Insight August 2021 by Prime Creative Media

INSIGHT AUG

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

E N V I S TA TO R I C I S N OW P R E LOA D E D

NEW

Focused on Outcomes. Fixated on Stability.

How do ophthalmologists and optometrists stack up against other health professionals?

PERFECTING THE PATIENT RECALL The quality of patient reminders can determine the success of optical businesses.

EYECARE SECTOR SALARIES REVEALED

INSIDE THE WORLD OF OCULOPLASTIC SURGEONS Three Australian specialists provide an update on the most pressing issues in their field.

Business ownership on your horizon? With growth comes opportunity and we’re now looking for the next generation of ambitious and dedicated optometrists to join us as partners. We’ve announced a number of new locations that form part of our ongoing plan to provide even greater access to eye care services across both Australia and New Zealand. If business ownership is on your future career agenda, now is the time to position yourself for a role at Specsavers. Go to spectrum-anz.com or contact us: Partnership enquiries: Marie Stewart +61 408 084 134 Optometry vacancy enquiries: Madeleine Curran +61 437 840 749

INSIGHT AUG

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

OPHTHALMOLOGISTS RANK AMONG TOP EARNING DOCTORS IN LATEST INCOME DATA

New income data from the Australian Tax Office (ATO) has revealed ophthalmologists are the second highest paid medical specialty – second only to neurosurgeons – earning more than half a million dollars on average, however the data suggests a significant gulf exists between male and female eye doctors. The national tax department recently released a detailed breakdown of the average taxable income for each occupation, including optometrists, orthoptists and optical dispensers. The data is the latest available and covers the 2018-19 financial year when the average taxable income in Australia was $62,549. Although the data provides

intriguing insight, it is a relatively crude measure with limitations. For example, it includes annual incomes of all part-time, casual and fulltime workers. For professions where a greater proportion work part-time, this could skew salaries down. Therefore, when comparing across professions or between men and women, it may not necessarily be a like-for-like comparison but, instead, an indication. According to the ATO, the average taxable income for Australian ophthalmologists was $524,804. For men – who made up 72% of all ophthalmologists in the ATO data – the number was much higher at $612,973. For females, that number was $294,528. Meanwhile, the

The average taxable income for an optometrist was $94,840.

average taxable income across 4,388 Australian optometrists was $94,840. Male optometrists earned $110,643 on average, while females earned $83,639, a difference of $27,004. For health practice managers the number was $74,956, orthoptists $62,417, optical mechanics $60,666 and optical dispensers $41,783. Ophthalmology was one of only two medical specialties earning more than half a

million dollars, with neurosurgeons topping the list with an average of $575,687. Other notable fields were orthopaedic specialist ($437,067), plastic and reconstructive surgeons ($433,226) and anaesthetist ($386,065). The gender pay difference in neurosurgery was also high, with men earning $629,967 – $325,677 more than females. This existed across most, if not all, medical specialties. Out of all occupations, the ATO data ranked ophthalmologists and neurosurgeons as the top two earners, but Australian Society of Ophthalmologists (ASO) vice president Dr Peter Sumich said it failed to capture multi-millionaire law continued page 8

WATCHDOG SENDS MESSAGE OVER MISCONDUCT CASES The health practitioner watchdog has warned optometrists to comply with their registration requirements after a New South Wales eyecare professional became aware that he wasn’t licenced to practise 16 years after his registration lapsed.

practitioners to keep on top of their registration requirements. Falsely claiming to be a registered health practitioner or prescribing optical appliances without being registered or authorised is a criminal offence under the National Law.”

The Sydney-based optometrist was recently fined $7,700 after pleading guilty to nine charges brought by the Australian Health Practitioner Regulation Agency (Ahpra). He was also ordered to pay Ahpra’s legal costs of $4,813.

According to Ahpra, the optometrist’s registration lapsed in 2003 after he failed to renew it. While unregistered, he continued to practise. In September 2019 he became aware he wasn’t registered and immediately ceased working. He has since returned to the register after reapplying.

“Maintaining current registration is an important professional obligation for all registered health practitioners,” Ahpra CEO Mr Martin Fletcher said. “This court outcome is a timely reminder for all registered

He was sentenced in May by the Downing Centre Local Court of New South Wales for one charge of holding himself out as an optometrist and eight charges of prescribing

optical appliances in breach of the National Law. Ahpra’s prosecution focused on the period between 1 July and 25 September 2019, when he worked and performed his usual duties as the clinic’s sole optometrist. Magistrate Megan Greenwood noted the optometrist was dedicated to his patients and there was no evidence of harm, but the “community has the right to expect all health practitioners they deal with to be registered”. Meanwhile, the Supreme Court of South Australia has extended the disqualification period imposed on a former Adelaide optometrist from one to five years after he changed the results of tests without clinical justification 410 times. The continued page 8

LATEST OPHTHALMIC INNOVATIONS With 2021 marking a near full return to normality for the ophthalmic market, Insight is bringing together a host of Australia’s leading suppliers and manufacturers to showcase their latest product releases. page 23

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IN THIS ISSUE AUG 2021

EDITORIAL

FEATURES

A SUGAR TAX IS INEVITABLE, SO WHAT'S THE HOLD UP? Australian politicians love delving into global comparisons whenever there are questions about the nation’s health. That’s until the prickly topic of a sugar tax emerges, as it so often does, with little action.

PRECISE RESULTS How optometry practices are optimising their workflow to reduce remakes.

LEVELLING UP Independents from one group are setting new sales records in 2021.

A 20% tax hike on sugar-sweetened beverages is a key plank in the Australian Medical Association (AMA)’s new blueprint to make Australia the healthiest country in the world. The report also highlights how Australia is falling behind, with more than 45 global jurisdictions already implementing such taxes. The UK, France, Mexico and parts of the US have done this to great effect, with reliable measures showing a drop in consumption. The AMA’s proposal is based on a WHO recommendation that the retail price needs to rise by at least 20% to have a meaningful impact. The AMA’s tax rate of $0.40/100g sugar would satisfy that, with the amount paid on a 375ml can of coke with 40g sugar (sugar content is 10.6g/100ml) being $0.16. A sugary drinks tax would have real world implications for eyecare. An infatuation with sugar is rendering thousands needlessly blind. Alarmingly, 280 more Australians develop diabetes daily, reaching 2.45 million by 2030. Over a 25-year period, a sugar tax could result in 16,000 fewer type 2 cases.

