive can make roads safer and compel drivers to visit their

AUSSIE OCT CO-FOUNDER JOINS COUNTRY’S MOST DISTINGUISHED SCIENTISTS WITH ACADEMY FELLOWSHIP Dr Simon Poole, a co-founder of Melbourne OCT company Cylite and entrepreneur in photonics, has been elected as a Fellow of the Australian Academy of Science, joining an elite class of the nation’s scientists. Poole is one of 24 new Fellows elected to the academy this year. The honour is in recognition of his leading research and enterprising work in photonics, particularly in the development of the Erbium-Doped Fibre Amplifier, which is now a ubiquitous part of optical fibre networks that underpin the global internet. He has also led the establishment of an export-competitive photonics industry in Australia. “I am a delighted to be recognised by

INSIGHT July 2020

leading A-scan speeds. It also captures volume data to provide accurate analytics for corneal and refractive specialists.

the academy in this way, and more than a little humbled to be part of such a distinguished group of Fellows.” Poole said. “For science to maintain its place in society it must remain connected to the needs of society and I hope to be able to assist the academy in ensuring that this happens.” Poole is a co-founder and vicepresident of business development for Cylite, an Australian company that is now pursuing regulatory approval for its diagnostic OCT systems for ophthalmology and optometry. His photonics expertise has contributed to the underlying technology of the instrument, which is said to differ from competing models by offering industry-

Simon Poole, Cylite.

Dr Steve Frisken, CEO of Cylite, said the recent honour was a testament to Poole’s significant contributions to photonics within Australia over many ventures, both in academia and industry. “Simon has proven to be one of the driving forces in establishing the hugely vibrant photonics industry in this country, in a career that spans some of the most successful commercial endeavours and which has impacted the careers of many students, researchers and colleagues,” he said. “His combination of technical and scientific insight and business acumen will prove an asset to Australia’s Science Academy." n

Your eyes are not made for screens. Sync III lenses are Sync III enhanced single vision lenses have a â&#x20AC;&#x2DC;boost zoneâ&#x20AC;&#x2122; at the bottom of the lens to support and relax the eye muscles, helping to relieve eye strain and provide visual comfort when looking at screens. Available in 3 power boost options (+0.57, +0.95 & +1.32), with position of wear parameters optional.

Ask your Hoya Sales Consultant or call 1800 500 971 to find out how Sync III lenses can help your patients and practice.

NEWS

COLLEGE WELCOMES MULTI-BILLION-DOLLAR FUNDING BOOST FOR STATE-RUN HOSPITALS Delays and knock on effects as a result of the pandemic-induced suspension on non-urgent surgery could be eased in the pubic system, according to RANZCO, following a record $131 billion funding agreement for state-run hospitals. Prime Minister Scott Morrison has revealed the new 2020‑25 National Health Reform Agreement will deliver more doctors, nurses and services across public hospitals in every state and territory for the next five years. The deal provides an estimated $131.4 billion in additional funding to public hospitals from 2020–21, and follows a more than $8 billion Commonwealth health investment during the COVID-19 response. As part of the deal, the government has provided a funding guarantee to all states and territories to ensure no jurisdiction is left worse off as a result of the pandemic, and guarantees the Commonwealth’s funding contribution for public hospitals until the end of 2025. Commenting on behalf of RANZCO, Professor Peter McCluskey, director of the Save Sight Institute at Sydney Eye Hospital and professor and chair of ophthalmology at the University of Sydney, welcomed the agreement. “While there is no specific mention

Increased funding will help to manage demand and reduce delays across the public system.

of ophthalmology funding, one would assume we will get increased funding for cataract surgery, glaucoma, diabetic retinopathy and [age-related macular degeneration] treatment to meet increasing demand,” he said.

"THE FLOWON EFFECTS AND POSSIBLE DELAYS ACROSS THE PUBLIC SECTOR MAY BE SIGNIFICANT. INCREASED FUNDING WILL HELP TO MANAGE THIS DEMAND" PETER MCCLUSKEY, RANZCO

and new patients to triage,” he said. “In total, across Australia these are likely to be substantial numbers and take a considerable period of time to sort through and then assess. The flowon effects and possible delays across the public sector may be significant. Increased funding will help to manage this demand and reduce delays.” In a consultation paper on the Pricing Framework for Australian Public Hospital Services 2016-17, published in 2015, RANZCO stated the most common principal diagnosis for elective admissions involving surgery in 2013/14 was ‘other cataract’. Overall 192,262 of those were reported in Australian hospitals, with 132,554 in the private sector and 59,708 in public hospitals.

Due to the COVID-19 pandemic, McCluskey noted all non-urgent eye surgery and non-urgent outpatient services were suspended. With the recent easing of restrictions, outpatient services and elective surgery are resuming with a staged return to normal capacity.

By 2020, it conservatively projected health costs of visual impairment would reach more than $3.7 billion, with indirect costs expected to add $3.2 billion. At the time, it also stated public hospitals waiting lists were at unprecedented levels due to insufficient funding: “Reduced overall financial resourcing to the public hospital sector will result in further fragmentation of services and potentially reduced patient care." n

“Given that cataract surgery is one of the commonest surgical procedures performed in Australia, there will be a significant backlog of surgical cases. There will be similar large numbers of outpatient appointments to re-schedule

ADVOCACY PAYS OFF WITH LOW-COST SPECS AVAILABLE FOR MORE UNDERPRIVILEGED SOUTH AUSTRALIANS South Australian optometrists have been part of a successful campaign to expand the state government’s GlassesSA program to provide more disadvantaged people access to free or low-cost glasses and contact lenses. South Australian Premier Mr Steven Marshall announced the government has now introduced free standard glasses for eligible Aboriginal customers, as well as optional upgrades to standard glasses for those who meet the criteria. As part of the expanded program, the government is also introducing a $50 contribution for eligible children wanting to upgrade their frames, and $50 for

INSIGHT July 2020

customers who want thinner lenses. Previously, customers did not have the option to upgrade frames or lenses from the standard GlassesSA offering at their own cost. Aboriginal customers also had to pay a gap and all eligible children couldn’t upgrade their frames. Since the program was introduced in 2016, GlassesSA has helped deliver more than 19,000 spectacles to disadvantaged and vulnerable South Australians. Optometry Victoria South Australia (OV/ SA) CEO Mr Pete Haydon said it is now imperative that many optometrists across

metro, regional and remote SA sign up for the scheme to provide vulnerable people access to affordable spectacles and contact lenses.

The scheme covers children's frames.

“It’s a much happier purchasing experience for both the patient and the dispenser when more choice is available, Haydon said. “No-one likes to stand in a practice full of sensational frames whilst being pointed towards a limited cheaper range that they must choose from.” With the recent enhancements. Haydon said patients now had the option to use GlassesSA as a starting point and top-up the government contribution to purchase a more expensive frame and/or lens. n

CENTURION® ACTIVE SENTRY® with ACTIVE SENTRY® Handpiece

Phaco’s most advanced control centre, at your fingertips*. Centurion

Vision System With ACTIVE SENTRY ™ Handpiece

© 2019 Alcon Inc. Alcon Laboratories (Australia) Pty Ltd ABN 88 000 740 830 Phone 1300 224 153 New Zealand : C/- PharmaCo, Auckland, NZ. NZBN 9249030206663 Phone 0800 101 106 *Based on the range of features available for the Centurion Active Sentry System that are not available with other devices currently on the market. ANZ-ASP-1900013

NEWS

OA MEMBERS GRANTED ACCESS TO PROVISION SUPPLIER DATABASE ProVision is allowing Optometry Australia-member independent practices access to the country’s largest frames database, ProSupply, which contains product availability information updated every 24 hours.

SUPPLIER ISSUES COVID-19 TONOMETER PROBE WARNING "IT IS BELIEVED THAT SOME USERS MAY CUT CORNERS AND USE THEIR PROBES MULTIPLE TIMES" DESIGNS FOR VISION

Designs For Vision (DFV) is reducing the cost of contact tonometer probes to encourage safer work practices amid concerns that some eyecare professionals may re-use the single-use probes. The Victorian-based supplier, which distributes the Icare tonometer range, is offering 20% off the cost of a box of 600 probes. Icare probes are intended for single use only.

ProVision has announced it is offering independent practices who are OA members three months’ access to ProSupply while COVID-19 restrictions remain in place.

“Although a fresh probe has always been required when using an Icare tonometer, it is believed that some users may cut corners and use their probes multiple times,” the company stated.

ProSupply is a ProVision system that offers access to 24,000 preferred supplier frames complete with frame imagery, specifications and suggested retail pricing.

“Apart from the obvious contamination risks, this may also lead to incorrect measurement of IOP or damage to the device.”

Additional benefits to practices with ‘Guest’ access to ProSupply include the ability to identify frame requirements to continue to operate smoothly while frame supplier representatives are in limited availability during COVID-19.

The company also noted that the unsafe practise of re-using probes for contact tonometers in multiple patients could lead to the transmission of the COVID-19 virus or other pathogens.

Practices can also search for frames using key criteria including brand, frame type, construction, material and shape. They find frames for patients with complex requirements using advanced search options including eye size, bridge and temple length. CEO Mr Steven Johnston said ProVision is sharing its ProSupply system with other OA-member independent practice owners with the aim of ensure ongoing viability of independent optometrists. “This initiative affirms the ProVision commitment of ensuring independent optometry is resilient in challenging times, by providing benefits not only to our members, but to the whole independent optometry ecosystem,” he said. “We recognise that just about everyone in the independent optometry ecosystem or supply chain is struggling right now, so for three months we will be extending access to ProSupply Guest, for all independent optometrists who are Optometry Australia members.”

“Tonometry with single-use probe is currently recommended by RANZCO as the safest modality for IOP measurement, considering the potential risk of aerosol contamination from puff tonometry,” the company stated. Two recent studies, one in Hong Kong

Public health researchers from the University of Hong Kong believe the eye may be a key entry point for coronavirus to infect the body. The researchers claim they are the first in the world to provide evidence that coronavirus can infect through both the upper respiratory airways and conjunctiva much more efficiently than the 2003 SARS virus. Separately, a new study into Italy’s first coronavirus patient has found she had traces of the virus in her eyes for several weeks, even after it had become undetectable in nasal swabs. The research is the latest to establish a connection between COVID-19 and ocular fluids, suggesting the eye is not only a potential entry point for the virus, but also a source of contagion. n

A new RANZCO-hosted webinar series, introduced in response to COVID-19, has been in high demand, with more than 200 professionals tuning in weekly to hear leading Australian and New Zealand experts discuss the latest evidence-based practices in ophthalmology. As the CPD program continues to gather momentum, Fellows and trainees are now calling for the college to make the trial a permanent fixture.

Guest ProSupply users will also be able to view 19 of Australia’s best frame wholesalers’ current ranges and latest releases. ProSupply Guest access is available immediately. n

In the first six weeks, between 114 and 258 trainees and fellows have attended

INSIGHT July 2020

and one in Italy, have demonstrated a connection between coronavirus and the eyes.

OPHTHALMOLOGISTS TURN OUT FOR NEW WEBINAR SERIES

Following the COVID-19 outbreak – and as many ophthalmology services were reduced due to a lockdown – RANZCO initiated the weekly webinar series for trainees and extended the invitation to all Fellows between 17 April and 19 June.

Single-use tonometry probes are recommended.

Feedback has been highly positive, RANZCO says.

the virtual presentations each week. The webinars were recorded and stored on the RANZCO VTP Moodle Course site, and Fellows can accrue CPD points. Data from the weekly survey feedback has been “highly positive”, with RANZCO to produce a final report on the trial at the end of June. n

NEWS

DRUG DEVELOPER REPORTS ENCOURAGING RESULTS WITH LUCENTIS BIOSIMILAR FOR LOCAL MARKET A biopharmaceutical company that is developing cheaper anti-VEGF treatments for major global markets, including Australia, has reported positive results from a Phase 3 clinical trial for its Lucentis biosimilar. Korean-based Samsung Bioepis has announced that it has met the primary end points in a randomised, double-masked trial assessing the efficacy, safety and immunogenicity of SB11, a ranibizumab (Lucentis) biosimilar candidate, for neovascular age-related macular degeneration (nAMD). Compared with Lucentis, which was used as the reference drug, SB11 demonstrated equivalent efficacy in terms of change in best corrected visual activity (BCVA) at week eight and central subfield thickness (CST) at week four. The results add momentum to the company’s efforts to develop and

of patients worldwide.” Further comparing the SB11 and Lucentis, the trial found the least squares (LS) mean change in BCVA was 6.2 letters for SB11, compared with 7.0 letters for the reference drug Lucentis.

commercialise two ophthalmology biosimilar candidates, SB11 (ranibizumab/Lucentis) and SB15 (aflibercept/Eylea), in the US, Canada, Europe, Japan and Australia. It is aiming to capitalise on the expiration of patents for Lucentis and Eylea – both listed on the Australian Pharmaceutical Benefits Scheme – in the coming years and offer a cheaper alternative for health systems and patients. In the US alone, it has been estimated that savings generated from biosimilar uptake could reach as high as US$150 billion (AU$217 b) over a 10-year period. “We are excited to share this news on the development of our first treatment for ophthalmic diseases,” Mr Seongwon Han, medical team leader at Samsung Bioepis, said. “These 24-week interim results suggest that SB11 will be a valuable treatment option for nAMD, potentially helping millions

The drug showed equivalent efficacy.