PATIENT RECALL New technology is allowing practices to create greater cut-through.

NICHE SPECIALTY With only 60 specialists nationally, oculoplastic surgery is a unique vocation.

EVERY ISSUE 07 UPFRONT

48 MANAGEMENT

09 NEWS THIS MONTH

49 CLASSIFIEDS

45 ORTHOPTICS AUSTRALIA

49 CALENDAR

46 OPTICAL DISPENSING

50 SOAPBOX

The AMA argues the sugar tax benefits are threefold: it tells consumers the product is unhealthy; creates a disincentive via higher prices; and incentivises manufacturers to reformulate to lower sugar content. It would also generate $814 million annually for the government. Australia knows how to stand up to corporate powers. It did so with the tobacco industry. So why the apathy with the more insidious fizzy drink producers? Given the powerful evidence, a sugar tax in Australia feels inevitable. Other countries have done the legwork, we just need to follow suit. MYLES HUME Editor

INSIGHT August 2021 5

The world’s first Hyperparallel OCT® is coming. Meet the Australian founding team using award-winning micro-optics technology to revolutionise whole-eye OCT imaging and measurements.

Read more at cyliteoptics.com/register

UPFRONT Just as Insight went to print, THE QUEENSLAND EYE INSTITUTE performed Australia’s first corneal allogenic intrastromal ring segment (CAIRS) surgery. Dr David Gunn recently conducted the procedure that overcomes higher complications rates associated with current synthetic corneal implants by using donor tissue instead.“We are so happy to be able to bring this innovative new treatment option to Australia,” he said. “CAIRS surgery is a major step towards opening up more treatment options

WEIRD

for keratoconus with other procedures rather than a full corneal graft." IN OTHER NEWS, Oscar Wylee is set to open six stores this month, taking its total number of new locations since June to 16. According to its website, the franchise opened three stores in June, and was scheduled to launch seven more in July. The six stores expected to open this month are in Salamander Bay Square in NSW, Keilor Downs Shopping Centre, Bendigo Marketplace and Plenty Valley Westfield in Victoria, Elizabeth City Centre in South Australia and Rockingham Shopping Centre in Western Australia. Once open, Oscar Wylee’s store network will stand at 98 since opening in 2015.

FINALLY, Professor James Wolffsohn has accepted the position of chief scientist of the International Myopia Institute (IMI), following the retirement of Professor Earl Smith. Wolffsohn has been part of the IMI advisory board since 2016 and helped to chair the taskforces that developed the 2019 and 2021 whitepapers. He was previously the head of optometry at Aston University, Birmingham, UK, before becoming the deputy executive dean for life and health sciences. “There is still much to do to nurture and support high quality science and translate this into evidence-based best practice guidelines for clinicians, to enhance the long-term quality of life of future generations,” he said.

STAT

WACKY

Prince Harry has revealed he is using a controversial psychotherapy called eye movement desensitisation and reprocessing (EMDR) to deal with the trauma of his childhood. The treatment uses lateral eye movements. Proponents theorise it helps access the traumatic memory network to improve information processing.

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WONDERFUL

China has celebrated Dr Zhang Xiaofang, a 101-year-old ophthalmologist who continues to work at his clinic in Zhengzhou. He recalls few slit lamps when he joined the profession, but “now we have the world's most advanced equipment and can carry out [many] cutting-edge treatments”.

Published by:

Publisher Christine Clancy

Sunglasses used in the new Disney film Cruella were stolen in a latenight raid on the luxury eyewear store Tom Davies in central London. The hundreds of stolen frames had a value of $700,000, but the Cruella pair were expected to fetch a larger sum alone at an upcoming charity auction. n

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PROSPERING INDEPENDENTS For the year-to-date May 2021 retail sales within an Australian independent optometry network were up 19% on fiscal year 2020, and 16% on 2019. Full report page 34.

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NEWS

OPTOMETRY SALARIES REMAIN STABLE continued from page 3

partners and executive businessmen who have limited visibility to tax authorities. “Many executives are paid with options or shares which are vested and only become visible later when they are sold,” he said. “Senior bureaucrats who can earn nearly a million dollars a year are diluted down by the employees at the RTA processing your licence registration … a genuine statistician would know that there is a lot more hidden and omitted in the figures than is shown.” In comparison to other medical specialists, he said ophthalmology was more akin to running small-to-medium businesses with the opportunity to use the cash flow for investment purposes. In terms of the gender divide, Sumich said it was common for female ophthalmologists to join practices as associates rather than own a practice because it allowed them more lifestyle flexibility. “Additionally, some ophthalmology practices run more like medical centres with multiple associates contributing to the revenues which can become a revenue source, although the cost of servicing the associates is not as profitable as many would believe after staffing, housing and equipping them,” he said. “The problem with running a small business is that we are extremely exposed to costs of new technology, wages, insurances, cyber security, disposables,

IT, administration and technology maintenance costs. Larger practices also encounter payroll tax, human resources expenses and much larger IT costs.” OTHER EYECARE PROFESSIONALS Optometry Australia’s general manager of policy and advocacy Ms Skye Cappuccio "WE WILL SEE THE said the optometry figures ($94,840) were HIGHEST NUMBER similar to its own data. OF QUALIFIED “Optometrist wages have been reasonably stable for a number of years. Whilst this is positive, we need to ensure the salary an optometrist receives is commensurate with expanding community eye health needs and expanding scope-of-practice,” she said. In response to the gender pay difference, Cappuccio added: “We support the many legislative systems in place nationally, and at a state level, associated with monitoring and closing the gender pay imbalance.”

DISPENSERS WITHIN THE INDUSTRY SINCE DEREGULATION, WHICH SHOULD BE REFLECTED IN A HIGHER AVERAGE WAGE" APRIL PETRUSMA, ACOD

For orthoptists, the ATO figures showed 827 women earned a taxable average of $60,631, and 123 men $74,424.

the importance of orthoptists in more senior management, non-patient facing roles or out in industry continuing to list ‘orthoptist’ as their occupation, so we ensure that data captured by organisations such the [Australian Bureau of Statistics] and ATO using these industrial classification codes for business statistics and economic purposes includes the diverse roles and broad range of workplaces orthoptists are employed.” Australasian College of Optical Dispensing (ACOD) senior trainer Ms April Petrusma said while it was disappointing to learn the customer-facing side of the optical industry fell in or was close to the low income bracket (at $41,783), it was unclear whether this was due to a large number of casual and part-time employees or low average hourly rates. There is also a level of ambiguity with industry awards due to the retail style structure of many practices. This has made it problematic for employers when determining the benchmark for salaries. “With this aside, the recent surge in training enrolments across Australia in the ACOD-provided Cert IV in Optical Dispensing is refreshing, with employers choosing to upskill and qualify their optical staff. In the coming years we will see the highest number of qualified dispensers within the industry since deregulation, which in turn should be reflected in a higher average wage across the profession.” n

Orthoptics Australia president Ms Jane Schuller said the figures reflected the organisation’s data from a membership perspective, with majority (87%) being women – and likely captured many of those working part-time. “We know from our last membership data that only 40% of the members stated they were working more than 30 hours per week,” she said. “This data also highlights

OBA SUCCESSFULLY APPEALS TO THE SUPREME COURT continued from page 3

decision followed the Optometry Board of Australia (OBA)’s appeal against an earlier South Australian Civil and Administrative Tribunal ruling in August 2020. The tribunal disqualified the practitioner from applying for registration for 12 months, ordered he be reprimanded and pay the OBA’s costs after it found his actions amounted to professional misconduct.

The glasses had to be remade at the store’s cost, and the optometrist whose records were changed lost confidence in their work. The misconduct came to light after an investigation by a forensic accountant.

It heard that between February 2015 and January 2016, the optometrist used his log in credentials to change patient records entered by another optometrist. Due to his actions, 313 sets of glasses from a total of

After considering the OBA’s appeal, the Supreme Court found in May that a significant period of disqualification was required to protect the public, maintain confidence in the profession and to send a

INSIGHT August 2021

message to the profession that such conduct cannot be tolerated. The court extended the registration disqualification period from one to five years, dated from 5 August 2020.

359 scripts were defective. In the remaining cases, alterations were corrected before the glasses were made. A total of 96 sets, or 30% of glasses, were later returned to the practice by customers, compared to a usual return rate of 4-5%. Ian Bluntish, OBA.

“This optometrist’s behaviour was contrary to patients’ best interests and this outcome reflects his serious departure from the high standards the board and Australian communities expect of registered optometrists,” OBA chair Mr Ian Bluntish said. Fletcher added: “This matter involved very deceptive behaviour by a registered health practitioner. Together with the National Boards, Ahpra will continue to take action against those who put members of the public at risk,” he said. n

NEWS

OPTOMETRISTS CAN OFFER COVID VACCINE INCENTIVES, TGA SAYS

IN BRIEF n

Optometry Australia (OA) is urging caution for practices considering offering gifts or discounts to fully vaccinated patients as part of changes to advertising regulations to support the COVID-19 vaccine rollout. In June, the Therapeutic Goods Administration (TGA) updated rules around the lawful communication and promotion of COVID-19 vaccines and is allowing businesses to offer incentives and rewards to people who have received two full doses. Since vaccines became available in Australia in February, there has been frustration over strict promotional and advertising regulations that work to prevent drug companies from advertising prescription drugs directly to consumers. Some felt this has hampered vaccination efforts, with 1.8 million (7.1%) Australians fully vaccinated at the time of writing. As part of the updated guidance, the TGA has advised any party, including health professionals, corporate entities and media outlets, can now create their own content to promote COVID-19 vaccines, provided this information is consistent with current Commonwealth health messaging. Any promotion must not reference brand names such as Pfizer

About 7% of the Australian population were fully vaccinated at 5 July.

or AstraZeneca or any active ingredients. The TGA’s updated guidelines also allow health providers and other businesses to incentivise people to receive the COVID-19 vaccine by offering discounts, prizes and cash. “While we firmly endorse COVID-19 vaccinations as another layer of protection in the fight against coronavirus, the decision to incentivise optometry patients to have a vaccination is a decision that rests with each optometry practice,” OA stated. “Where a practice decides to take this option, we would caution that the practice is following both the TGA’s guidance and advertising requirements of the national law.” The changes expire December 2022.

SAFILO FORGES AHEAD WITH SUSTAINABILITY GOALS Global eyewear giant Safilo is continuing to press ahead with its sustainability agenda with the introduction of electronic invoicing in Australia and the launch of a new sun lens material. The company told Insight from 25 May that its local clients would now receive emailed invoices in a PDF format. By eliminating hard copy invoices, it is expected to save more than 50,000 pieces of paper per year.

Consuming large amounts of daily caffeine may increase the risk of glaucoma more than three-fold for those with a genetic predisposition to higher intraocular pressure. The research, led by the Icahn School of Medicine at Mount Sinai, is the first to demonstrate a dietary-genetic interaction in glaucoma. Published in Ophthalmology, lead author Dr Louis Pasquale said: “We previously published work suggesting that high caffeine intake increased the risk of the high-tension open angle glaucoma among people with a family history of disease. In this study we show an adverse relation between high caffeine intake and glaucoma was evident only among those with the highest genetic risk score for elevated eye pressure.”

It comes amid a raft of sustainability initiatives by Safilo, which launched a Polaroid Sustainable Collection in Australia earlier this year, and signed a sustainabilityrelated deal with global advanced materials manufacturer Eastman.

crystal clear polymer made from 40% biomass and 100% renewable energy, resulting in a 50% lower carbon footprint. Safilo will debut the material in January 2022 with the Boss Spring/Summer collection before being progressively rolled out across its portfolio.

In its latest announcement, the company is building on a 20-year partnership with German specialty chemicals company Evonik for its Trogamid TmyCX eCO material for premium sun lenses. It is said to be a sustainable, high-performance,

“Sustainability is an integral part of the Safilo’s business philosophy and firmly rooted in our company strategy," Mr Vladimiro Baldin, chief licensed brand and global product officer at Safilo Group, said. n

WARBY PARKER

US eyeglass brand Warby Parker announced its intention to go public. The New York-based firm has confidentially filed for a stock market listing in the US, which is expected to go ahead after the Securities and Exchange Commission completes its review process, which is still subject to market conditions. Warby Parker raised $120 million in its most recent 2020 funding round, giving it a value of $3 billion, according to PitchBook data. The direct-to-consumer company is an online retailer of prescription glasses and sunglasses, but also features retail locations across the US and Canada. It also designs its eyewear in-house.

Safilo’s new Polaroid Sustainable Collection.