The LS mean change in CST was −108.4μm for SB11 versus −100.1μm for Lucentis. The confidence interval (CI) of the difference between the two treatments in BCVA and CST was within the predefined equivalence margins. The incidence of treatment-emergent adverse events was 66% for SB11 and 66.9% for Lucentis. The overall incidence of anti-drug antibodies was low (3.0% for SB11 vs 3.1% for Lucentis). Pharmacokinetic serum concentrations also appeared comparable. In November, Samsung Bioepis announced a commercialisation agreement with Biogen worth US$310 million (AU$453 m) to supply the biosimilar therapies. n

NEWS

NEW MYOPIA MANAGEMENT PAPER ADDRESSES KEY OPTOMETRY QUESTIONS A new open-access paper providing a comprehensive analysis of evidencebased myopia management could equip optometrists to better manage future cases including when to modify or cease care. Published in peer-reviewed journal Ophthalmic & Physiological Optics, University of Houston authors Professor Mark Bullimore and Associate Professor Kathryn Richdale have presented a range of critically evaluated safety and efficacy considerations for behavioural, optical and pharmaceutical myopia management pathways. The authors note the paper, entitled ‘Myopia Control 2020: Where are we and where are we heading?’, seeks to present a snapshot of the rapid evolution of the field, addressing multiple questions that optometrists may have. These include not only who to manage, but also relative strengths of various methodologies and when to modify or stop care. The paper, which was supported by an educational grant from CooperVision, also discusses potential future avenues for myopia management, including a continuum of care starting with the delay of onset followed by individual or combination therapies to slow myopia progression. Mr James Gardner, vice president of global myopia management at CooperVision, said he hoped the paper would have global reach, including Australian practitioners. “We hope this comprehensive review reaches optometrists to offer sound, science-backed evaluation that can help advance myopia management strategies in practices worldwide,” he said. “Clinical education plays an important role in our efforts to see more children undertake myopia management, alongside ongoing research, groundbreaking products such as our MiSight 1-day contact lenses, advocacy and corporate social responsibility initiatives.” Bullimore was guest speaker at a special CPD-accredited live webinar, entitled 'Myopia MythBusters Down Under', presented by the CooperVision Academy in May. n

INSIGHT July 2020

UNSW STUDENT WINS PRESTIGIOUS AMERICAN FELLOWSHIP "THIS FELLOWSHIP IDENTIFIES LEADERS WHO HAVE CONTRIBUTED NOT ONLY TO RESEARCH BUT ALSO TO EDUCATION, TEACHING AND CLINICAL PRACTICE" RABIA MOBEEN, UNSW

Emerging talent Ms Rabia Mobeen, a post-doctoral research student at the University of NSW School of Optometry and Vision Science, has received a prestigious fellowship from the American Academy of Optometry Foundation. Mobeen, whose research has focused on the effect of age and contact lens wear on corneal inflammatory response, is the only Australian-based student among the 2020 recipients of the William C. Ezell Fellowships, recently announced by the foundation. Born in Dubai and educated in Pakistan, she received her Bachelor’s degree and Masters in optometry from King Edward Medical University in Lahore, Punjab. She was appointed as a Faculty Fellow and lecturer and taught both graduate and postgraduate students for almost eight years before moving to Australia to undertake a PhD. Mobeen’s fellowship submission included a biosketch of her qualifications, experience, awards, achievements and contribution to science. It also involved a publication bibliography, three reference letters and questions relating to her contribution to optometry. “Ezell is a fellowship not just confined to your research or your project, they want to look at your contributions to the field of optometry. This fellowship identifies

Rabia Mobeen's fellowship includes two travel grants.

leaders who have contributed not only to research but also to education, teaching and clinical practice,” she said. “I believe my recognition as an Ezell Fellow will significantly complement my current efforts to strengthen my research focus, improve clinical skills and advance the optometry profession. My goal is to secure an opportunity to continue my PhD research as a postdoctoral fellow in an internationally recognised institute and expand this research in contact lens-related ocular neuroimmunological responses.” The fellowship includes two travel grants; one to attend the annual meeting of the American Academy of Optometry 2020, taking place in Nashville in October; and the other to attend the annual meeting of the Association of Research and Vision Ophthalmology, in San Francisco in May, 2021. n

FRED HOLLOWS FOUNDATION FAREWELLS FRIEND OF 40 YEARS Wife of the late Fred Hollows, Ms Gabi Hollows, has paid tribute to leading ophthalmologist Dr Pararajasegaram, affectionately known as Dr Para, a friend and colleague since 1977. Dr Para was the former president of the International Agency for the Prevention of Blindness and in 1999 launched Vision 2020, a global initiative for the elimination of avoidable blindness. He died recently in Chennai, India. Gabi Hollows said in the 1970s Dr Para travelled with the Hollows family for a year to remote communities around Australia as part of the National Trachoma and Eye Health Program. “Thanks to Dr Para, what we did on

Dr Pararajasegaram. Image: International Agency for the Prevention of Blindness.

the National Trachoma and Eye Health Program became the blueprint for so much of the work we carry out in other countries," she said. “He not only opened doors for us to help people internationally, he also made eye health a global issue.” n

NEWS

CYBER SECURITY: AUSTRALIAN HEALTH SYSTEM LAGGING BEHIND GLOBAL COUNTERPARTS A new report has found that Australia’s healthcare sector is ill-equipped to fend off cyberattacks compared with other regions, and that ransomware attacks are on the rise as a result of vulnerabilities caused by the global COVID-19 crisis.

However, Australia performed better than Europe (0.88) and Asia-Pacific (0.45).

Global technology services provider NTT Ltd recently published its 2020 Global Threat Intelligence Report, which reveals that despite efforts by organisations to layer their cyber defences, attackers are continuing to innovate faster and automate their attacks.

He said a combination of highly sensitive personal data and poorly defended networks created a high risk-reward situation.

While the technology and government sectors were more frequently targeted, the report showed Australia’s healthcare sector is less mature than other health markets in terms of cyber resilience. A score of 0.96 put it behind the global average of 1.12, with The Middle East and Africa topping the category with a score of 1.56, ahead of the Americas on 1.24.

Mr John Karabin, NTT’s Australian director of cybersecurity, said the healthcare sector has always been a key target for cyber criminals. Ransomware attacks are on the rise.

Australia’s healthcare sector also has a significant reliance on legacy systems, which are typically tough for IT leaders to protect because they are disparate, siloed and vulnerable to unsophisticated attacks. “As Australia starts to bring more of these systems online, by connecting them to the internet and to one another, we’re bringing 10-year-old devices into contact with threats that they have not encountered before,” Karabin said.

“And whilst our research showed that threats are evolving, we also found that old vulnerabilities persist because organisations aren’t performing basic cyber hygiene practices such as patching. This trend is particularly problematic in industrial and legacy technology environments, including healthcare.” Karabin said cybersecurity has not traditionally been a priority for healthcare providers, which typically focus budgets and technology on saving lives and maintaining health. The current COVID-19 crisis has also demonstrated that cyber criminals will take advantage of any situation. “We are already seeing an increased number of ransomware attacks on the health sector and we expect this to get worse before it gets better,” he said. n

Henson 9000 Visual Field Analyzer • Ergonomic compact design compatibility and • Universal comparison with data from other perimeters

Intelligent Fast Threshold • Algorithms

Threshold testing under • 24-2 2 ½ minutes per eye with maximum sensitivity

binocular driving • Esterman tests

progression • Comprehensive analysis

Telephone: (02) 96437888

Toll Free: 1800804331

Email: sales@bocinstruments.com.au

Website: www.bocinstruments.com.au

COMPANY

NOVARTIS ACQUIRES GAMING COMPANY FOR ‘LAZY EYE’ THERAPY Novartis is collaborating with video game developers and academics to develop digital technology to treat amblyopia, following its completed acquisition of USbased software startup, Amblyotech. Amblyopia is estimated to affect roughly 3% of the global population. Current treatment options include patching and atropine, however they are associated with low compliance and success rates. Designed to enhance compliance, Amblyotech utilises active gaming and passive video technology with 3D glasses, training the eyes to work together to view an image in full. The software employs a unique visual presentation, called dichoptic display, where each eye is presented with different images using a proprietary algorithm. In early clinical studies, Amblyotech’s software demonstrated improvements in vision in both children and adults with faster onset compared to standard of care treatments. Novartis is now seeking regulatory approval for the digital therapy. “By offering a non-invasive solution that has the potential to be significantly faster than current standards of care such as patching for children and adults impacted by lazy eye, Amblyotech’s software is a great example of how we can reimagine medicine using digital technology,” Novartis ophthalmology global business franchise head Mr Nikos Tripodis said. “We look forward to using our deep clinical development expertise in ophthalmology to accelerate this platform toward regulatory approval, and our global commercial footprint to maximise access for patients who need it.” Novartis will work with Ubisoft and McGill University in Canada to accelerate product development to enable faster uptake for patients with proof-of-concept studies planned later in 2020, the company stated. Professor Robert Hess, director of research in the Department of Ophthalmology at McGill University, was presented with the 2013 H Barry Collin Research Medal, bestowed by Optometry Australia, at the Southern Regional Congress in 2014 in recognition of his amblyopia research. n

INSIGHT July 2020

COVID BITES INTO GRANDVISION REVENUE; MAJOR DEAL ON TRACK "WE EITHER FULLY CLOSED OUR STORES OR HAVE STRONGLY REDUCED THE OPENING HOURS AND SERVICES OFFERED" STEPHEN BORCHERT, GRANDVISION

GrandVision's first quarter revenue of €926 million (AU$1.5 billion) has declined 4.4% largely as a result of the coronavirus, which at its peak saw the multinational optical retailer close 60% of its stores. The Dutch-based company, which operates more than 7,300 stores and is one of the world’s largest optical and sunwear retailers, recently reported its financial results, laying bare the full impact of the COVID-19 crisis. Executives are also continuing to pursue regulatory approval of a highly anticipated sale of HAL’s 76% stake in GrandVision to EssilorLuxottica, seeing the Franco-Italian conglomerate secure a controlling interest in the company and vastly expand its own retail presence. In the first quarter, GrandVision’s comparable store growth shrunk 8.2%, reflecting the negative COVID-19 impact in the second half of March. It follows a strong start to the year with 5.5% comparable growth in January and February.

COVID-19 caused revenue to drop more than 80% across GrandVision's business.

approximately 60% of the company's stores were fully closed and 40% were partially open but impacted by various degrees of sales limitations and a significant reduction in traffic. "Our business has been facing unprecedented challenges due to the global outbreak of COVID-19,” he said.

In the month of April, COVID-19 caused a revenue reduction of more than 80% across GrandVision's business.

“In compliance with governmental measures and health authority recommendations around the world, we either fully closed our stores or have strongly reduced the opening hours and services offered, and this is in almost all countries we operate in. As a result, we have seen a significant decline of revenue and profit, in particular since mid-March..”

Mr Stephan Borchert, GrandVision CEO, said as of 30 April 2020,

GrandVision is present in more than 40 countries. n

US REGULATORS APPROVE B+L'S BREAKTHROUGH CONTACT LENS Bausch + Lomb (B+L) has secured US Food and Drug Administration (FDA) approval for its new Infuse daily disposable silicone hydrogel (SiHy daily) contact lens. The product is said to feature a next generation material (kalifilcon A), which is to designed to address unmet demands of contact lens wearers, including dryness issues. The Infuse lens is also said to offer improved breathability for healthy lens wear alongside the provision of all-day comfort and high definition optics. "Bausch + Lomb continues to push the innovation curve in the contact lens space with the FDA's clearance of Bausch + Lomb Infuse," Mr Joe Gordon, US president of B+L, said.

Bausch + Lomb's new contact lens overcomes dryness and breathability issues.

"We are excited to add this breakthrough new SiHy daily contact lens to our portfolio and provide the outstanding health, vision and comfort that practitioners expect and patients deserve. "We anticipate it will be available to eyecare practitioners in the second half of 2020. n

OPTICIANS FEATURE ON BRITAIN’S 2020 RICH LIST Specsavers founders Mr Doug and Dame Mary Perkins have featured on Britain’s 2020 Rich List, alongside another eyecare professional who sold his contact lens company to CooperVision for more than AU$1 billion. The Sunday Times compiles the list annually, which is based on wealth Doug and Mary Perkins. estimates of Britain’s 1,000 richest people or families. Sir James Dyson and family, best known for inventing the Dual Cyclone bagless vacuum cleaner, topped the list with £16.2 billion (AU$30.2 b). The Perkins family, which founded Specsavers in 1984, came in at 82nd place with an estimated wealth of £1.8 billion (AU$3.3 b). The husband and wife team, who met during their optometry studies at Cardiff University in the UK, pioneered the joint venture partnership from a ping pong table in their spare room, with the first store opening on Bond Street, Bristol. Since then, they have produced the largest privately-owned opticians’ group in the world. The British multinational now operates in the UK, Republic Ireland, The Netherlands, Spain, the Nordic countries and Australasia where it recently celebrated its 400th store opening.

CMY

NEW PRODUCT Alcohol Wipes

140mm

Dame Mary Perkins was appointed a Dame Commander of the Order of the British Empire in the Queen’s Birthday Honours List in 2007, the first female optician to reportedly receive the honour.

160mm

She was also reported to be Britain’s first self-made female billionaire in 2011. Doug Perkins remains as a chairman and joint CEO of Specsavers alongside son John. The other optician to appear on the 2020 Rich List was Mr Alan Wells and his family, with an estimated wealth of £200 million (AU$373 m). From southwest London, Wells set up a contact lens business that went on to have factories in London, Kent and Hungary. He later sold the business, Sauflon Pharmaceuticals, to CooperVision in 2014 for £700 million (AU$1.3 b). According to The Sunday Times, the valuations were carried out up to the end of April to take account of the early economic impacts of the coronavirus lockdown. It has adjusted valuations of the richest 1,000 where there have been significant movements in the share prices of quoted companies, estimating the knock-on effect on the fortunes of owners of large stakes in those companies. The publication measures identifiable wealth, assessing land, property, racehorses, art or significant shares in publicly quoted companies. It excludes bank accounts to which it has no access and small shareholdings in a private equity. n

The alcohol towels are made from white crepe paper material saturated with 70% Isopropyl alcohol. They are a great size - 160 x 140mm, easy to dispose and environment friendly. .... and they are “Made in Australia” Good Optical Services p: +61 3 9645 1066 e: goodopt@ozemail.com.au www.goodopticalservices.com.au

RESEARCH

STUDY FINDS TOOTH-ENAMEL PROTEIN IN EYES WITH DRY AMD

CL DROPOUT RATE FALLS AFTER SIX MONTHS A corporation-commissioned survey into contact lens wear has found that new wearers are most likely to dropout in the first six months mainly due to handling and comfort. As part of its 'Consumer Insight Series', CooperVision conducted a survey with new contact lens wearers to identify why people begin wearing them and continue to, while others drop out. It surveyed 1,000 adults in the US and Germany who had been wearing contacts between two and twelve months. One of the biggest benefits of contact lenses, according to new wearers, is the ability to play sports or participate in physical activities, closely followed by wearing sunglasses of their choosing, and seeing clearly during activities in which they can’t wear glasses. Despite the benefits, between three and six months after starting, one in four new contact lens wearers identified handling and comfort as top obstacles to continued wear, with 31% saying they would likely stop wearing lenses in the next six months. Tellingly, the survey results showed that when wearers stay in lenses beyond six months, the dropout rate falls by 42%. It continues to fall over time: nine months after starting, 19% said they would likely stop wearing lenses in the next six months. Meanwhile, 12 months after starting, 18% said they would likely stop wearing lenses in the next six months. A spokesperson for CooperVision said the survey results offer valuable information that eyecare professionals can use to better reach new patients, increase their satisfaction and reduce dropout. “This new research validates some assumptions that have existed for years and gives eyecare professionals compelling data to engage new contact lens wearers in conversations that could improve their near- and long-term experiences,” they said. n

"PRIOR TO THIS STUDY, NOBODY REALLY KNEW HOW THE HYDROXYAPATITE WAS ACCUMULATING IN THE DRY AMD DRUSEN" DINUSHA RAJAPAKSE, US NATIONAL EYE INSTITUTE

A protein that normally deposits mineralised calcium in tooth enamel may also be responsible for calcium deposits in the back of the eye in people with atrophic age-related macular degeneration (AMD), according to a new study. The research team, from the US National Eye Institute (NEI), now believe the protein called amelotin could eventually become a therapeutic target for the blinding disease that still has no treatment. “Using a simple cell culture model of retinal pigment epithelial cells, we were able to show that amelotin gets turned on by a certain kind of stress and causes formation of a particular kind of calcium deposit also seen in bones and teeth,” senior author Mr Graeme Wistow said. “When we looked in human donor eyes with dry AMD, we saw the same thing.” Recently, researchers found a calciumcontaining mineral compound called hydroxyapatite (HAP) in atrophic AMD deposits. HAP is a key component of tooth enamel and bone. Small balls of HAP filled with cholesterol, called spherules, were found only in drusen from people with atrophic AMD, and not in those with neovascular AMD or without AMD. In this study, Wistow’s team discovered that if they starved RPE cells grown in

“Prior to this study, nobody really knew how the hydroxyapatite was accumulating in the dry AMD drusen,” Ms Dinusha Rajapakse, the first author of the study, said. “Finding this toothspecific protein in the eye, this protein that’s linked to hydroxyapatite deposition – that was really unexpected.” n

New research into occupations that have an increased risk of COVID-19 exposure has shown that eyecare professionals face a higher threat than most other professions. The UK’s Office for National Statistics (ONS) created an estimate of exposure to generic diseases and physical proximity to other people for UK jobs based on US analysis of these factors and 2019 data.