CAFFEINE AND GLAUCOMA

IOL LAUNCH

Johnson & Johnson Vision has announced the availability of its Tecnis Eyhance Toric II IOL with the Tecnis Simplicity Delivery System in Europe. Designed for cataract patients with astigmatism, the monofocal design allows for high-quality vision at both intermediate and far distances and is engineered for rotational stability, the company said. In the US and Canada, it recently launched the presbyopiacorrecting Tecnis Synergy and Tecnis Synergy Toric II. The design combines the best of extended depth-of-focus and multifocal technologies to deliver “the widest range of continuous vision and the best near vision among leading PC-IOLs, without the visual gaps seen with some existing multifocal technologies”.

INSIGHT August 2021 9

NEWS

‘THE GREAT MASQUERADE’: OCULAR SYPHILIS CASES SOAR AMID EPIDEMIC IN MELBOURNE The Royal Victorian Eye and Ear Hospital (RVEEH) is concerned about the exponential rise in ocular syphilis presentations, particularly in women, stemming from what experts have described as a syphilis epidemic in Victoria. Dr Danielle Ong, who worked with a team of doctors at the hospital researching the condition from 2006 to 2019, said in the early 2000s RVEEH was recording approximately two cases of ocular syphilis per year. But in 2018, cases had risen to 17, which then increased to 21 in 2019, seven whom were women. The disease can lead to permanent vision loss. It comes after analysis by Alfred Health’s Melbourne Sexual Health Centre that found a 45% increase in notified syphilis cases from 950 cases in 2015 to 1,375 cases in 2018 in Victoria. While the number of syphilis infections among gay men continued to rise (21% increase), there was a sharp increase in cases among women (220% increase) and heterosexual men (129% increase). The alarming rise has prompted experts to warn that an “epidemic” is in place

She said treatment is readily available and accessible, and the outcome is often favourable if patients are willing to finish their course of treatment.

and swift action is required to bring it under control. Ong, who specialises in medical retinal and uveitis at RVEEH, said she was concerned “by the exponential increase” in ocular syphilis presentations. She said it was a manifestation of the syphilis endemic occurring in Victoria and across the country. “Ocular syphilis occurs when the bacteria enters the body and if left untreated can spread to the eye, and causes vision loss,” she said. “We call syphilis the great masquerade because it can cause many different eye conditions, such as panuveitis, optic disc swelling, posterior placoid chorioretinitis or retinal vasculitis. When interviewing people with ocular syphilis, we find the most common symptoms are blurred vision or floaters. However, these can also be common symptoms of other eye conditions.” Ong said the disease was often treated with two weeks of intravenous antibiotics. But the challenge from a diagnostic point of view is the possibility of syphilis in high risk groups.

Dr Danielle Ong, RVEEH.

“Early detection is paramount. We strongly recommend to general public to present to an eyecare health professional if they notice any sudden changes in their vision,” Ong said. “Optometrists and ophthalmologists work together as a team to care for patients. Optometrists are at the frontline screening people with eye symptoms. People with first presentation of uveitis are then referred to an ophthalmologist for uveitis work up following the standard protocol.” Epidemiologist Associate Professor Eric Chow, who was involved in the recent Alfred Health syphilis analysis, said the increasing number of cases in women was of most concern. “We know syphilis can cause major complications during pregnancy and even result in the death of the child so we’re urging all women at high risk to get screened during their third trimester in addition to the universal screening during the first.” n

CONJUNCTIVITIS IMPACTS SEMI-PRO AFL COMPETITION A conjunctivitis outbreak caused major disruption to a semi-professional AFL competition in Queensland after around 50 players from two teams became infected.

it spreads so easily. There's been some heartache about how we go about this and that's why we've sought advice. If you get on top of it, it passes fairly quickly."

Reports of the contagious eye infection emerged around 19 May when the South Cairns Cutters informed Cairns AFL authorities that several of its players were displaying symptoms.

Young said the highly contagious nature of the condition made it hard to blame players for its spread.

Cairns AFL immediately postponed three games involving the club’s senior, reserve, and women’s teams. Then a few days later North Cairns reported about 20 of its players also had conjunctivitis. Overall, it was estimated about 50 players at two clubs contracted conjunctivitis, with six games postponed in total. The league consulted with Queensland Health and AFL headquarters and requested infected players to self-isolate. Cairns league

INSIGHT August 2021

About 50 players at two clubs became infected, with the league postponing six matches.

president Mr Gary Young told the ABC that while the delay was disappointing, case numbers would likely have skyrocketed had games gone ahead. "I wouldn't have wanted to be responsible for that," he said. "We have to protect the health and welfare of our footy community because

"It could be as innocent as an [infected] child giving mum or dad a hug. Then they've come to footy training, shaken someone's hand and it's off and racing. It's that contagious." In the latest announcement, Young said appeared the outbreak had been contained to the two clubs. “Please be vigilant and ask players and club personnel to take precautions. Norths and Souths have temporarily closed their senior clubs in an effort to contain and eliminate this spread as quickly as possible." n

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NEWS

FOUR EYECARE PROFESSIONALS RECOGNISED IN 2021 QUEEN’S BIRTHDAY HONOURS LIST RANZCO’s first female president has joined a Sydney ophthalmologist, one optometrist and an orthoptist in the 2021 Queen’s Birthday Honours List. Melbourne’s Associate Professor Heather Mack, who led the college from 2018-2020, was made a Member in the General Division (AM) for significant service to ophthalmology, particularly to professional colleges. She joined Bellevue Hill eye doctor Dr Michael Newman, who was awarded a Medal in the General Division (OAM) for his contributions to ophthalmology, as well as South Australian optometrist Associate Professor Anthony (Tony) Phillips (AM) and NSW’s Ms Shayne Brown (AM) for her service to orthoptics. The four eyecare professionals were among 1,190 Queen’s Birthday Honours recipients this year, which had the highest ever percentage of women (44%) recognised through the General Division of the Order of Australia. In addition to being RANZCO’s first and only female president in its 52-year history, Mack has held numerous roles within the college since joining as a fellow in 1992, and has been involved with the Royal Australasian College of Surgeons, International Council of Ophthalmology, Victorian Surgical Consultative Council

A/Prof Heather Mack was among four recipients from the ophthalmic sector in 2021.

and the University of Melbourne. A medical retina specialist, she is currently a senior associate at Eye Surgery Associates in Melbourne, and honorary researcher at the Centre for Eye Research Australia (CERA). Meanwhile, Newman’s contributions to ophthalmology include Cambodia Vision where he has been chief surgeon since 2014, as well as other overseas initiatives such as such the Eyes on China Program, Papua New Guinea Eyecare Project, and as a volunteer surgeon and trainer in Burma in 2010. He’s worked in private practice at Miranda Eye Surgical Centre, Sydney, since 1991. Brown was recognised for significant service to medicine through orthoptic associations. This includes as past

"[A/PROF MACK] WAS MADE A MEMBER IN THE GENERAL DIVISION FOR SIGNIFICANT SERVICE TO OPHTHALMOLOGY, PARTICULARLY TO PROFESSIONAL COLLEGES" THE GOVERNORGENERAL OF THE COMMONWEALTH OF AUSTRALIA

president of the International Orthoptic Association (IOA) from 1983-87, and as the IOA Australian representative between 1975-83. For Orthoptics Australia, she served as the national secretary and as a board member, and was president of the NSW branch (1974-77 and 197881). She was also orthoptist in-charge at Sydney Eye Hospital (1978-85), and a past research assistant at CERA. A strong interest in orthoptic research has seen her publish 42 scientific journal articles, including 19 in the Australian Orthoptic Journal, and in 2019 she co-authored the book Rear Vision: A History of Australia’s Early Orthoptists. Phillips, a Craigburn Farm optometrist and contact lens expert, received his AM for service to optometry, and to professional optical societies. Most notably, he was president of the Cornea and Contact Lens Society of Australia in 1989 and 2007. As well as being the former head of contact lens teaching at Flinders, he has previously led the medical contact lens units at the Flinders Medical Centre and the Adelaide Women’s and Children’s hospitals. He is the co-editor of the standard optometric textbook Contact Lenses, now in its sixth edition. n

JUKURRPA DESIGNS PROVIDES GLASSES TO BOND UNIVERSITY INDIGENOUS STUDENTS The creator of a frames collection that showcases and directly supports the work of Aboriginal artists has partnered with Bond University to offer complimentary spectacles to Indigenous students. Jukurrpa Designs, launched in 2019 by eyewear designer and UK-qualified dispensing optician Mr Murray O’Keeffe, FBDO, is supplying its collection of frames, including lenses, to Aboriginal and Torres Strait Islander students who require glasses at the university. The full cost of the eyewear – approximately $4,500 in value – has been covered by Jukurrpa Designs. A full eye test is also recommended before the glasses are dispensed. The collection 12

INSIGHT August 2021

art centres in Central Australia, who receive a 10% royalty for every pair sold. O’Keeffe said he was proud and honoured to partner with Bond University. “We will also supply any lenses needed, no matter what their prescription requirements are. We are so happy to be involved and contributing to their vision and needs to help further their education,” he said. Murray O'Keeffe with Bond University's Narelle Urquhart and eyesaBOve director Anthony Parisi.

features licensed work from the art centre Warlukurlangu Artists of Yuendumu, one of the longest-running Aboriginal-owned

The initiative kicked off in May when the first 10 Indigenous students chose their pair of Jukurrpa Designs frames. “It was great to see them all happy and proud to wear a pair that is linked to their Aboriginal culture,” O’Keeffe added. n

GLAUCOMA AUSTRALIA APPOINTS NEW PRESIDENT, BIDS FAREWELL TO A/PROF SIMON SKALICKY Glaucoma Australia (GA) has appointed Ms Maree O’Brien as its new president who will replace outgoing Associate Professor Simon Skalicky who has served the charity organisation for the past seven years. O’Brien joined GA through its ICT Committee in 2017, becoming chair of the committee and a member of the board in 2019. She is also a member of the audit and risk committees. She has extensive experience in senior management and leadership roles with multinational technology and professional services companies. Her experience in organisational transformation is expected to assist GA as it further develops its digital strategy and future direction. Her career spans commercial, government and not-forprofit organisations, both internationally and in Australia.

“I have a strong family history of glaucoma and am committed to Glaucoma Australia’s mission to eliminate glaucoma blindness,” O’Brien said. “As glaucoma is often referred to as the ‘silent thief of sight’ I am looking forward to working with the directors and CEO to increase awareness of glaucoma in the community and encourage people to have their eyes tested regularly.”

Maree O’Brien, Glaucoma Australia.

Skalicky’s involvement with GA began in 2014, when he joined the organisation’s Ophthalmology Committee. Using his research skills in quality of life in glaucoma he led a multicentre Australiawide randomised clinical trial evaluating the impact of GA education for newly diagnosed glaucoma patients. In 2016 he became chair of the Ophthalmology Committee and joined the board, before being appointed president in 2019.

Following his recent departure from the board, Ms Annie Gibbins thanked Skalicky for his support in her role as GA CEO and commended him for his contributions, as well as his dedication to patient care and quality of life through education. “Simon was instrumental in establishing the Glaucoma Australia Research Grants program, and in co-ordinating the Glaucoma Australia involvement in the Medicare submission for MIGS,” she said. “He actively promotes collaborative care between ophthalmology and optometry and has worked closely with colleagues in optometry to establish the Glaucoma Australia Patient Referral Pathway and integrate Glaucoma Australia services with the online referral platform Oculo, enhancing digital referral of new glaucoma patients to the Glaucoma Australia service.” n

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NEWS

MOTHER’S PLIGHT SPARKS $750K DONATION FOR LIONS EYE INSTITUTE STEM CELL ROBOT A mother’s moving speech about her sons’ blinding genetic condition has prompted a prominent Perth family to donate $750,000 for a stem cell robot at the Lions Eye Institute (LEI). In a remarkable show of generosity, Mrs Rhonda Wyllie and her family will cover the full cost of the machine that can be used for research into many disorders. They were spurred by Ms Bronwyn Doak – whose two boys Eamon, 8, and Kealan, 6, both have Usher syndrome – after she spoke at the Leeuwin Lunch for Telethon in Margaret River on 26 May. The Wyllie donation was a highlight of the event, which raised more than $3.55 million. The family has a strong affiliation with LEI, with the late Mr Bill Wyllie and one of its patrons. In a Western Australian first, the stem cell robot will potentially allow LEI researchers to save the sight of

would allow laboratory staff to work more efficiently and effectively to develop new drugs to treat IRDs such as retinitis pigmentosa, Usher syndrome and

hundreds of children by accelerating the development of therapies for patients with inherited retinal diseases (IRDs). By automating the cell culture work involved in producing human miniorgans, it can convert significantly more human skin cells into retina and other tissue types. “Having a stem cell robot will be a game changer for our research,” LEI clinician researcher Dr Fred Chen said.