The report also highlighted that healthcare workers have a particularly high potential risk, due to regular

INSIGHT July 2020

transwells for nine days, the cells began to deposit HAP. They determined the protein amelotin, is strongly upregulated after extended starvation and is responsible for the mineralisation of HAP in their cell culture model.

OPTOMETRISTS RANK HIGH IN TERMS OF PROXIMITY TO CUSTOMERS

The analysis, according to Optometry Today, demonstrated that ‘ophthalmic opticians’ were at the higher end of the scale, ranking at 17 out of 359 professions for exposure to disease, and ninth for proximity to others.

Top: HAP spherules (pink) and amelotin protein (green) in soft drusen from eye with dry AMD. Bottom: OCT image of dry AMD, showing soft drusen beneath the retinal pigment epithelium.

exposure to disease and close contact with others. However, it noted “during the pandemic they are more likely to be using personal protective equipment”. “This suggests eyecare professionals may be subject to higher potential risk, with ‘weekly’ exposure to diseases and physical proximity typically between arm’s length and touching distance,” the publication reported. n

EYES ‘IMPORTANT ROUTE’ FOR COVID TRANSMISSION transmissibility of COVID-19 than that of SARS. This study also highlights the fact that eyes may be an important route of SARS-CoV-2 human infection.”

Hong Kong researchers believe the eyes may be an important route for coronavirus transmission, in a world-first study that reveals the current strain is up to 100 times more infectious than SARS. New testing data published in The Lancet Respiratory Medicine has demonstrated SARS-Cov-2 – the strain of coronavirus that causes COVID-19 disease – infected the upper respiratory airways and conjunctiva much more efficiently than the 2003 SARS-CoV (SARS). The research team from School of Public Health, LKS Faculty of Medicine of the University of Hong Kong (HKUMed), claim they are the first in the world to provide evidence that coronavirus can infect through both facial entry points. In this study, co-author Dr Michael Chan Chi-wai, Associate Professor of the School of Public Health, HKUMed, and his research team compared the infection of SARS-CoV-2, SARS-CoV and

Taken together, the researchers say this explains the higher transmissibility of the novel pandemic SARS-CoV-2 than that of SARS-CoV. In a previous study, the research team discovered that SARS-CoV-2 can remain alive for several days on smooth surfaces such as stainless steel, glass and plastic.

The virus is efficient in infecting the human conjunctiva.

the influenza viruses H5N1 (Bird flu) and H1N1pdm2009 (Swine flu) using human upper respiratory tract and eye tissues.

The latest findings highlight the possibility that infectious virus can be spread from such contaminated surfaces by hands, when a person touches the surfaces and rubs their eyes afterwards.

“We found that SARS-Cov-2 is much more efficient in infecting the human conjunctiva, the cells lining the surfaces of the eyes, and the upper respiratory airways than SARS, with virus level some 80 to 100 times higher,” Chan said told the South China Morning Post, adding that its level of infection is comparable to that observed with Swine flu.

This, the researchers state, demonstrates why it is vital to avoid touching the eyes when in public areas, and the importance of regular hand washing to prevent accidental transfer of SARS-CoV-2 from contaminated surfaces to human eyes and noses. n

“This explains the higher

THINNING RETINAS EARLY ALZHEIMER’S SIGNAL Biomedical engineers at Duke University have devised a new imaging device that measures changes in the thickness and texture of the retina that could reveal early signs of Alzheimer’s disease. Mr Adam Wax, professor of biomedical engineering at Duke, said changes in the retina represent the newest frontier in research for how the eye can reveal Alzheimer’s biomarkers. “Previous research has seen a thinning of the retina in Alzheimer’s patients, but by adding a light-scattering technique to the measurement, we’ve found that the retinal nerve fibre layer is also rougher and more disordered,” he said. “Our hope is that we can use this insight to create an easy and cheap screening device that wouldn’t only be available at your doctor’s office, but at places like your local pharmacy as well.” As it currently stands, Alzheimer’s diagnoses are only made after a person begins to display symptoms of cognitive decline, which typically occur after the age of 65. The only way to determine Alzheimer’s with certainty involves MRI

Fluorescence image of retinal layers from wild, healthy mice (right) and mice genetically bred to show Alzheimer’s (left). Green represents amyloid deposits correlating with disease.

or PET scans, or post-mortem diagnosis with an autopsy. Researchers in a 2018 study concluded that declining vision may be driving cognitive decline and they speculated that protecting vision could help preserve cognition. “The retina can provide easy access to the brain, and its thinning can be indicative of a decrease in the amount of neural tissue, which can mean that Alzheimer’s is present,” Wax said. “We’re excited because this research

"THINNING CAN BE INDICATIVE OF A DECREASE IN THE AMOUNT OF NEURAL TISSUE, WHICH CAN MEAN THAT ALZHEIMER’S IS PRESENT"

shows a new way of using low-cost OCT technologies outside of simply screening for traditional retinal diseases.

ADAM WAX, DUKE UNIVERSITY

Other diseases such as glaucoma and Parkinson’s disease can also cause a thinning of the retina. Inconsistent test results might also come from differences between the machines most often used for these types of measurements, such as OCT devices, and how researchers use them.

“If we can use these devices as a window into early signs of neurodegenerative diseases, maybe we can help people get into an early intervention treatment program before it’s too late.”

In the new paper, Wax and his graduate student Mr Ge Song show that the topmost layer of neurons in the retina of a mouse model of Alzheimer’s disease exhibit a change in their structural texture. Combined with data on the changes in thickness of this layer, the new measurement could prove to be a more easily accessible biomarker of Alzheimer’s disease. n

INSIGHT July 2020 23

TECHNOLOGY

NEW CORNEA-ON-A-CHIP SIMULATES BLINKING OF THE EYE

DR GRADER PERFECTS VISION THREATENING DETECTION International researchers have demonstrated that an artificial intelligence-enabled algorithm can achieve 100% sensitivity in detecting vision-threatening diabetic retinopathy. US company Eyenuk is behind the autonomous product, the EyeArt AI Eye Screening System, which was the subject of the study which featured in the British Journal of Ophthalmology. According to the independent research paper, produced by authors from the Moorfields Eye Hospital NHS Foundation Trust, the University College London Institute of Ophthalmology and the Homerton University Hospital NHS Foundation Trust, the EyeArt system achieved 92-100% sensitivity in diabetic retinopathy detection with multiple retinal imaging platforms. The study involved 1,257 patients attending annual diabetic eye screening in the UK. The EyeArt System processed images acquired by CenterVue’s EIDON platform with wide-field true-colour confocal scanning technology, as well as images acquired by standard cameras in the English National Diabetic Eye Screening Programme (NDESP). With EIDON images, EyeArt achieved sensitivities of 92% for any retinopathy, 99% for vision-threatening retinopathy and 100% for proliferative retinopathy. The system’s sensitivities for NDESP images were 92.26% for any retinopathy, 100% for vision-threatening retinopathy and 100% for proliferative retinopathy. “With this [impressive] performance, if the [EyeArt] software were to be hypothetically deployed as a part of the English NDESP, the EyeArt could reduce the need to grade R0M0 (no retinopathy and hence no maculopathy) by half when using EIDON images and by almost twothirds when using the NDESP images, a considerable workload reduction,” the authors noted. According to Eyenuk, the UK has been leading the world in diabetic retinopathy screening, achieving patient uptake rates of more than 80%, with nearly 2.5 million patients annually in England. Elsewhere, typically fewer than half of diabetes patients receive annual eye screening. As a result, diabetic retinopathy is no longer the leading cause of blindness in the working age group in England. n

INSIGHT July 2020

"IT WAS REALLY INTERESTING TO FIND THAT AN EYE-BLINKINGLIKE STIMULUS HAS A DIRECT BIOLOGICAL IMPACT ON THESE CELLS" RODI ABDALKADER, KYOTO UNIVERSITY

Japanese scientists have engineered a new approach could lead to the development of ‘cornea-on-a-chip’ devices that more accurately test the effects of ophthalmic drugs. Researchers from Kyoto University’s Institute for Integrated Cell-Material Sciences (iCeMS) hope their findings, reported in Lab on a Chip, will also advance understanding of how blinking affects the corneal surface. Traditionally, scientists have tested ophthalmic drugs by administering them into rabbits, which blink significantly less than humans, allowing drugs a greater chance of permeating the cornea. Alternatively, scientists use small wells containing human corneal cells. However, the cells aren’t exposed to the environment of a living human eye. Kyoto University pharmaceutical scientist Mr Rodi Abdalkader and micro-engineer Associate Professor Ken-ichiro Kamei collaborated to develop a device that overcomes these issues by replicating fluid movements over the cornea. They 3D-printed a device contains four upper and four lower channels, separated by a clear polyester porous membrane. Corneal cells are incubated in each upper channel on top of the membrane. After seven days, they are said to

The cornea-on-a-chip device by Kyoto University.

form a barrier of cells that separates the upper and lower channels. Fluid is then moved through the device to emulate the pressure exerted on one side of the cornea by a blinking eyelid and moving tears, and on the other side by the fluid of the inner eye. They found this movement changed the shape of the cells and increased the production of filaments, which keep corneal cells flexible and elastic. “It was really interesting to find that an eye-blinking-like stimulus has a direct biological impact on these cells,” Abdalkader said. “We blink frequently and unconsciously all the time. With each blink, a shear stress is applied on the corneal barrier that causes the cornea counter-defence system to secrete fibrous filaments, like keratins, to overcome the effects of the stress.” n

SMART CL SENSOR FOR POINT-OFCARE EYE HEALTH MONITORING Chinese researchers have developed a smart contact lens that can show realtime changes in moisture and pressure by changing colour. The contact lens was developed by a research group, led by Professor Du Xuemin from the Shenzhen Institutes of Advanced Technology (SIAT) of the Chinese Academy of Sciences, who believes the prototype can overcome common challenges associated with ophthalmic health monitoring. The structurally coloured contact lens sensor is made from a biocompatible hydrogel, without the addition of chemical pigments, allowing for superior biosafety and comfort for wearable applications. Importantly, the researchers state the spacing of periodic nanostructures

The lens responds to eye pressure changes.

within the pHEMA hydrogel are sensitive to changes in moisture and pressure, leading to real-time colour changes. “Based on these features, the ‘smart’ contact lens was explored as a means for monitoring xerophthalmia and high intraocular pressure disease,” Mr Zhao Qilong, first author of the study, said. n

PRACTICE HYGIENE

REIGNS SUPREME IN RETURN TO PRACTICE The days of casually leaning on the reception desk at medical clinics are gone, replaced instead with plastic screens, hand sanitiser and non-contact thermometers. Insight takes a snapshot of the return-to-work landscape as the sector emerges from COVID-19.

yecare professionals only need to cast their minds to the origin of the COVID-19 crisis as a reminder of the risks they now face in their line of work.

Dr Li Wenliang, a Wuhan ophthalmologist who helped blow the whistle on the emergency, was among the first of many global healthcare workers to die from the disease after contracting it from a glaucoma patient. Since then, several studies have demonstrated a connection between coronavirus and its potential to transmit and replicate in the eyes. Because of their physical proximity to patients, ophthalmic professionals have also been identified as one of the most at-risk occupations for virus exposure.

INSIGHT July 2020 25

PRACTICE HYGIENE XX

In the face of such evidence, Australian eyecare providers and health authorities have enforced strict practice hygiene and protective measures that many predict will be in place for months, or even permanently. It has all come at a great cost too. Restrictions on patient volumes has impacted the revenue line for many practices and clinics. This is in addition to the lay-off during forced shutdown, and the added expense of additional personal protection equipment (PPE) and breath shields and barriers – some of which is purpose-made or even sourced from Bunnings. Alongside practice hygiene guidelines, the government-led directive on surgery volume governing how many patients can go under the knife is also affecting through-put and feeding concerns about an eminent backlog. Insight speaks to three ophthalmologists about how they are managing a safe return to work.

OPTOMETRY WARNING OVER

TONOMETRY AND VISUAL FIELDS Optometry Australia (OA) is recommending high level disinfection for reusable tonometer probes as part of its infection control advice to help optometrists return to work safely alongside their patients. OA’s Infection control and COVID-19 factsheet, released in June, provides updated, evidence-based information for optometrists, their staff and their practices on pertinent pandemic infection control procedures. It highlights that the gold standard for disinfection of semi-critical devices – a category that includes tonometer probes – requires either sodium hydrochlorite or Tristel Duo OPH, a new product which uses chlorine dioxide as the active agent, and is approved by the Therapeutic Goods Administration (TGA) for high level disinfection of instrument grade surfaces. Compiled by OA’s policy and standards advisors, optometrists Ms Kerryn Hart and Ms Cassandra Haines, the factsheet summarises infection control in a compact resource designed to be used in practices. Hart says one of the most important changes to instrument disinfection relates to contact tonometry. “What is now suggested is using high level disinfectant, like Tristel Duo, on reusable probes, which has obtained TGA approval for semicritical medical devices, or – if not available – bleach, as our review of the literature suggests use of an alcohol swab does not provide appropriate viricidal activity,” she says. “If tonometry cannot be deferred, a single-use disposable applanation tonometry prism, or iCare tonometer with disposable probes, is recommended.” OA’s advice on visual field instrument disinfection notes that infection control practices suggest using an appropriate disinfectant to reduce potential surface contamination on the chin rest, forehead rest, trigger and bowl. However, as OA’s factsheet acknowledges it may be impractical to clean the interior of the perimeter bowl without damaging the machine and the virus could remain airborne in the enclosed space for an unknown length of time. It recommends visual field testing should be avoided if possible. “Some hospitals and ophthalmology practices have ceased visual field testing unless urgent and our guide suggests suspected or confirmed COVID-19 patients wear masks if testing is unavoidable,” the authors note. Infection control and COVID-19 factsheet is an open access document available on OA’s website.

INSIGHT July 2020

A SURREAL SITUATION Sydney-based ophthalmologist Tim Roberts is Clinical Associate Professor at The University of Sydney and medical director of Vision Eye Institute (VEI), the largest private provider of ophthalmic care in Australia with 27 locations across the country. He is also a consultant at Royal North Shore Hospital, a major public teaching hospital in Sydney with COVID-19 dedicated facilities. From the beginning of the coronavirus outbreak, Roberts has met weekly via video-conferencing (but more frequently during the height of the pandemic) with CEO and managing director James Thiedeman, and VEI’s Medical Advisory Board, to steer VEI through the pandemic. Roberts says the policy for his group has been to adhere to the National Cabinet and Federal Government’s Department of Health guidelines, and follow the advice of the Australian Government Chief Medical Officer throughout the initial disruptions and subsequent tightening restrictions on healthcare. “One of Australia’s strengths during COVID-19 has been a strong collaborative allegiance at National Cabinet,” he says. “We’ve determined our policies based on Australia’s Chief Medical Officer’s guidelines, even though they’ve differed slightly from time-to-time from those of RANZCO and the AMA (Australian Medical Association).” Roberts says that while there has been a significant reduction in patient numbers, their focus at VEI has been to support and maintain their staff while continuing to provide patient care. “We have been converting our practices which has included installing splashguards on all our equipment and removing all magazines, brochures and children’s toys from our waiting rooms. Each clinic has ample supplies of hand sanitiser for staff and visitors and undertakes two-hourly cleaning of all surfaces, with consulting rooms cleaned after each patient,” he says. “We’re also conducting a pre-screening concierge service. We question patients about their travel history and if they are displaying any symptoms of illness. We ask them to sign a disclaimer, and then they are admitted into the practice. If a patient rings and wishes to cancel their appointment, we offer a telehealth consultation, and take that opportunity to promote a public health message.” Despite being costly and difficult to source at times, VEI has also ensured it has appropriate infection control including PPE in theatre and clinics, hand sanitiser, and face masks. Roberts says reduced consulting numbers and ensuring social distancing measures in waiting rooms have helped keep infection risks low. “The risk of infection is two-fold; from contact outside of 1.5 metres,

which is why we have line markings on the floor for social-distancing, and from aerosolisation inside 1.5 metres, which is why we have installed splashguards on equipment including slit lamps and lasers, and limited the time staff and doctors spend close up with patients,” he says. “We’re seeing fewer patients because we have to socially distance patients in the waiting room, including patient carers.” Roberts says VEI’s time-in-motion studies show exactly how many patients can be safely seen in the clinic. “We’ve seen a 70% reduction in work and revenue in April. It’s starting to plateau off and our patient volumes are now improving,” he said in May. The single largest contributor to this downturn was the Federal Government’s suspension on elective surgeries across private and public hospitals on 25 March as the health sector braced for a looming public health emergency in response to the pandemic. “Similar to other industries, the pandemic has resulted in a significant economic downturn for doctors and hospitals providers. The cost of operating at only 25% capacity is significant, but that is the price we are willing to pay to protect our community,” he says. The restriction on elective surgery was partially lifted on 27 April with the government announcing the first phase in a gradual loosening of elective surgery restrictions with all Category 2 procedures, and ‘important’ Category 3 surgeries, which include cataracts and eye procedures, getting the green light.