Stargardt disease. Bronwyn Doak and Rhonda Wyllie embrace.

“Having the stem cell robot will bring hope to families like the Doaks, whose two young boys Eamon and Kealan were both born with Usher syndrome,” he said. “Usher syndrome is a particularly cruel disease. Children are born deaf and face becoming legally blind in their 20s or 30s. There are currently no treatments for Usher syndrome, and Eamon and his brother Kealan will soon start losing their sight without a medical breakthrough.”

“It will allow researchers to develop treatments for myriad childhood diseases including cancer, diabetes and inherited diseases like cystic fibrosis and IRDs. We have already discovered a treatment for one gene that causes inherited eye disease and it is our mission to discover treatments for all 250 types of genetic eye diseases.”

Chen said the robot would operate 24 hours a day, seven days a week: “We estimate we are five years away from crucial scientific discoveries that could save Eamon and Kealan’s sight.” n

LEI managing director Professor Bill Morgan said the new piece of equipment

AWARENESS OF DIABETIC EYE DISEASES LACKING, ACCORDING TO POLL OF WORKING AGE POPULATION A survey of Australia’s working-age population has revealed that most can’t name the most common cause of blindness among their age group – diabetic retinopathy (DR). This is despite a higher proportion of respondents knowing that diabetes affects eyes, compared with other body parts such as the feet, kidneys and heart. Macular Disease Foundation Australia (MDFA) has shared the results of a YouGov poll it commissioned, showing only 29% of Aussies aged 50 to 70 have heard of DR, while only 26% are aware of diabetic macular oedema (DMO). DR is the most common diabetic eye disease and the top cause of blindness in working-age Aussies, affecting between 300,000 and 400,000 people, according to MDFA. The organisation notes that around 1.7 million Australians have diabetes, and that figure is expected to climb past two million by 2025, driving a surge in diabetic eye disease.

INSIGHT August 2021

The study was commissioned to mark Macula Month, MDFA’s annual awareness campaign each May urging at-risk Aussies to check their macula. The survey comprised 1,049 Australians aged between 50 and 70 and was conducted online between 18-22 February 2021. “Although 82% identified the eyes as a body part that diabetes can affect – higher than feet (74%), kidneys (68%), and even the heart (53%) – the lack of awareness of what these conditions are called means many people who are at risk remain in the dark about these sightthreatening complications,” MDFA said. MDFA CEO Dee Hopkins is concerned that most people can’t name DR. “Diabetic retinopathy claims the eyesight of more working-age Australians than any other eye condition, yet less than 30% of people know its name,” Hopkins said. However, more than two thirds of people polled are having regular eye checks.

Dee Hopkins, MDFA.

“The YouGov study showed that 68% of respondents have had an eye examination and/or macula check in the last two years – more than other health checks such as cholesterol (66%), bowel cancer screenings (51%), glucose/ diabetes (44%) and skin checks (36%),” MDFA said. MDFA Ambassador and 2020 Australian of the Year, Adelaide ophthalmologist Dr James Muecke AM, said DR was the only reversible macular condition. “If you control your diabetes, or if you are able to put your type 2 diabetes into remission, you can turn this blinding disease around. We want people to not only understand the name of the disease, we want everyone to take action to avoid its devastating outcome,” he said. “This is easily done through regular eye examinations and managing your diabetes. When the disease is picked up early, you can make lifestyle changes and access good treatments that maintain sight and prevent severe vision loss.” n

NEWS

AGREEMENT TO STRENGTHEN MBS REVIEW PROCESS AND INFORMED FINANCIAL CONSENT The Federal Government and the Australian Medical Association (AMA) have agreed to co-design the administrative processes around future changes to Medicare to ensure a smooth transition and allow patients the time for informed financial consent. The MBS Review Taskforce has overseen the most comprehensive review of Medicare since it began, with the aim of modernising the system and supporting reinvestment of savings into new and amended items. The taskforce has delivered more than 60 reports across many health fields, outlining almost 1,400 recommendations to the government. This includes 19 recommendations for ophthalmology items, and 11 for optometry. In reaching the agreement, the government and AMA say they recognise some changes are complex and require

anni ver sar y 19 5 1 - 2 0 2 1

additional time to flow through systems to support high quality patient care and informed financial consent. It also comes as the MBS review process, which commenced in 2015, will now shift to a more ‘business-as-usual’ footing, embedding a new continuous review of the schedule as recommended by the taskforce, led by Professor Bruce Robinson. Federal Health Minister Mr Greg Hunt said the government would continue to work with the health insurance and hospital sectors to implement improvements to administrative processes to allow time for all patients to have informed financial consent, including insurance rebates, before their procedures. It would also be monitoring the flow on effects of changes to health funds to ensure access remains affordable. “We will continue to expand the Out

Dr Omar Khorshid, AMA.

of Pocket Costs website, which was first established in 2018, to further support patient choice and informed financial consent, including information about specialist medical fees and information about the private health insurance rebates,” he said. AMA president Dr Omar Khorshid said the organisation welcomed the commitment to work on changes to the MBS review process to give additional time between public notice of the items and implementation. “The goal of these changes is to ensure that while changing the MBS, we provide all the information a patient and a doctor need about Medicare and insurer rebates to provide informed financial consent,” he said. “We will begin the co-design process after 1 July following implementation of the latest changes.” n

NEWS

FUNDING NEEDED FOR DIAGNOSTIC TOOL THAT CAN HALVE WAITING TIME

Max Thomson, a one-year-old with LCA.