SRP from $ 110. Contact your Safilo Area Manager to discover the full Polaroid range and our special offers for your practice.

“In 30 years in ophthalmology, this is the first time we’ve gone months without operating,” Roberts explains. “Reflecting on different generations, you can’t choose the world you live in. Other generations have lived through the Depression, World Wars, and the Spanish Flu.”

DR LI WENLIANG The Wuhan ophthalmologist, who sounded an early alarm before later dying of the COVID-19, was awarded the title of ‘martyr’ – the highest honour the Communist Party of China. He apparently contracted the virus from a glaucoma patient.

He describes the ban on elective surgery in medicine and the government closure of private hospitals as “surreal” and has seen the “ripple effect” of the psychological and social impact of COVID. “People are uneasy; they’re tentative. Anxiety is creeping in; there’s a hint of agoraphobia as the Southern Hemisphere heads into winter,” he says. “We’ve been calling patients to say we’re open but many are declining to make an appointment in the immediate future. Elderly patients don’t want to come out; adult children with elderly parents don’t want them to come out.” Looking ahead, Roberts predicts if there isn’t a second wave outbreak, surgery capacity should continue to return to pre-COVID levels, but if there is a second wave, there’ll be a rapid reactivation of restrictions to preserve PPE. He also knows there will be a patient backlog, particularly in the public

PRACTICE HYGIENE

health system, which he has seen first-hand at Royal North Shore Hospital. “Public hospitals will need to re-think how to categorise cases and schedule surgery and appointments, as outpatient and elective surgery waiting lists have understandably blown out,” he notes. “The volume of patient loads is different between the private and public system. The private system can expand capacity, but the public system has limited capacity, and budget, to expand,” Roberts says. “I’m concerned for patients on public waiting lists, particularly cataract surgery patients, as performing cataract surgery and improving vision has significant social and public health value.” HYGIENE PROTOCOL VARIABLE Heather Mack is president of RANZCO and Clinical Associate Professor of Ophthalmology at the University of Melbourne. She practices in Doncaster, East Melbourne, and Malvern. She notes that consulting and surgery volumes are down for a number of reasons, but having fewer patients makes it easier to manage practice hygiene without the pressure of high volumes of patients and their carers coming through the clinic. “Day surgeries and centres put in place their own practice hygiene guidelines, guided by Federal Government guidelines, and local state, hospital or agency guidelines, such as Safer Care Victoria, the peak Victorian authority for quality and safety improvement in healthcare." Mack says practice hygiene protocol varies from place to place: “Cabrini Health in Melbourne is screening patients, visitors and staff with a verbal questionnaire, infra-red temperature check, and hand sanitiser before entering the hospital. In my practice, we’re screening patients with a questionnaire by phone before arrival, and instructing carers and drivers to wait elsewhere, such as in their car. “Patients are required to sanitise their hands when they arrive, and we run through a series of questions about health and travel again. We allow a minimum number of people in the practice and we’ve installed Perspex screens – they will remain in place indefinitely.” When the government announced it was easing surgery restrictions, RANZCO released its own Return to elective surgery guide, cautioning that operating lists and through-put would be restricted by social distancing and infective precautions. It offered advice on how ophthalmologists

INSIGHT July 2020

should handle asymptomatic patients with no known symptoms, as well as confirmed or suspected cases. “We’re limiting patient examinations to less than 15 minutes wherever possible – some ophthalmologists are taking patient history over the phone rather than in person,” Mack says. “We limit what we do; we’re not doing lacrimal syringing because of the high risk of aerosolisation. We’re taking precautions, our equipment is regularly cleaned, we’ve installed breath shields on slit lamps. Wearing masks is variable – it depends on jurisdiction.” Advertising the availability of ophthalmology clinic services also comes with inherent challenges. Regulated health services must comply with stringent advertising criteria stipulated by Medical Board of Australia guidelines, under the Australian Health Practitioner Regulation Agency umbrella. As such, ophthalmologists are notifying patients that they are ‘open for business’ the old-fashioned way, by phoning patients individually. “There is a big risk of patients not attending for care,” Mack says, which is why community service announcements such as those by the Macular Disease Foundation Australia and patron Ita Buttrose about intravitreal injections appointments are supported across the board, including by RANZCO. Like Dr Roberts, Mack predicts there will be a backlog of patients requiring eye procedures as restrictions on capacity continue to lift. “When it’s possible to resume normal care, there’ll be a backlog of patients with visual loss. This is already happening with some immunosuppressed uveitis patients. It’s possible we’ll see more patients presenting with serious ocular pathology because they haven’t received treatment for four to six weeks, during the forced shutdown.” CAPACITY CONFUSION Associate Professor Adrian Fung is a retinal surgeon who works at multiple sites in Sydney including Westmead Hospital, Macquarie University Hospital, and private practice in Miranda, Hurstville, Chatswood, Bondi Junction and Liverpool. He is a co-author of the RANZCO COVID-19 guidelines and is vicechair of the college’s Clinical Standards Committee. He was guest speaker at a recent international webinar on practice hygiene

"I’M AWARE OF SURGEONS WHO BOOKED A NUMBER OF PATIENTS ON THEIR ELECTIVE OPERATION LIST, ONLY TO BE TOLD BY THEIR HOSPITAL AT THE LAST MINUTE TO REDUCE THEIR LIST"

"WE’RE SCREENING PATIENTS WITH A QUESTIONNAIRE BY PHONE BEFORE ARRIVAL, AND INSTRUCTING CARERS AND DRIVERS TO WAIT ELSEWHERE, SUCH AS IN THEIR CAR"

"THE PANDEMIC HAS RESULTED IN A SIGNIFICANT ECONOMIC DOWNTURN FOR DOCTORS AND HOSPITALS PROVIDERS. THE COST OF OPERATING AT ONLY 25% CAPACITY IS SIGNIFICANT"

ADRIAN FUNG

HEATHER MACK

TIM ROBERTS

and how to mitigate risk for patients in-clinic, particularly macular disease patients.

“I spoke about RANZCO’s triage guidelines in Australia and the importance of continuing intravitreal injections for conditions such as AMD, despite the seriousness of the pandemic," Fung says. Most Australian ophthalmologists follow a treat-and-extend regime and the guidelines suggested extending this to the maximum interval possible in order to minimise visits. This is similar to the USA but contrasts to many other counties in the world who have a fixed regime or a pro re nata (PRN, or as-needed) regimen. We’re encouraging patients to see their ophthalmologist, in line with advice from the Chief Medical Officer." He says RANZCO’s guidelines and protocols adopted during the pandemic are in accordance with national and state Department of Health guidelines. “We’ve tried to allow for some flexibility for the local situation. Our guidelines don’t contradict national or state guidelines, but we try to give discretion to ophthalmologists to adopt the recommendations according to the prevalence and level of risk of COVID-19 in their area,” Fung states. “We’re conscious that COVID is a serious public health emergency but we’re also conscious of the ocular morbidity associated with not seeing patients to provide treatment in a timely manner.” State governments have given hospitals in NSW and Victoria the green light to increase elective surgery from 25% of pre-pandemic levels – the limit imposed when the ban on most non-essential surgeries was partially lifted in late April – to 50% by May 31, then 75% by June 30. Fung says most ophthalmologists are compliant with COVID guidelines but the 25% capacity directive from the Federal Government – in place when Fung spoke with Insight – had caused some confusion. “There has been some difficulty in knowing how to interpret that 25% reduction. In some hospitals, surgeons had not been given clear directions on how many patients they were allowed to book. I’m aware of some surgeons who booked a number of patients on their elective operation list, only to be told by their hospital at the last minute to reduce their list,” Fung says. More recently there have been clearer instructions depending on the volume of surgery each surgeon had historically booked. Fung welcomes the Federal Government’s staged approach to relaxing the rules around elective surgery but was wary that a second-wave outbreak could potentially diminish supply of PPE and put another stop-work on elective surgery. He says precautions are heightened in a bid to avoid complacency. “Our profession’s key message is it is important to see patients because ocular morbidity will increase if we don’t. We’ve put precautions in place, such as pre-screening patients for COVID-19 risk factors, enforcing 1.5 metre social distancing in waiting rooms, limiting accompanying persons to one, installing breath shields over slit lamps, and regularly cleaning the clinic.” Some measures that have been introduced during the pandemic to reduce the risk of infection might be here to stay, he adds. “Avoiding shaking hands, the removal of magazines and toys from waiting rooms, contactless payment instead of cash, and non-contact temperature checks, may all be here to stay permanently.” n

ZEISS UNVEILS DISINFECTANT AND PROTECTION PROGRAMS Since the outbreak, Zeiss has been fielding many inquiries by Australian eyecare professionals about the best disinfection methods for its surgical microscopes, OCT devices and perimetry systems – without causing damage to key components. It has responded with a range of comprehensive cleaning guides and has also been supplying protective equipment that can be attached to instruments to help eyecare professionals reduce the risk of COVID-19 infection. The most successful of those has been its free slit lamp breath shield offer, which is also available to non-Zeiss customers. Some 3,000 breath shields have been sent across Australasia, along with 80,000 globally. In line with advice from the US Centers for Disease Control and Prevention (CDC), Zeiss recommends disinfecting device surfaces with a disinfectant solution of at least 70% alcohol, such as isopropyl alcohol. Based on experience, Zeiss states disinfecting the surfaces of its surgical microscopes with such solutions does not affect their performance or pose a risk to the patient/user. However, there is a chance that surfaces can become dull or matt. It is also possible that adhesive labels may become detached during long-term exposure, but won’t fall off. For surgical microscopes, Zeiss also provides single-use drapes that can cover the microscope body and head, as well as drapes that cover the objective lens (called VisionGuard). For its Cirrus OCT systems, the company advises lenses should be cleaned using only water, isopropyl alcohol and acetone. Up to 99% isopropyl alcohol can be used for cleaning the optical surfaces. Cleaning of optical surfaces can be done as much as needed – such as between patients – but there will be an increased risk of damage to the optical surfaces if there are hard particles on the surface and too much pressure is applied. For the HFA, professionals are required to take extra care due to the delicate surfaces of the perimeter’s bowl and optics. Zeiss has detailed cleaning instructions on how to treat Humphrey perimeters and the testing room. Also included is new guidance on how to clean the bowl, which includes warnings about the potential for scratching, discolouring or staining the bowl surface. It also advises care to avoid getting distilled water or isopropyl alcohol cleaning liquid inside the fixation target openings or on mirrored surfaces. Zeiss has also provided advice on how to set up Cirrus HD-OCT and HFA so that eyecare professionals can operate it somewhat remotely.

INSIGHT July 2020 29

CATARACT REPORT

CATARACT SURGERY

BUT NOT AS WE KNOW IT Cataract surgeons are reporting unexpected flow on effects as a result of the pandemic. RHIANNON BOWMAN finds out how they are faring as they return to operating theatres, albeit at reduced capacity with an ever-increasing backlog.

uantitative data on the true impact of the recent suspension on cataract surgery won’t be known for some time, but early anecdotal evidence suggests a myriad of challenges have emerged for patients and surgeons alike. Denser cataracts, anisometropia and logistical headaches in terms of hygiene practices and through-put levels feature near the top of a list of knock-on effects caused by a monthlong hiatus on non-urgent procedures. Cataracts are the most common elective surgical procedure in Australia, accounting for 245,797 hospitalisations alone in 2014-15. As surgeries and hospitals work through an overwhelming backlog and brace for pentup demand, concerns are also increasing over the potential deterioration of quality of life for some patients, with the incidence of falls and other accidents to possibly increase as delays prolong.

INSIGHT July 2020

“Whilst it is important that cataract surgeries are done, we must remember that there are many other eye surgeries on retina, eyelids and corneas which must not be deferred in order for state governments to tidy up their cataract KPI figures.” With so many challenges to consider, Insight asks how surgeons are managing their cataract surgery caseloads and what unforeseen circumstances have arisen with COVID. LONGER WAIT “First and foremost, in my mind, is how will COVID change the way we perform cataract surgery? What will be the new normal?” asks Associate Professor Colin Chan.

Complicating matters are limits on the operating capacity for elective surgery from state-to-state. Hospitals in New South Wales and Victoria were given the green light to increase elective surgery from 25% of pre-pandemic levels to 50% by May 31, then 75% by June 30.

Chan is an internationally recognised expert in laser eye surgery, refractive lens exchange and laser cataract surgery, and has performed more than 7,000 eye surgery procedures. He practices at the Vision Eye Institute in Chatswood and Bondi Junction and is an Adjunct Associate Professor at the University of Canberra and a senior clinical lecturer at the University of Sydney.

South Australia was the first to fully restore all elective procdure capacity by early-to-mid-June, while Western Australia was sitting on 50% surgery volume, with just two COVID-19 cases. In Tasmania there has been a gradual and progressive restart at the discretion of medical professionals.

He spoke to Insight in May when ophthalmologists in New South Wales were restricted to performing up to 25% of normal surgical activity levels for patients needing treatment within 90 days (Category 2) or at some point in the next 12 months (Category 3).

Meanwhile, in the public system, Australian Society of Ophthalmologists president and Sydney cataract and refractive surgeon Dr Peter Sumich believes COVID will blow out cataract wait times by up to two years in some places.

“The partial return to volume has been good. It has provided an opportunity to look closer at our processes and ease our way into it with a focus on the safety of patients and the general public,” he says.

He says optometrists and GPs should warn patients about this and make them aware of local private services as an alternative.

“We’re trying to address the current situation. We’re not necessarily thinking about the latest intraocular lenses and new technology. We’re trying to do what’s necessary, what’s essential.”

“Many patients who are faced with a two-year public wait will ‘find the funding’ through their Gen X and Gen Y children

who are often unaware that their parents even had a problem accessing services,” he says.

A major concern for Chan is the impact of a six to 10-

week delay or longer for appointments, leading to denser cataracts for some patients. In turn, this could result in poorer outcomes in visual acuity. Further, Chan explains that denser cataracts can lead to longer surgical times and requiring more thermal energy to remove via phacoemulsification. “There is greater risk of tissue damage and that can have an effect on visual acuity. There is greater risk of corneal oedema,” he says. The knock-on effect of the cancellation of scheduled surgery, and reprioritising and rescheduling patients, is longer waiting lists. Even with social distancing measures, and stringent practice hygiene, Chan notes there is also a lingering fear among elderly patients to leave their home for care. “The term ‘elective surgery’ sounds optional but patients could potentially fall and fracture their hip or not be able to drive because of poor visibility due to cataract,” he says, his point being that for some patients, cataract surgery is not a lifestyle choice; it’s a necessity. “Australian ophthalmologists are some of the best in the world. The reality is it’s going to take longer to get through the system than before COVID, whether public or private. “There are delays getting an appointment, it’s taking longer than usual. This is going to have sequential effects on the system. There’ll be an extended backlog.” With the emphasis now on timelines, some cases that would have previously warranted surgery sooner, are being scheduled later. Chan says the ‘new normal’ will not return to the previous capacity. “A cataract patient who is experiencing night-time driving vision issues such as glare and halos, who would normally be scheduled for surgery, may have to wait longer because we can’t operate at our previous capacity and technically they still meet the legal standards of being able to drive,” he explains.

Associate Professor Colin Chan.

Dr Andrew Atkins.

PRIORITISING CRITICAL CARE Cataract surgeon Dr Andrew Atkins was on the road to Shepparton when he first spoke with Insight. His practice is divided between metropolitan Melbourne (Footscray and Brighton) and rural Shepparton, and encompasses surgery on both private and public cases. The restrictions on surgery volume following a month-long hiatus on all surgery is creating a “reasonable backlog” and patients are subsequently growing frustrated and anxious. “The restrictions on surgery volume is a grey area; it’s not clear what 25% means. Is it 25% of your overall capacity, or is it 25% of your preCOVID patient load?” His cataract patients typically want their surgery done in April and May, but that hasn’t been possible this year. “Those months are usually a busy time of year for cataract surgeons because patients want to go travelling during the Southern Hemisphere winter. Some want to travel overseas for summer in the Northern Hemisphere, others want to hook up their caravan and head up to Queensland for the warmer weather,” he says.

CATARACT REPORT

An enforced quiet period is not the only disruption to routine cataract surgery this year. Atkins says the level of infection-risk precautions has also increased sharply. “Right from the first phone call to a patient, we’re taking precautions to protect public health and triage our patients. If they are at-risk [of COVID], we postpone their appointment; if they are not at risk, we see them but under controlled restrictions, such as measuring their temperature on arrival, and taking less than 15 minutes for a consultation," he says. “We also have signs up asking patients about any risk factors, and all patients are directly questioned on arrival. Due to social distancing requirements we ask relatives to stay in the car park in their cars and the patient numbers are reduced overall and at any one time with regards to the number in the actual waiting room. I consider all of these actions to be very important.” He says another significant difference in routine cataract surgery – between pre-COVID and the present – is a heightened need to prioritise critical care. “When surgery was restricted I did manage to do a cataract operation on a patient with a dense cataract who was blind in the other eye and I considered this to be a priority but essentially the vast majority of cataracts are Category 3 and hence we were restricted regarding cases.” Atkins says there is a silver lining for most ophthalmologists and optometrists as the stages of restrictions are gradually eased. “The good news is that the usual ‘quiet period’ in July will be busy, as long as the number of coronavirus cases remains low and there isn’t a secondwave outbreak.” DISRUPTION CAUSES DILEMMA Perth-based surgeon Dr Tom Cunneen specialises in cataract, laser, and eyelid surgery. He operates privately at St John of God Subiaco and the Perth Eye Hospital and holds a consultant position at Sir Charles Gairdner Hospital, a teaching hospital colloquially referred to as “Charlies”. Despite ophthalmologists in Western Australia being able to increase elective surgery to 50% of all normal elective surgical activity in May, unlike colleagues on the eastern seaboard who were still only operating at 25%, it’s been a frustrating set of circumstances. (Surgical capacity was reinstated 100% in WA on 15 June)

Dr Peter Sumich.

Dr Tom Cunneen.

“It’s frustrating. We’re consulting at full capacity, but operating surgically at 50% of our previous through-put,” Cunneen says. “This is creating a friction whereby a patient is diagnosed with a condition, but can’t have surgery in a timely manner.” The Federal Government introduced staged guidelines for gradually returning to full elective surgery capacity but the reality on the ground varies from state-to-state. Speaking in May, Cunneen said there were only two active COVID cases in Western Australia. “I feel that the state government [in WA] can use their discretion based on the number of positive COVID cases and lift the capacity restrictions,” he says. Cunneen says he hasn’t observed cataract cases worsening or growing denser among his patient cohort during the surgery hiatus, but it has caused another unexpected knock-on effect. “The issue has been the patient’s second eye. Cataract patients who I operated on before COVID are now in a holding pattern. They’re struggling as they’ve had one eye operated on but now there’s a delay in getting their second eye done. They’re troubled by anisometropic symptoms as a result.” Anisometropia is another way of describing an imbalance between the two eyes. This can sometimes occur following surgery as the brain tries to adjust to the changes in vision. “I’m prioritising patients who are waiting for a cataract operation on their second eye,” Cunneen says. “Optometrists can prescribe a contact lens to tide these patients over so they are not suffering anisometropic symptoms which can include poor depth perception, dizziness, headaches, and nausea.” n

CALLS FOR PRIVATE PROVIDERS TO RESCUE PUBLIC SYSTEM planning for the return of elective surgery in the immediate and longer term.”

With public hospital wait times expected to blow out by up to two years for cataract surgery, RANZCO and The Fred Hollows Foundation are jointly encouraging private hospitals to offer their capacity to their public counterparts to address a backlog of Indigenous patients awaiting the procedure. In a joint statement, the duo are also encouraging ophthalmologists to bulk bill Aboriginal and Torres Strait Islander patients to ensure equity of access to eye surgery. Australian data shows only 59% of Indigenous people who need cataract surgery will get it, compared with 89% of other Australians. They will also wait 40% longer. “As the Australian health system recovers from the COVID-19 pandemic and recommences standard services, The foundation and RANZCO note that access to ophthalmic care may worsen for Aboriginal and Torres Strait Islander Peoples if this is

INSIGHT July 2020

As such, RANZCO and Fred Hollows called on private hospitals to offer their capacity to public hospitals to help meet the growing backlog of Aboriginal and Torres Strait Islander patients waiting for cataract surgery, especially during the next phases of the recommencement of elective surgery. Image: Daniel Jesus Vignolli, Fred Hollows Foundation.

not specifically addressed in health service planning,” the organisations stated. “Additional barriers such as restrictions in and out of remote communities will limit access to ophthalmic services, and further delay access to cataract surgery and other essential eye health procedures. It is essential that equitable access is a core part of the

It also encouraged ophthalmologists to bulk bill Indigenous patients to ensure equity of access to cataract surgery and other ophthalmic treatment. The organisations urged health providers to ‘ask the question’; giving patients an opportunity to identify as Aboriginal and/ or Torres Strait Islander, and encouraged the Australian Health Protection Principal Committee to include equity for Aboriginal and Torres Strait Islander Peoples as a core principle in the resumption of elective surgery.

CATARACT REPORT

AN IOL TO CHANGE THE CATARACT SURGERY PARADIGM? Alcon’s newest EDOF intraocular lens has only been available to a handful of Australian ophthalmologists, but it’s already receiving major plaudits. Could it really change the game for cataract patients and spell the end of monofocals as we know them?

here is a buzz building in Australian ophthalmological circles about a new extended depth of focus intraocular lens (EFOF IOL) that some are anticipating could become the default lens for cataract surgeons.

I’ve now been able to follow them enough to now say that it definitely performs like a monofocal lens in terms of photic phenomena and quality of vision – and they get about a dioptre and a half of extra near and intermediate vision,” he says.

The Alcon AcrySof IQ Vivity Extended Vision IOL has only been used by a handful of Australian ophthalmologists for a matter of months, but some are already predicting it may drastically alter the IOL landscape and push current monofocals designs to the periphery.

“I don’t really see the use of a monofocal lens now, unless the patient requires something outside the power range available. With what I know after six months, I feel obligated to tell my patients about this lens.”

Associate Professor Michael Lawless, from the Vision Eye Institute (VEI) and University of Sydney, has implanted 39 Vivity IOLs – the most of any Australian surgeon – in a range of patients for the past six months. He is now convinced of the hype that’s building around the presbyopia-correcting, non-diffractive device. “I am pretty confident now that this will replace monofocals and become my default lens,” he says. “I guess this is the lens I’ve been looking for for 25 years. It would be nice if it guaranteed the ability to read without glasses completely – it doesn’t quite do that – but in every other respect it is such a leap forward compared to all other designs. And I think people are just only starting to realise this.”

While Alcon will reveal the mechanism of action of its novel technology at an official Australian launch event soon, its product information states Vivity is a non-diffractive extended vision posterior chamber IOL. Its depth of field extension and monofocal-like visual disturbance profile are achieved through wavefront focusing technology located on the IOL’s anterior surface. Like a monofocal, the technology utilises essentially all of the transmitted light energy across the range of vision. The location of the wavefront focusing optic is identical for all lens powers, with the anterior surface designed with negative spherical aberration to compensate for the positive spherical aberration of the cornea. It also provides protection against UV light and filters blue light.

Lawless, who is an Alcon and Zeiss consultant, says a key difference with the Vivity IOL is that it offers a visual disturbance profile comparable to a monofocal lens. This, he says, sets it apart from other EDOF lenses, which typically provide “the double whammy” in terms of photic phenomena – such as glare, haloes and reduced contrast sensitivity – and some spectacle dependence for near activities. While regular Vivity patients (some opt for mini-monovision) may still require light reading glasses, ophthalmologists believe this advancement in EDOF lens development could have an impact on both the monofocal and, to a lesser extent, multifocal markets. “I’ve put it in a range of people, including those with macular disease, people have had Lasik in the past, people who drive at night and

Associate Professor Michael Lawless.

Professor Gerard Sutton.

INSIGHT July 2020 33

CATARACT REPORT

According to a press release for the European launch in March, recent clinical trials found Vivity provides ‘very good’ quality of vision at distance and intermediate ranges in bright and dim light. Without glasses, 94% of patients reported ‘good’ or ‘very good’ vision at distance, and 92% reported ‘good’ or ‘very good’ vision at arm’s length. Additionally, Vivity patients reported such low levels of starbursts, halos and glares that its visual disturbance profile was said to be comparable to a monofocal lens. Like Lawless, Professor Gerard Sutton, also from VEI and University of Sydney, sees Vivity becoming a default option in future. He has been using the lens since the beginning of the year and is yet to find any significant trade-offs. He is not an Alcon consultant. “With the studies that are occurring, I suspect we’re going to see better binocularity and similar visual quality outcomes compared to a monofocal lens, and I suspect this is where we are heading in terms of the standard lens selection for surgeons in Australia, but it is important to do the studies so we have data to back up that initial impression.” Sutton and Lawless agree that multifocals will continue to have a place for patients who desire complete spectacle independence. Monofocals may also be required when there are doubts over the patient’s optical system or if they fall outside the Vivity power range. But the Vivity will create a more nuanced conversation. “If someone comes to me wanting the maximum chance of never having to wear glasses again, then I’ll talk about the multifocal or trifocal options, but you’ve got to be selective about who you offer it to - not just in terms of people’s careers, such as truck drivers who drive at night, but you need to consider the health of their ocular system,” Sutton explains. “That involves no significant dry eye and no irregular corneas, so there are a lot of restrictions on the multifocal lens that are not as relevant for the Vivity EDOF lens.” As such, he says Vivity is for people who are prepared to accept they may still occasionally wear reading glasses. “But they are going to get good visual quality and good social vision. This means they can check their emails, their phone, go down the shops and see what they are buying. They’re getting good binocular vision without having to worry about issues with night driving,” Sutton says. While it’s important to stress to patients they may not be completely spectacle free for near activities, Sutton and Lawless are having success with those opting for minimonovision (blended vision). “With a bit of blended vision we move the near point of their non-dominant eye a little closer and the idea being that will further reduce their dependency on glasses. It’s important you don’t promise these patients they will be independent of glasses, although a lot of them are,” Sutton explains. Additionally, centration of the Vivity IOL is not as critical compared with multifocal designs. The AcrySof IQ Vivity remains in the pre-launch phase in Australia. Image reproduced with permission of Alcon.

INSIGHT July 2020

“It’s a bit more forgiving in that sense,” Sutton explains. “Occasionally

ØT 13.0

ØB 6.0 ASPERIC ANTERIOR SURFACE WITH THE WAVEFRONT FOCUSING TECHNOLOGY

SPHERICAL POSTERIOR SURFACE

Figure 1 – Design of the AcrySof IQ Vivity IOL Model DFT015 (all dimensions in millimeters), as per the Alcon Product Information.

over time a lens can tilt and that tends to induce aberrations in some multifocal lenses, but again that’s not as relevant for the Vivity lens.” Lawless discussed centration issues with the lens designer at the European Society of Cataract & Refractive Surgeons Congress in Paris last year. He was told that it wouldn’t cause visual disturbances, but may slightly impact its reading effect. From a surgical perspective, Sutton says the uptake of the lens could be rapid once it’s supported by the outcomes of ongoing studies. The Vivity adopts Alcon’s AcrySof IQ IOL platform, which is similar to those that ophthalmologists adopt for standard monofocals, and has been used in more than 120 million eyes globally. “The lens material is exactly the same and so is the injector, so it’s a lens that most Australian surgeons will be very familiar with. There’s really no learning curve in terms of the surgery,” Sutton says. When it comes to how Vivity will disrupt the market dynamics, Lawless anticipates it will have an impact on both the multifocal and monofocal categories. However, he believes it will take at least another 18 months before Australian ophthalmologists begin to appreciate its potential. “This is where it gets really interesting because I think the Vivity will tend to cannibalise part of the trifocal market, but there will be smaller place for trifocals,” Lawless says. “Of more interest is the monofocal market. Monofocals are the mainstay of all lens companies, they’re not too expensive and that’s what is put in every day, all around the world. But why would you put that lens in somebody and make them more dependent on reading and intermediate glasses when you have got a lens that does the same job plus a bit more?” An Alcon Australia and New Zealand spokesperson confirmed to Insight the company is in a pre-launch phase, with some early access surgeons assessing the technology and providing feedback to Alcon. “The launch timing is under review due to COVID-19,” the spokesperson said. “We are excited about the launch of this novel technology and the anticipation from the ophthalmic community. We look forward to sharing more information closer to official the launch date." n This article was independently initiated and developed by Insight. Alcon had no influence on the content.

FEATURE

The Cosentino family (from left) son Ricardo, mother Luisa, father Tony and daughter Daniella.

BOC OPHTHALMIC INSTRUMENTS This year BOC Ophthalmic Instruments is celebrating its centenary. Managing director TONY COSENTINO reflects on the company’s remarkable past and explains how its founding principles live on today.

hen Alex Gordon Champion, a little-known optician from New Zealand, arrived in Australia around the end of the First World War, it wasn’t long before he began carving out a career that would leave an indelible impression on the Australian optical industry. Back then in 1918, Champion sailed across the Tasman and started a modest practice in the outer Melbourne suburb of Dandenong, and became involved in the original Victorian Opticians’ Association. By 1920 he had moved to Sydney where he initiated the first of his two legacy projects. Champion established the British Optical Company, a business that operates today – 100 years later – as ophthalmic equipment distributor BOC Ophthalmic Instruments.