Funds raised from a campaign in Queensland will help purchase a state-of-the-art diagnostic tool allowing ophthalmologists to see conditions that other tests can’t. Queensland Eye Institute (QEI) is raising funds to purchase an additional electroretinogram machine, used to diagnose conditions including Lebers congenital amaruosis (LCA), retinitis pigmentosa, Stargardt disease and cone dystrophy. In most cases, patients suffering from these conditions do not go blind immediately, meaning early intervention strategies can be sight-saving. QEI executive director and CEO Professor Mark Radford said only visual electrophysiological tests allowed eyecare practitioners to clearly delineate which layers of the retina aren’t functional. “We are the only service in Queensland who provide comprehensive electrophysiology testing for all ages, but demand is high and wait lists are long," he said. QEI currently receives referrals for patients from across Queensland, the Northern Territory and northern NSW. It takes approximately 3.5 hours for each test, meaning only two patients can be seen each day – less than 400 annually. “Another electroretinogram for Queensland means we halve the waiting time and potentially double the number of people’s sight that we save,” Radford said. QEI dubbed 31 May as “Max Day” to mark the launch of the campaign and highlight the value of the electroretinogram machine. Fifteen-month-old Max Thomson has benefitted from the electrodiagnostic unit at QEI. He was diagnosed with suspected LCA. It affects about two in every 100,000 babies. n

INSIGHT August 2021

CONSORTIUM SECURES FINANCING FOR BIOENGINEERED EYE TISSUE A project funded through the Federal Government’s Medical Research Future Fund (MRFF) is developing bioengineered eye tissue to treat corneal blindness in a world-first solution to a global problem. Sydney’s Professor Gerard Sutton is leading the national consortium of clinical, scientific and governance experts to develop the technology and address corneal disease – the third most common cause of blindness among all age groups and the leading cause of unilateral blindness among Aboriginal and Torres Strait Islanders. The project is called: ‘Australian Corneal Bioengineering: Novel Therapies to Fight Blindness’ and received $999,224. It includes the University of Sydney, University of Wollongong, University of Melbourne, Queensland University of Technology, Centre for Eye Research Australia, and the NSW Organ & Tissue Donation Service. Sutton, a corneal specialist and comedical director of the NSW Tissue Bank, said that although access to services was an ongoing challenge, developing customised, easy-to-apply therapies was a realistic solution for at-risk populations, including Indigenous Australians.

Globally, donor corneas are available for only one in 70 patients.

“These novel treatments address various stages of corneal disease, minimising dependency on donor tissue and will have a significant and direct impact on blindness in the world,” he said. The national consortium will develop corneal replacement tissue that will provide multiple, customised therapies, with an emphasis on transportable treatments with extended shelf-life for use in remote communities. “The success of this program will help millions of patients both nationally and globally to restore vision, improving their quality of life and reducing the social and economic burden associated with blindness,” Sutton said. The project is being funded via the MRFF 2021 Frontier Health and Medical Research Initiative. n

KEEPSIGHT MESSAGE TAILORED TO DARLING DOWNS REGION Diabetes Australia (DA) has joined forces with an Indigenous-run health organisation to promote KeepSight in the Darling Downs region of southern Queensland. Carbal Medical Services in Toowoomba and Warwick will promote DA’s KeepSight eye check reminder program using locally developed, culturally appropriate resources to encourage local Aboriginal and Torres Strait Islander people to have regular eye exams. Indigenous Australians are almost four times more likely than non-Indigenous Australians to be living with diabetes. Carbal Medical Services’ CEO Mr Brian Hewitt said eye health may not typically be the first diabetes-related problem people accessing Carbal’s

The initiative will cover Toowoomba and Warwick in Queensland.

services think they need to consider. “Diabetes eye checks can get overlooked easily when there are so many other aspects to managing our diabetes and health – but the good news is that vision loss from diabetes is preventable if acted on early,” he said. “Regular checks are possibly the most important thing people can do to keep their eyes in good health.” n

NEWS

LINK BETWEEN SCREEN TIME, SLEEP, AND MYOPIA An optometrist’s research at Flinders University has established a link between myopia and poor sleep quality due to increased screen time. Dr Ranjay Chakraborty from the Flinders Caring Futures Institute led the study that found people with myopia have more delayed circadian rhythms and lower production of melatonin, a hormone secreted in the brain and responsible for regulating sleep at night, compared to people with normal vision. The findings, published in the journal Sleep, showed participants with myopia took longer to fall asleep, sleep for shorter periods of time at night and were more likely to go to bed later or be ‘night owls’. These sleeping habits were related to people with myopia spending more time on computers and other digital devices or studying before going to bed. “Disruptions in circadian rhythms and sleep due to the advent of artificial light

Chakraborty said children’s sleeping habits and exposure to screen time must be re-evaluated to reduce the chances of myopia progressing in young people.

and the use of light-emitting electronic devices for reading and entertainment has become a recognised health concern in several fields, but its impact on eye health has not been studied extensively,” Chakraborty said. “These findings provide important evidence that optimal sleep and circadian rhythms are not only essential for general health, but also for good vision.” In the study, the circadian timing and production of melatonin was measured in both people with myopia and people with normal sight. All participants were university students, aged in their twenties. Their melatonin levels were measured through saliva and urine samples, and those with myopia had significantly delayed circadian rhythms and lower outputs of melatonin compared to normal sighted participants.

Dr Ranjay Chakraborty, Flinders University.

“A lot of digital devices emit blue light, which can suppress the production of melatonin and cause delay in circadian rhythms at night, resulting in delayed and poor sleep,” he said. Chakraborty hoped to expand his research. “Because myopia typically develops during childhood, as a next step, we would like to examine circadian rhythm timing, total production of melatonin sleep and light exposure at night in young children – the actual target population for myopia prevention,” he said. “Such a study will provide novel insights into the biological and environmental factors underlying myopia, which will aid in early diagnosis and treatment of myopia in children.” n

NEWS

QUEENSLAND OPHTHALMOLOGIST PERFORMS AUSTRALIAN-FIRST CATARACT LASER TECHNIQUE A Brisbane eye surgery clinic has become the first in Australia to offer the CAPSULaser procedure, enabling surgeons to perform highly accurate and consistent capsulotomies in less than one-third of a second. OKKO Eye Specialist Centre, founded by leading ophthalmic surgeon Dr Mathew Russell, recently adopted the technology that he says also ensures precise size, circularity and position of the lens implant. Developed in the US, CAPSULaser is a pain-free, non-invasive procedure that uses laser to perform the critical component of the cataract procedure. When combined with the latest capsular-fixated IOLs, the technology reportedly has the ability to improve vision stability, increasing the predictability of vision outcomes. Russell said femtosecond laserassisted cataract surgery (FLACS) – the most used laser-assisted cataract surgery approach nationally – requires two separate procedures, often in different procedure rooms. It also involves a suction element applied directly to the eye that can be uncomfortable for patients. Replacing the FLACS approach, he said CAPSULaser can be seamlessly integrated into current cataract surgery,

Dr Matthew Russell, specialist ophthalmic surgeon, OKKO Eye Specialist Centre.

eliminating the need for a two-staged procedure. With a predictable and precise capsule opening, the procedure enables the use of a new generation of extended depth of focus (EDOF) capsular-fixated implants.