Champion originally wanted to name the company Australian Optical, but the name was already taken by a Melbourne firm. British Optical suited Australia’s close ties to the motherland and soon began securing agencies from Britain, Europe and the US to provide spectacles frames, lenses, cases, equipment and accessories to the Australian optical market. Some industry figures quipped that Champion was more of an entrepreneur than optician and, in 1932 as The Depression started to impact BOC’s profit line, he and renowned ophthalmologist DR Darcy Williams identified a unique opportunity to take on the exploitative fees opticians charged for dispensing Rx scripts. Ophthalmologists were also keen on a dispensing-only service that

did not undercut their eye testing business. Champion and Williams collaborated in secret to establish Optical Prescription Spectacles Makers, presently known as OPSM, that began dispensing competitively priced scripts in Macquarie St, Sydney, before going on to become a national industry powerhouse. For many years, BOC supplied OPSM. The fact Champion was behind two companies with such longevity is no surprise to Mr Tony Cosentino, who joined BOC as a technical consultant in 1980 and has been its managing director for the past 26 years. “One thing I really admired about Alex Gordon Champion was that he obtained the best agencies and found people who he could trust to deliver,” he says. “And I can honestly say that is something I continue today; the company is still a private business, with the same virtues of employing good people to deliver the goods and services to ensure our customers are successful so we can prosper together.” Now in its 100th year of operation, BOC remains in Sydney with 16 employees, including Cosentino’s wife Luisa and their adult children Ricardo and Daniella, distributing ophthalmic equipment from more than 10 leading manufacturers such as Nidek, Righton, Reichert, Optovue, SBM Sistemi, Welch Allyn, Yuratek, Optomed and Topcon Lasers . Under Cosentino’s tutelage, BOC’s purpose remains largely reflective of the Champion-owned era. However, the company has come full circle after enduring a turbulent history.

INSIGHT July 2020 35

FEATURE

ASSISTING THE WWII CAMPAIGN During the Second World War, in 1942, and 22 years after the establishment of British Optical, Champion’s knack for seizing lucrative opportunities came to the fore once again. After securing a contract from the Commonwealth Government, BOC established a munitions factory in Palmer Street, Woolloomooloo, to manufacture lenses, casings and assembling gun sights for the Australian Army and Navy. Mr Francis Lord, a BOC employee, was requisitioned by the Commonwealth to design the all-important optics for the war effort. Lord himself came to Sydney after escaping Nazi rule from his Czechoslovakian homeland via passage on an Italian ship. According to historical records, he worked at BOC, but the company let him go when fellow employees grew suspicious due to his nationality. Champion was sympathetic and when he heard the Commonwealth Solar Observatory was looking to undertake optical munitions work, he chaperoned him to ACT for the job. During that time, BOC also manufactured optical equipment including chairs and stands and the famous ‘bead heater’ for spectacle frame fitting and lenses. However, after the war, the munitions contract was terminated, forcing the closure of the prosperous manufacturing plant. The equipment was relocated to Concord West and Framemakers Australia was formed to manufacture frames for OPSM. BOC also established itself at the same premises. “During the war we showed we could manufacture in this country and should have continued to, much like the US did,” Cosentino says. “We had the resources; we could make the optical glass thanks to companies like ACI (Australian Consolidated Industries) and Art Glass. The way it was set up, it was a great opportunity for Australia’s optical industry, but that went out the door because the Prime Minister at the time wanted to please the House of Lords who wanted to disband the munitions operations.” OPSM TAKEOVER Following the closure of the manufacturing business, the BOC group comprised J.R. Beck, an optical supplier in Melbourne, Tasmanian Optical in Hobart and a branch in Brisbane. In September 1956, Champion died from a heart attack and BOC was sold from his private estate to Diamond & Boart, a concrete cutting and diamond tools company that had a stake in OPSM. In 1972, OPSM purchased 100% of BOC, excluding Tasmanian Optical which was sold to the Martin Wells Group (a company owned by Adelaide Steamship) after optometrists there resisted the OPSM sale. BOC continued trading as a separate entity servicing the ophthalmic profession. Separately, but around that time, Cosentino joined now-defunct global industry heavyweight American Optical as a technician servicing equipment in its lens laboratory. He trained in optical mechanics and dispensing and soon became a technical consultant as American Optical began introducing its instruments to Australia, including the first Non-Contact Tonometer. American Optical was eventually purchased by a large pharmaceutical firm, and its Australian operations eventually closed in 1980. BOC became distributers for American Optical instruments and, with his expertise, Cosentino joined the company. Four years later in 1984 he became the product manager for BOC’s product portfolio. In 1987, OPSM sold BOC to the Adelaide Steamship Company, seeing it become part of the Martin Wells Group. OPSM’s sale was motivated by a reduction in ophthalmology-issued scripts, seeing it buy optometry chains to boost its retail sales and go into direct competition with optometrists. This was disadvantageous to BOC, an optometry supplier at the time, because its clients grew concerned about supplying information to – and purchasing products from – an OPSM-owned company.

INSIGHT July 2020

That same year, BOC management travelled to Italy to secure Luxottica spectacle frames and sunglasses for BOC to distribute to the Australian market, in a major boon for the company. By 1991, the Martin Wells group, including BOC, was sold to Hancock and Gore (HGL), a publicly listed investment company, for $14 million. However, HGL had shares in Luxottica’s major Italian rival Safilo, so to avoid a conflict the BOC frame collection was split into new ventures establishing Miralink (Luxottica range) and OP’s (Charmant, Cazal, POP & Metzler). Luxottica Italy eventually purchased Miralink and also went BOC's original certificate of incorporation. on to acquire the OPSM group, including Laubman & Pank and Budget Specs. BOC continued sales and service of ophthalmic Instruments and in 1994 Cosentino and his wife agreed to an offer from HGL for a 50% stake in the business. Cosentino had previously travelled to meet suppliers and attend trade events, but people often asked whether the British Optical Company was based in London or Birmingham. To avoid confusion, the name was changed to BOC Ophthalmic Instruments. A FAMILY-OWNED BUSINESS By 2013, HGL wanted to move away from its role as a passive investor, seeing the Cosentino family obtain full private ownership of the company. It remains that way today, with son Ricardo employed as operations manager, wife Luisa as accounts administrator and daughter Daniella in charge of administration and IT. “Even today our overseas distributors say they are always amazed to see the same faces; our staff turnover hasn’t been like it has in many other distributors around the world,” Cosentino says. “I’ve got a bevy of people who have now worked with me for 25 years, and one that recently retired, for 30 years. That’s one of our strong points – it’s run as a family business, in many ways. The only boss we have is the customer. Keep them happy and everyone else is happy.” Being a student of history, Cosentino enjoys being at the helm of a company with such an eventful past. “I was born in Sicily, and if you look over the centuries it has a very colourful history with the number of different people who have tried to invade it. It’s survived, and I look at BOC in the same way. It’s survived all the curses that have been put on it,” he says. Today, BOC supplies and services ophthalmologists, corporate and independent optometry, optical dispensers, hospitals, universities and government facilities. “We have helped a lot of businesses get going, that’s a major part of our history, helping people and practices get better,” Cosentino adds. “At the end of the day if our customers can’t go forward, then we can’t either, so we’re in business to make sure the customer is successful.” n

FEATURE

RECLAIMING INDEPENDENCE: NEW VENTURE TO SHAKE UP SUPPLY CHAIN The Optometry Network has arrived to the market promising to supply some of the most competitivelypriced goods and services in Australia. Its founder CONAN LOMAS discusses why it will put independent optometrists first and empower them in the face of corporate competition.

nder increasing pressure from corporate optometry, optometrist and businessman, Mr Conan Lomas, believes his new enterprise can help struggling independents recapture control of their businesses. Called ‘The Optometry Network’, it is launching on 1 August vowing to generate significant savings for independent optometrists on the cost of optical lenses and shopfitting through a newly established supply chain.

approximately half the cost that main suppliers currently charge. It will also focus on saving tens of thousands of dollars for independents through a fit-out supply service for practices. Lomas says the key to the venture is his knowledge of optical supply chains and knowing what optometrists and patients want. The company will source lenses from factories throughout the world that, it claims, incorporate the same optical technology as the major lens brands.

The initiative, which is free to join, comes in response to the rise of corporate optometry providers that, during the past decade, have imposed themselves on a market once enjoyed by many independents. Through his own optical business dealings and 21 years of industry experience, Lomas has encountered many Australian independents who are keen to sell up. They are in a financial predicament, worn down by expensive overheads and trying to compete with the corporates that sell low cost products imported through cleverly developed supply channels. “When I talk to them about their financials they are at a bit of a loss as to how to improve their business without capital investment and they simply don’t have the money to pay for shopfitting and marketing,” he explains. “They don’t really want to sell, but they realise they could actually make more money working for a big corporate group. Many are taking on the responsibility of running their own business and then paying themselves less than what they could earn elsewhere; they take all the risk but aren’t being rewarded.” To empower independents, The Optometry Network will become Australia’s newest lens supplier, promising to offer lenses at

"ESSENTIALLY THE SAME QUALITY LENSES YOU GET FROM THE TOP BRANDS CAN BE PRODUCED ELSEWHERE BUT AT A FRACTION OF THE COST" CONAN LOMAS

“I’ve done my homework and we will be the cheapest retailer of lenses in Australia; there is nobody who can beat us on the current price list – we are basically cutting out the middle-man,” Lomas says. “The Optometry Network is really about changing the supply chain to make it easier for independents – and this was before COVID-19 arrived, so now we are better placed than ever.”

INSIGHT July 2020 37

FEATURE

RETAKING CONTROL The Optometry Network model is said to reflect the corporate practice whereby lenses are sourced on price and quality, and not necessarily brand. The company will hold a niche bouquet of stock lenses concentrating on products that bring added value to the patient and practice that would traditionally either not be readily available or more expensive to source. “Essentially the same quality lenses you get from the top brands can be produced elsewhere but at a fraction of the cost. Optometrists and dispensers can place too much emphasis on the brand names of lenses when consumers are often uninterested,” Lomas explains. For Lomas, the motivation behind the company has roots to his childhood in a poor family where every dollar was stretched to its full potential value. He is often amazed at motorists who pay $1.50 a litre at the bowser when a fuel station a few hundred metres down the street is selling the same product for $1. “The saving on a full tank of petrol that takes 60 litres is $30. That’s 30 Slurpees for my kids. And yet our own optical profession does that every day. Why?”

caused by the increasing corporate presence and aggressive pricing structures. He uses the example of a practice he assessed that was fully booked Monday to Saturday, yet it was operating at a book loss of $26,000, while the owner optometrist was paying himself only $80,000 per annum. By using different products of the same quality, he calculated the business could save $120,000 per annum. “That’s an incredible amount of money to save. You are then in the territory of changing your own lifestyle as the owner who can now pay themselves the rewards deserved for the risk of owning a store. Or you can put the money back into the business to increase marketing presence and improve customer service levels to ensure long term sustainability of the practice. “Any optometrist that’s running their own business should be making more than they would working for someone else on a salary, that’s why we take the risk. The real emphasis is to make sure the optometrist and retailer, along with the customer, are the ones who win.”

While it depends on the type of lens ordered, he says optometrists who traditionally pay $70 for one lens will pay approximately $40 with The Optometry Network. It equates to a 40-50% saving, reducing the cost of a pair of spectacles by around $60. Meanwhile, because of the business’s streamlined structure, he says there is no need for him to add high margins like other lens suppliers who need to recoup R&D, staff, marketing and infrastructure costs. “So the potential for an increase in profitability for independents is considerable. Optometrists will of course have the choice to offer patients a quality lens for the same price, or charge less for the same product.” The lenses will also be available up to a minus 4 cylinder off the shelf. “As an optometrist myself, I know there is nothing more frustrating when you’ve got one lens in stock but the other has to be surfaced because it’s overpowered. You shouldn’t have to grind a single vision lens up to that power. This automatically cuts costs by a huge amount along with time.” For optometrists who join the network, lenses can be ordered via satellite tracing or the professional can send the frames into its laboratory. Those using satellite tracing will be sent the ready cut lens for the professional to insert into the frame themselves, while those who send in the frames will receive a complete pair of spectacles. By supplying lenses at a fraction of the price, Lomas is aware that some professionals may be wary. He says he has tested the lenses extensively on staff members within his existing optometry stores who have traditionally been the most difficult to satisfy with progressives. All were happy with the product. “The best thing for people to do is to try them as they will not be disappointed.” Initially, he’s also aware some may be apprehensive about changing lens supplier. “Optometrists may not jump on board 100% immediately. If you have a relationship for 10 years with a supplier you are often going to have loyalties, even if it's to the detriment of your own business. We are starting off with baby steps.” In future, he hopes the venture will have an impact on several fronts. Primarily, the cost savings could give independents greater control over the direction of their business. In the longer term, it could impact the pricing structure of the Australian lens market. Further, he says Australia is an anomaly in terms of having some of the highest optometry salaries in the world, alongside some of highest set up, equipment and regulation costs. Meanwhile, the sale price of spectacles are among the lowest, largely

INSIGHT July 2020

SHOPFIT SAVINGS While the lens-related cost savings could offer more flexibility, The Optometry Network’s is also keen to extend its services into shopfitting. Lomas, the company founder, has set up and revamped several practices in the UK, South Africa and Australia. He believes costefficient refitting is a key area that can help independents better compete against the corporates. “If you look at optometry, one of the biggest investments is the shop fit,” he says. “But if you are having to invest more in the shopfit than you are to equip your optometry rooms, it becomes very difficult to justify the cashflow to afford it. That’s why you see a lot of stores looking a bit tired.” Through his offshore industry contacts, Lomas says, with some forward planning, he can help independents potentially save tens of thousands of dollars on their shopfitting costs. Lomas has already done so with an optometry practice in Brisbane where he saved more than $100,000. They still used local contractors for electrical, plumbing and dry wall work, but overseas suppliers provided the finer points such as furniture and joinery. “If you look at the corporates, they have got it right, their supply chain is so well organised that they make real profits which, in turn, gets reinvested so they can grow rapidly. The Optometry Network is there to bring that same supply chain to the independent without the headache of finding it themselves and the cost of scale required to create it.” n

FEATURE

THE EYE HEALTH CENTRE The Eye Health Centre has expanded with a second ophthalmologist joining the team, helping take its unique optometry-ophthalmology collaborative care model to two more Brisbane suburbs. Founder DR ANDREW APEL discusses the centre’s key role in treating conditions of the anterior segment.

t was in the early 1990s while on his fellowship in Toronto that Queensland ophthalmologist Dr Andrew Apel saw the benefit of a collaborative care model bringing together ophthalmologists and optometrists under one roof. Back then, both professions had a somewhat adversarial relationship in Australia, however that did not stop Apel from importing the model once he returned to his native Brisbane to start working in private practice. His experience of the Canadian eyecare system left a marked impression and lives on today through his practices that comprise The Eye Health Centre. The network has expanded its existing presence in the Brisbane CBD and Booval, Ipswich, with the opening of two more locations in the suburbs of Aspley and Wynnum in recent months. The centres specialise in the medical and surgical management of conditions of the anterior segment of the eye, receiving referrals from primary eyecare professionals and GPs across wider Brisbane, as well as tertiary referrals from other opthalmologists. The expansion into the northern and eastern suburbs has come thanks to a new partnership with ophthalmologist Dr John Hogden who completed his subspecialty training in corneal and refractive surgery at the world-renowned University of British Columbia Vancouver Eye Care Centre in Canada.

Dr Andrew Apel.

Dr John Hogden.

Hogden’s skillset parallels that of Apel, who undertook a two-year corneal and external diseases fellowship at the University of Toronto in 1992 and has more than 25 years’ experience in treating medical and surgical conditions of the anterior segment. Within a unique collaborative care model, Apel and Hogden work alongside a group of clinical optometrists to manage patients for a range of conditions, including cataract and refractive surgery, keratoconus, pterygium, Fuchs endothelial dystrophy, dry eye and ocular surface disorders and vision disorders. They also perform Lasik, Smile, PRK, laser surgery and ICL. Apel says the optometrists play an integral role by conducting the patient work-up, while also helping take responsibility for triage, pre- or postoperative assessment or independent clinical management. Each optometrist is highly trained in clinical assessment and management in accordance with Apel’s methods and protocols. They also have technical expertise in advanced contact lens fitting and the treatment

INSIGHT July 2020 39

FEATURE

of advanced dry eye disease, including the E-eye IPL and Rexon-Eye treatment for meibomian gland dysfunction. “The Eye Health Centre is the ultimate collaboration. We have got half a dozen optometrists who work in a part time capacity and a couple that are fulltime, and that has meant we can assist community optometrists with their difficult cornea and anterior segment patients. All of this is undertaken in an environment where a highly experienced ophthalmologist is available for collaboration.” Apel says, adding that the care model also helps determine the best lens and refractive choices for patients undergoing cataract surgery. “Our optometrists undergo rigorous training, and it amazes me how as the network has grown over the years that people tend to self-select with optometrists who are very keen on the clinical aspect. It takes some years before they learn the nuances of how these processes work and the subtleties involved in the working-up of patients. “But being anterior cornea and anterior segment surgeons, the model allows John and I to focus on what we are good at. There’s a set of procedures that we do and conditions we treat, and so patients have been worked-up by our optometrists with that in mind.” EXPANDED FOOTPRINT Since Hogden’s appointment in February alongside the recent openings in Aspley and Wynnum, Apel says The Eye Health Centre has increased its clinical optometrist workforce by around 30% and is looking to recruit more. Apel, who is also qualified to examine the ocular health of pilots, air traffic controllers, police force and the defence force personnel, oversees the Brisbane and Ipswich patients, while Hogden has responsibility for Aspley and Wynnum. Optometrists hold their own clinics in each of the four locations. “John’s skillset parallels mine, we identified in Aspley and Wynnum that there was an opportunity to provide care to patients in these areas with our particular subset of skills,” Apel explains. “We are also very lucky there are day surgeries in close proximity to where we conduct our consulting in each location, which the patients enjoy – it means they don’t have to travel far to get their procedures and consults done.” The opening of the two new locations has required significant investment, with each location fit out with identical diagnostic equipment and technology. That includes an Oculus Pentacam, Zeiss IOLMaster 700, OCT, and specular microscopy. “We have kept the same logo and branding across all of our centres so people are familiar and comfortable with the colour schemes and duplicating the equipment helps from a workflow point of view for the optometrists,” Apel says. “It also means we don’t have to send patients to another one of our centres to get a particular test done, so it helps build a better patient experience.” Having some of the latest diagnostic equipment also means Brisbane primary eyecare professionals refer their patients to The Eye Health Centre optometrists for measurements and mapping, among other services. IMPORTING COLLABORATIVE CARE Reflecting on his Canadian fellowship, Apel says the collaborative care model was highly effective then and anticipates it could be adopted more frequently across Queensland in future. In the early 1990s, he says the relationship between optometry and ophthalmology in Canada was much different to what it was in Australia. “In the past it has been a bit adversarial in Australia, but at the University of Toronto they had optometry helping out with anterior segment work and conducting work-ups and contact lens care and helping us with refractions and difficult anterior segment and cornea patients,” he says. “When I came home to set up private practice that relationship didn’t exist,

INSIGHT July 2020

Dr John Hodgen (left) and Dr Andrew Apel outside the Wynnum centre, which is now one of four across wider Brisbane.

but I saw the benefit of a collaborative care model bringing together ophthalmologists and optometrists under one roof. Our doctors respect for optometrists also allows us to work by co-managing with community optometrists.” Back in Brisbane after his fellowship, Apel set up a practice in the rooms neighbouring his father’s in Wickham Terrace, historically known as the city’s street of private medical specialists. His father Dr John Apel was also an ophthalmologist who was instrumental in bringing posterior chamber intraocular lenses to Australia in the 1970s and early 1980s. Impressed by what he had experienced in Canada, Apel soon had Dr Nathan Walker, an optometrist at the time who was undertaking his medical training, working with him. (Walker is now a retinal surgeon on the Gold Coast). “He essentially became an ophthalmic assistant and because of his optometry skills it was very useful in the practice. Traditionally ophthalmologists had either people who had no basic background training or were nurses or orthoptists. But Nathan was great in giving us a leg up in terms of integrating optometry and ophthalmology. That was in around 1997.” Meanwhile clinical optometrist Mr Jason Holland began working with Apel in 2001 alongside other optometrists, which evolved into the formal establishment of The Eye Health Centre in 2006. Holland still works there today, running a busy glaucoma and advanced dry eye clinic at the Brisbane centre. The network soon branched out from its main Brisbane location to establish the Ipswich satellite practice after two ophthalmologists there retired precipitously, leaving a significant unmet need for patients in the area. Now that the Aspley and Wynnum locations are fully operational, The Eye Health Centre in the process of connecting with primary eyecare professionals, GPs and other referrers to create awareness about their services in those areas. The COVID-19 emergency has also helped them hold a “soft launch” of their new locations. Although the optometry-ophthalmology collaborative care model is yet to fully take hold locally, Apel believes it could have a greater role to address future eye health needs. “Since we first started our collaborative care model, we have eye doctors that send in their staff to see how it works, and some have even come interstate,” he says. “I haven’t seen it as a common thing yet, but I think we will see it become more prevalent as the population ages and as we need more hands on deck.” n

WORKPLACE ADAPTATION DURING A PANDEMIC COVID-19 HAS DRASTICALLY ALTERED THE WAY ORTHOPTISTS APPROACH THEIR WORK. FROM CLINICAL PRACTICE TO WELLBEING, BREANNA BAN DISCUSSES HOW HER COLLEAGUES ARE ADAPTING TO THE NEW NORMAL.

vernight, it felt as though our working environment transformed as the coronavirus presented a myriad of new challenges for orthoptists in ophthalmology clinics.

BREANNA BAN

THE ABILITY TO RECOGNISE THAT IT’S OK NOT TO BE OK SOME DAYS AND KNOW WHEN TO RAISE CONCERNS AT A HIGHER LEVEL IS PARAMOUNT

Many of those challenges will be here to stay, so how do workplaces adapt to change while ensuring the health and safety of colleagues and patients? And how do they provide support and adapt to a new kind of normal? For orthoptists, reality hit when it became increasingly difficult to obtain personal protective equipment, as well as basic cleaning and sanitising products due to global shortages. Additional measures were put in place as protective screens appeared at reception desks and on slit lamps. Scrubs paired with masks became an essential part of the work uniform. The need for intensive routine disinfections of high touch surfaces in between patients arose. Mandatory temperature checks on arrival and patients using their cars as a waiting room were incorporated into a clinical attendance. We needed to reconsider the whole approach to patient referrals to decrease patient volumes within the clinic. New triaging guidelines introduced more complex concerns such as how to appropriately allocate appointments according to their urgency.

Orthoptists are amongst those on the frontline when it comes to seeing patients in an ophthalmology clinic. This can be overwhelming, especially when the first concern is preventing any transmission of the virus. Therefore it’s vital that not only new approaches to a patient consultation are developed, but also that managers enforce these new protocols. Such implementations can include the time spent with patients being kept to a minimum and, for tasks such as visual field testing, the orthoptist ensures a 1.5-metre distance from the patient after the initial set up. Additionally, orthoptists are modifying their choice of tests where appropriate. For example, measuring intraocular pressure with an Icare instead of a Perkins tonometer. The probes of the Icare are disposable between patients and this method also creates more distance between the clinician and patient when taking the measurement. Simple procedural and technological implementations like these allow an orthoptist to continue their work safely whilst reducing infection risk and adhering to social distancing protocols.

Entire clinical sessions and ophthalmologist rosters were re-scheduled to accommodate new guidelines. Tag-team rosters and reduced working hours were implemented, which not only generated challenges in communication between team members, but also created uncertainty, highlighting the need for monitoring the wellbeing of individuals.

Another important consideration is effective communication. Segregated teams working on alternating days or working from home means extra time needs to be allocated for the preparation of comprehensive and carefully considered handovers. This requires accountability and if implemented correctly, reduces the risk of errors and oversights. It is easy to take for granted the value of face-to-face discussions and handovers within the workplace. Now more than ever, clinics are relying on virtual collaboration for clear and concise communication. In some cases, email content can be misinterpreted and body language cues that might indicate feelings such as stress are often lost.

To effectively navigate change of this magnitude, firstly, leaders in the workplace need to stay informed of rapidly changing policies and guidelines and develop daily solutions with new work models that prioritise health and safety.

It can feel stressful and overwhelming during an event like the coronavirus outbreak and people can be affected differently. The increasing uncertainty and the constant need to be flexible with changes presents daily challenges.

Cases deemed as low urgency were deferred and placed on a cancellation waiting list. Telehealth consultations became a focus but could only provide so much information in an eye assessment.

Face masks have become part of the new normal.

As a result, it is vital that supervisors and managers are approachable, responsive and encourage a self-care model to adequately support the needs of coworkers. The ability to recognise that it’s OK not to be OK some days and know when to raise concerns at a higher level is paramount. By simply checking in with colleagues and really listening to how they are coping can go a long way. Encouraging mood-boosting activities such as exercise, mindfulness and connecting as a work group via video conferencing can also help in overcoming the feelings of isolation. With adjustments to a new normal in an orthoptist’s role and no end date in sight, it’s crucial to acknowledge the value in discovering silver linings and reminding colleagues and patients that we are all in this together. n

ABOUT THE AUTHOR: BREANNA BAN is an orthoptist, working in a multi-doctor private ophthalmology clinic in Melbourne. She graduated from La Trobe University Melbourne with a Bachelor of Health Sciences and Masters of Orthoptics in 2015. She is the Victorian Branch Secretary and Federal PR coordinator for Orthoptics Australia. ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au

INSIGHT July 2020 41

XXX DISPENSING

MEASUREMENTS IN DISPENSING: PART 1 GRANT HANNAFORD DISCUSSES WHY PRACTITIONERS GET MORE FROM A LENS WITH GREATER ATTENTION TO QUALITY MEASUREMENTS, AND HOW THIS TRANSLATES INTO BETTER PATIENT OUTCOMES.

ost, if not all, practitioners who dispense optical appliances engage in the assessment of the quality of measurements on a daily basis. So often so, that it’s become an unconscious exercise.

GRANT HANNAFORD

IN AN IDEAL FITTING, THE EYE WILL BE ALIGNED PERFECTLY WITH THE APPROPRIATE FITTING POINT OF THE LENS SO THE DESIGN CAN FUNCTION CORRECTLY

Since the introduction of freeform lens generation techniques, lens manufacturers have implemented ever more complex surface geometry in their designs. Many of the benefits to be found are only realised once practitioners increase the precision of their measurements. This is a common source of complaint where practitioners do not see any meaningful difference between older and newer lens designs, simply due to measurement techniques. PRECISION, ACCURACY, UNCERTAINTY These terms are often used interchangeably. While they all deal with aspects of the quality of a measurement, they speak to different parts of the process. Precision generally refers to the smallest increment or scale of our measurement for example, 1mm or 0.01mm. It may seem like 0.01mm increments are better but if our equipment is poorly calibrated or maintained, then we may find that the larger increment is the better one to use as it is more reliable. Uncertainty for measurements indicates the range in which our true value might be expected to fall and may be systemic (predictable and inherent to the system or device) or random. If we are using a millimetre ruler, then a reasonable uncertainty would be half the smallest increment i.e. 0.5mm. That is to say, if we measured a pupillary distance (PD) as 32mm, then there is a chance the measurement might be 31.5mm or 32.5mm as well, simply because the smallest increment on the ruler doesn’t reliably allow for better measurements than this. Experienced practitioners may indicate they can give results to 0.3mm or even 0.1mm on a millimetre ruler, data that suggests that while they can record a result at this resolution, the results are

INSIGHT July 2020

not reliably replicated [1-4]. These elements, which contribute to the uncertainty of the data, accrue, so that a person using a PD rule to take measurements may feel they are working to millimetre precision. In reality the uncertainty for a full set of facial measurements can be as high as 3mm once all the variables are accounted for (using the RSS method)[5]. Finally, we can look at how accurate our measurements may be through their repeatability. If our measurements are always giving the same answer, then we have good quality data. However, if the measurements are constantly changing then we have an issue with the reliability of the data and our accuracy will be suspect.

Figure 1 – Error boxes and eye placement. Technique

Claimed Precision (mm)

Systemic uncertainty (mm)

Ruler

Measuring jig

Phone app

0.1

0.3

Lab developed app

0.1

0.3

Tower based system

0.01

0.03

Comparison chart of measuring techniques.

THE ‘ERROR BOX’ Taking measurements to greater levels of accuracy ensures the patient’s visual system is aligned correctly with the corrective lens. In an ideal fitting, the eye will be aligned perfectly with the appropriate fitting point of the lens so the design can function correctly.

measuring techniques and systems used in practice, ranging from rulers through to tower-based systems. The ideas above have been used to determine the systemic uncertainty and hence relative reliability of some of these systems for nine monocular measurements.

This can only occur once we have fitted the frames prior to taking measurements. In reality patients will have slightly different placement of their spectacles every time they put them on but using the concept of an error box we can minimise the effect of these changes in placement.

These uncertainties are solely systemic. Once we discuss the influence of the operator in part two of this article, we will see how potential errors for some techniques can exceed 4mm, even with a skilled operator. n

Figure 1 shows two placements of an eye in a hypothetical error box with a yellow fitting cross at its centre representing the area in which a lens will perform best. In the left image the eye is offset in the error box so that if the patient were to put their spectacles on crooked there is a high chance that their eye may be outside the area of best vision, making the lenses perform poorly. The image on the right shows a more accurate placement with maximum tolerances in place to allow for changes in fitting or wearing placement. COMPARING MEASUREMENT DEVICES In the second part of this article we will consider the different types of

REFERENCES: 1. McMahon, T.T., E.L. Irving, and C. Lee, Accuracy and repeatability of self-measurement of interpupillary distance. Optom Vis Sci, 2012. 89(6): p. 901-7. 2. Brooks, C.W. and I.M. Borish, System for ophthalmic dispensing. 3rd ed. 2007, St. Louis, Mo.: Butterworth Heinemann. xx, 665 p. 3. Brooks, C.W.R., Hubert D, Efect of Prescribed Prism on Monocular Interpupillary Distances and Fitting Heights for Progressive Add Lenses. Optometry and Vision Science, 1994. 71(6): p. 401-7. 4. Gerstman, D.R., Ophthalmic lens decentration as a function of reading distance. Br J Physiol Opt, 1973. 28(1): p. 34-7. 5. Gbur, G., Mathematical methods for optical physics and engineering. 2011, Cambridge ; New York: Cambridge University Press. xvii, 800 p.

GRANT HANNAFORD is the co-founder and director of the Academy of Advanced Ophthalmic Optics. He has been practising in optics for more than two decades and works with optometry and dispensing students, as well as industry professionals.

MANAGEMENT

NEW FINANCIAL YEAR – TIME FOR REFLECTION KAREN CROUCH SAYS FORECASTING FOR THE ‘NEW NORMAL’ COULD REQUIRE A MORE CONSERVATIVE OUTLOOK AS THE NATIONAL ECONOMY BATTLES ITS WAY THROUGH AN EXPECTED RECESSION.

KAREN CROUCH

GROWING UNEMPLOYMENT WILL LIMIT FUNDS AVAILABLE FOR MEDICAL ATTENTION, POSSIBLY RESULTING IN DEFERRAL OF NON-CRITICAL ATTENTION

new financial year is here again, not to mention other significant distractions such as world turmoil following US protests and riots. And, of course, we have the coronavirus which will eclipse the economy and naturally have an impact on every industry and business, including the manner in which practices will have to consider plans for the upcoming financial year. I trust you all enjoyed a fruitful 2019– 2020, at least until about February when the whole world changed. Regardless, practices must be fully prepared for yet another financial year which could look quite different to previous ones. The beginning of a new financial year usually triggers some navel gazing, personal reflections on events of the past 12 months and formulation of new resolutions in preparation for the year ahead. By contrast, 2020/21 may require some crystal ball gazing as client finances and related buying capacity may have a notable impact on ‘business as usual’ projections. Naturally, resolutions, objectives and budgetary settings are aimed at improvements on the previous year’s achievements and targeted better performance for the next year. However, forecasting what the ‘new normal’ may look like could require a more conservative outlook as the national economy battles its way through a forecast recession. This ‘self-audit’ process is relevant for health practices. While individual plans and resolutions may be amended ‘on the fly’, Business Plans deserve deeper planning, more time to affect changes and alignment with longer term Strategic Plans. Practices, like other businesses, are comprised of a few essential factors which operate in tandem and direct relationship to each other: • Plans/goals (financial, non- financial, clinical, strategic). • Administrative (client service). • Personnel (employees, owners). The most obvious aspect that deserves attention at the end of a financial year is

the annual review of progress to date and performance against targets and budgets, regardless of the hitherto unpredictable events of the second half of 2019/20. Consequently, results may be poorer than projected following nearly half a year of COVID-19 impact. Accountants should construct a snapshot of progress to the end of the financial year, reflecting not only performance to date, but also trends indicated by the past 12-month ‘actuals’. For example, does performance to date suggest similar goals will be reasonable for the upcoming financial year? Probably not as growing unemployment will limit funds available for medical attention, possibly resulting in deferral of non-critical attention. Will there be a pressing need to increase performance outcomes, such as competitive, marketing, even price discounting? In light of the new environment, what budgetary or business management changes are required to ensure targets are met or, preferably, exceeded? Of course, not all targets are financial in nature. For example, did client surveys, if conducted, reflect the desired level of satisfaction with clinical and administrative service quality? Has the efficiency/ speed of pre/post consultation client service improved or, as a minimum, not decreased below previous year levels? Have any variations, positive or negative, been analysed and appropriate actions captured in the next Business Plan? And let’s not forget requirements of the ever-present COVID-19 which will require changes to working habits and maintenance of the practice working/ living conditions. These include social distancing in the waiting room, hand sanitisers in several areas and general monitoring of client, staff and visiting tradesmen health while in the practice. On the clinical front, have there been notable changes to government regulations that require rewriting policy and procedure manuals? Do technological advances adopted by other practices deserve investigation/ investment to defend the practice’s competitive position?

The COVID-19 crisis is expected to impact the bottom line of businesses in almost every sector.

In respect of business development, marketing plans deserve review. Have there been notable changes in community health conditions that demand new treatment methods or employment of new equipment? And, of course, the need to maintain close ties with all referral sources is a matter for ongoing consideration to ensure a reliable client pipeline. While the ‘practice business’ usually receives most attention in annual reviews, it’s most important resource, employees, must not be overlooked. Is it time to consider whether an effective staff appraisal system is in place and well-planned to occur during upcoming months? Is the appraisal program well-documented and performance reviews planned? Were individual staff appraisals undertaken as failure or delays in completing them often results in staff dissatisfaction? And, as the current financial year’s Business Plan is reviewed, attention should also be given to the practice’s longer term Strategic Plan. Did the 2019/20 Business Plan performance results align with longer term goals? Or does the Strategic Plan itself deserve tweaking and is it still achievable? n

KAREN CROUCH is Managing Director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal and financial management of practices. Contact her on 0433 233 478, kcrouch@hpcnsw.com.au or www.hpcgroup.com.au.

INSIGHT July 2020 43

SPECSAVERS – YOUR CAREER, NO LIMITS All Specsa ve stores rs no with O w CT

SRS – Full time/part time positions in WA

At Specsavers, our vision is to passionately provide the best value eye care to everyone, simply, clearly and affordably, exceeding customer expectations every time. We are currently seeking WA’s most dedicated and driven optometrists to join our Specsavers family. We have full and part-time roles available across the state. We will provide you with a fantastic working environment with a supportive team, state of the art equipment – including OCT, and the opportunity to deliver optimal patient care whilst further developing your clinical skills to their full potential.

Graduate recruitment Are you thinking about kick starting your Graduate career in regional Australia or New Zealand? The Specsavers Graduate Recruitment team are keen to talk to you about opportunities available across ANZ. If you’re looking to make a genuine impact, and deliver patient-centric, evidence-based preventative eye care and work collaboratively to manage health outcomes, then we urge you to talk to us about how you can join our mission to transform eye health. At Specsavers you will have access to cutting edge technology and be part of the driving force bringing optometry into the forefront of the healthcare industry.

SRS – Full-time, part-time and locum positions across ANZ Specsavers is on a continual mission to transform eye health in Australia and New Zealand – and we would like you to join us on that mission. Our Transforming Eye Health Strategy is focused on eliminating preventable vision loss and blindness, particularly with diseases such as glaucoma and diabetes, through improved prevention, early detection and co-management. We have various fulltime, part-time and locum positions available with extremely attractive salaries on offer, access to state-of-the-art market leading technology including OCT in all stores and ongoing professional development opportunities.

Partner recruitment – joint venture partnership opportunity – Specsavers Cairns Earlville, QLD Specsavers is currently on the lookout for an experienced optometrist to join us as a joint venture partner in our Cairns Earlville, QLD store. The store is located within the Cairns Stockland Centre, which houses over 90 specialty stores including major retailers such as Coles, Big W and BCC Cinemas. The store itself boasts 2 fully equipped testing rooms with OCT, five dispense desks and over 1,000 frames on display. Specsavers Cairns Earlville opened in 2009 and has built a loyal database of patients over the past 11 years. This is a rare opportunity to make your mark and build a profit earning business.

Full-time optometrist opportunities – Specsavers Sunshine Coast, QLD

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

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

Specsavers Sunshine Coast is looking for patient-focused optometrists to join their warm and welcoming team. We offer flexible rosters for work-life balance while working with fully-automated equipment – including OCT, experienced retail support teams and a host of professional development opportunities on offer. Plus, we offer a competitive salary including access to Specsavers Perks staff discount program.

Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

OPTICAL DISPENSER - SYDNEY

Eyecare Plus provides business support and marketing services to over 155 clinically focused independent full scope optometry practices throughout Australia.

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

Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment, including an OCT in the majority of our practices. Eyecare Plus offers three membership options; branded, co-branded and unbranded. Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training. We also actively assist Optometrists and Dispensers who are looking to establish their own practice. If you are looking to buy, or sell, an optometry practice, please contact us. For more information call Philip Rose: 0416 807 546 or email: Philip.rose@eyecareplus.com.au.

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

If you believe you would be an asset to the practice, please apply by forwarding your resume in confidence to kingsgrove@eyecareplus.com.au. Only potential candidates will be contacted.

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

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

CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/ OPTICAL DISPENSER / SALES ASSISTANT: Sydney, Brisbane, Corrimal. OPTOMETRIST: Taree & Gloucester.

2020/21 CALENDAR JULY 2020 PAEDIATRIC SPECIAL INTEREST GROUP VIRTUAL MEETING Australia 10 July ranzco.edu

WENZHOU INTERNATIONAL OPTICS FAIR Wenzhou, China 24 – 26 July opticsfair.com

AUGUST 2020 ASIA-PACIFIC ACADEMY OF OPHTHALMOLOGY Xiamen, China 5 – 9 August (Cancelled) apaophth.org

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

SPECSAVERS CLINICAL CONFERENCE SCC9 Brisbane, Australia 12 – 13 September spectrum-anz.com

EUROPEAN ASSOCIATION FOR VISION AND EYE RESEARCH CONGRESS Nice, France 24 – 26 September ever2020.org

20TH EURETINA CONGRESS Amsterdam, Netherlands, 1 – 4 October euretina.org

5TH WCPOS Amsterdam, Netherlands 2 – 4 October wspos.org

SILMO PARIS Paris, France 2 – 5 October silmoparis.com

EUROPEAN SOCIETY OF CATARACT AND REFRACTIVE SURGEONS CONGRESS Amsterdam, Netherlands 3 – 7 October escrs.org

AMERICAN ACADEMY OF OPTOMETRY MEETING Nashville, USA 7 – 10 October academymeeting.org

Taipei, Taiwan 6 – 8 November 2020.apvrs.org

OPTOMETRY NSW/ACT CANBERRA CONFERENCE Canberra, Australia 8 November optometry.org.au

AAO ANNUAL MEETING Las Vegas, USA 14 – 17 November aao.org

OV/SA BLUE SKY CONGRESS 2020 Adelaide, Australia 19 – 21 November optometry.org

AUSCRS 2020 Noosa, Australia 22 – 25 November www.auscrs.org.au

SILMO BANGKOK Bangkok, Thailand 25 – 27 November silmobangkok.com

DECEMBER 2020 CONFERENCE OF THE GERMAN SOCIETY OF OPHTHALMOLOGY

Shanghai, China 18 – 20 September cooc.org.cn

Berlin, Germany 8 – 11 October dog.org

Las Vegas, USA 23 – 26 September east.visionexpo.com

ASIA-PACIFIC VITREORETINA SOCIETY CONGRESS

OCTOBER 2020

CONGRESS OF OPHTHALMOLOGY AND OPTOMETRY CHINA

VISION EXPO – EAST & WEST

NOVEMBER 2020

INTERNATIONAL OPTICAL FAIR Tokyo, Japan 27 – 29 October ioft.jp

14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS 2020 Brussels, Belgium 14 – 16 December egs2020.org

JANUARY 2021 OPTI 2021 Stuttgart, Germany 8 – 10 January opti.de

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

GLOBAL SPECIALTY LENS SYMPOSIUM Las Vegas, USA 20 – 23 January na.eventscloud.com

100% OPTICAL London, UK 23 – 25 January 100percentoptical.com

EUROPEAN MEETING OF YOUNG OPHTHALMOLOGISTS Brussels, Belgium 30 – 31 January emyo2020@seauton-international

FEBRUARY 2021 MIDO EYEWEAR SHOW Milan, Italy 6 – 8 February mido.com silmobangkok.com

MARCH 2021

SKI CONFERENCES FOR EYECARE PROFESSIONALS Furano, Japan 6 March skiconf.com silmobangkok.com

APRIL 2021

BARCELONA SPECS Barcelona, Spain 10 – 11 April barcelonaspecs.com

JULY 2021 APOTS MEETING Bali, Indonesia 1 – 4 July apots2020.com apots2020.com

JULY 2021

OPHTHALMOLOGY UPDATES! Sydney, Australia 28 – 29 August ophthalmologyupdates.com

INSIGHT July 2020 45

SOAPBOX

FOCUS ON CPD DURING ISOLATION and other large meetings as a way to catch up on the latest developments in education, socialise with colleagues and chat about the profession and wider industry, there are still ways of achieving meaningful professional development including how the new requirements can be facilitated by the available technology. During this time we are getting the opportunity to become comfortable using online systems and resources and we will benefit from the additional flexibility when we become so very busy again

hile many health practitioners have played a critical role on the frontline dealing with the COVID-19 pandemic, some of the challenges they have faced have attracted fewer headlines. A question the Optometry Board of Australia (the Board) has consistently been asked from practitioners across Australia is how to maintain the requirements for ongoing professional development during this time. Continuing professional development (CPD) is a requirement for all practitioners as set out under the Health Practitioner Regulation National Law, and the registration standards and guidelines established by each of the National Boards. The current environment has forced conferences and other face-to-face events to be cancelled, putting a real dent in the plans of most practitioners. A few words of advice: Don’t worry. The Board will be understanding if you genuinely have trouble meeting your CPD requirements during the current registration period amid the downturn in professional development activities. It will take this into account when it comes time to make your declaration during registration renewal later this year. For many practitioners, a reduced consulting environment provides a real opportunity to focus on upcoming changes to the CPD registration standard. In 2019, Health Ministers

INSIGHT July 2020

approved a significant change to the registration standards and guidelines for several professions, including optometry, which will provide far greater flexibility for practitioners. The new standard emphasises a need for practitioners to reflect on their personal professional development needs and seek out opportunities to undertake CPD. You will need to reflect on how these activities have influenced your practice and, ultimately, how they benefit patients and the wider community seeking optometric care. From 1 December 2020, you will only need to record the hours you spend on these activities and not worry about points as you have in the past. Key elements include the requirement to reflect on your personal needs, critically assessing the quality of the materials and the resulting effect on your practice. The new standard acknowledges that adult learning and professional development can occur in many different ways. Even learning about what we need to do regarding COVID-19, its transmission and how to implement higher levels of infection control is considered professional development. I encourage practitioners to record what you have read and how it will affect your practices not only now but in the future. There will remain a need for optometrists to interact with others, as this facilitates important peer-to-peer learning. While we all miss conferences

As we are coming to appreciate, much can be done through the use of Zoom, Skype and other virtual interactive meeting apps. With the new standard taking effect in summer, now is an ideal time to begin using the range of online resources including journals, webinars and other tools provided by traditional and non-traditional education sources. In addition to the resources on the Board’s website explaining how the new CPD standard will work, CPD providers will also be able to help meet your individual needs. Your professional association, special interest groups, educators and the wider optical industry have launched a range of new and exciting CPD activities. I encourage you to take advantage of the opportunities this unique environment presents. Get online and familiarise yourself with the new requirements of the standard and read the guidance material. Use your time wisely and learn as much as you can about how your CPD will change. That will mean you will be very well positioned when the new standard takes effect on 1 December. I look forward to catching up with many of you at next year’s conferences as we anticipate life returning to normal. These events always re-energise my interest and provide something to think about that hadn’t previously occurred to me. Take care and stay safe. n Name: Ian Bluntish Qualifications: BOptom, MBA, FACO, MAICD, JP Business: Holdfast Bay Optometry Position: Chair, Optometry Board of Australia Location: Glenelg, South Australia. Years in the profession: 40

THE BOARD WILL BE UNDERSTANDING IF YOU GENUINELY HAVE TROUBLE MEETING YOUR CPD REQUIREMENTS DURING THE CURRENT REGISTRATION PERIOD

See more, know more with more Insight Subscribe FREE and receive the latest news

Find jobs and advance your career with Insightâ&#x20AC;&#x2122;s Classifieds

Insight is mobile and tablet friendly

Get to know the newest products from suppliers across Australia

Insightâ&#x20AC;&#x2122;s new website keeps you updated on the latest industry news and information. With a world-class responsive design, Insight is now accessible seamlessly on any device, 24/7. Sign-up FREE to our eNewsletters and industry reports delivered weekly straight to your inbox.

www.insightnews.com.au

Carl Zeiss Pty Ltd, NSW 2113 AUSTRALIA. Carl Zeiss (NZ) Ltd, AUCKLAND 1026 NZ.

Seeing more with the first digital microscope.

ZEISS ARTEVO 800

ZEISS AU: 1300 365 470 NZ: 0800 334 353 med.au@zeiss.com

The first digital ophthalmic microscope brings a new era in visualisation for greater certainty in surgery. ZEISS optics and the expansive possibilities of digital imaging enable you to see even more with greater comfort thanks to DigitalOptics™, AdVision™ and Cloud Connectivity.

zeiss.com/artevo800