"UNTIL NOW, IT HASN’T BEEN POSSIBLE FOR MANY DAY SURGERIES TO AFFORD THE INCREDIBLE EXPENSE THAT COMES WITH THE CURRENT LASER TECHNOLOGY"

technology available to Queenslanders who need to undergo cataract surgery,” Russell said.

MATTHEW RUSSELL, OKKO EYE SPECIALIST CENTRE

Russell believes most surgical centres across Australia will eventually regard CAPSULaser as the preferred laser platform for cataract surgery.

“Until now, it hasn’t been possible for many day surgeries to afford the incredible expense that comes with the current laser technology, but CAPSULaser is much more accessible, which will have tremendous potential benefits for clinics, day surgeries and patients.”

“By introducing this state-of-theart procedure to our practice, we’re able to offer our patients an excellent level of service while creating greater certainty of our surgical outcomes and increased long-term satisfaction because CAPSULaser allows us to take advantage of new EDOF lens technology,” he said.

In clinical studies, CAPSULaser has demonstrated superior consistency in creating a capsulotomy. The laser precision allows surgeons to pre-select the intended capsulotomy size from 4 mm to 5.5 mm in 0.1 mm increments. Having performed more than 20,000 surgical procedures over the last 15 years, Russell said this was the first time Australians had access to this modality of laser during cataract surgery.

“The evidence so far suggests that capsulotomy created by CAPSULaser may be stronger than and therefore potentially safer than current laser cataract surgery.

“We’re thrilled to be at the forefront of bringing this innovative laser procedure to Australia and making the very latest

"However, this will need to be verified in longer-term clinical studies.” n

GLAUKOS SECURES APPROVAL FOR GLAUCOMA IMPLANT Glaukos has secured Australian regulatory approval for the Preserflo MicroShunt, offering late-stage glaucoma patients a more elegant alternative to conventional filtration procedures. The ophthalmic medical technology and pharmaceutical company announced the Therapeutic Goods Administration (TGA) has cleared the implant that is intended for the reduction of IOP in patients with primary open-angle glaucoma where IOP remains uncontrollable while on maximum tolerated medical therapy and/or where glaucoma progression warrants surgery. Glaukos is planning an initial commercial launch in Australia in late 2021, with a full commercial launch targeted in mid-2022 following formal

INSIGHT August 2021

reimbursement. “We are delighted to receive regulatory approval from Australia’s TGA for the MicroShunt, marking a notable milestone in advancing our goal to bring this important late-stage glaucoma technology to ophthalmic surgeons and patients,” Mr Thomas Burns, Glaukos president and CEO, said. “We believe there is a strong appetite within the global ophthalmic community for the MicroShunt as a more elegant, ab-externo alternative to conventional filtration surgeries for late-stage glaucoma management. We are excited for the opportunity to leverage our bestin-class sales organisation to bring this novel technology to patients in Australia.”

Anatomy with the MicroShunt implant.

The technology is an ab-externo, drainage system that helps drain eye fluid and reduces IOP in patients with primary open-angle glaucoma. Made of a proprietary, biocompatible material called SIBS [poly(styrene-block-isobutyleneblock-styrene)], the MicroShunt is a flexible, 8.5-mm-long tube with planar fins to help fixate the device in the tissue through a micro-incision and prevent leakage and migration. Glaukos recently signed an updated deal with Santen Pharmaceuticals for the implant. It has exclusive commercialisation and development rights in Australia, New Zealand, Canada, Brazil, Mexico and the remainder of Latin America. n

NEWS

EDUCATION A MAJOR COMPONENT OF OPTOMETRY AUSTRALIA'S THREE-YEAR ROADMAP Optometry Australia (OA) wants to expand its education programs internationally to showcase the contribution optometrists make to Australian eye health, while also meeting its social obligations by sharing knowledge in countries where the profession is less advanced.

OA said education was the driver of change and supported optometrists to meet community eye health expectations, emergent eye health conditions and evolving scope-of-practice.

“We will also seek to take our quality education offshore and to share our knowledge with regions where optometry is less advanced and through this, contribute to our social responsibility obligations. By taking our education programs internationally, we can profile the strong contribution that our optometrists make in leading vision and community eye health services in Australia and through this, we can open up new and interesting opportunities for our members and profession.”

“Tools such as webcasts, podcasts, on-demand courses, virtual and hybrid conferences and publications will play a strong role in our commitment to our

Released on 2 June, the strategic plan details four areas OA believes are critical for a sustainability future. These include evolving scope-of-practice,

The organisation has highlighted continuing professional education as a key facet in its recently released 2021-2024 Strategic Plan, which is a collaboration between the national organisation and all state divisions.

continuing professional education, structure optimisation within the federated organisation, and sustainability.

members’ education needs. We will continue to expand our offerings and particularly, the provision of courses that members can access anytime, anywhere,” OA stated.

The plan highlights four focus areas.

“We must ensure that those within public health are aware of the role and the experience that optometrists bring to supporting community eye health,” OA stated, arguing that an optometry workforce operating at its maximum scope is vital to easing the pressure on public health management of eye disease. Internally, the national body and its five state divisions are assessing how they can generate greater efficiencies. In terms of sustainability, OA stated the profession must be mindful of risks and demonstrate brave decision making – “whether this means investing more in digital technologies and applications, embracing data to drive decisions or seeking ways to reduce our environmental footprint”. n

“Eyecare Plus develop and manage essential digital marketing and national promotions that help grow my practice, so we can focus on caring for our patients.” Liz Muller Optometrist, Eyecare Plus Altona

Looking to buy, sell or join contact Philip Rose 0416 807 546 or philip.rose@eyecareplus.com.au

COMPANY

NOC-EYEQ ALLIANCE ANNOUNCES NEW APPOINTMENT Current EyeQ Optometrists chief business development officer Ms Lily Wegrzynowski will transition into a new role as general Lily Wegrzynowski, manager eyecare & EyeQ and NOC. professional services as part of the company’s alliance with National Optical Care (NOC). Last November, EyeQ and NOC – the latter being one of Australian optometry’s newest players with 14 practices – agreed to work together. Since then, they have been strengthening the operations of both businesses and considering ways to better harness the collective skills and expertise of their personnel. Both organisations are advocates for eyecare-led models of optometry, prompting the creation of a new role for Wegrzynowski. As general manager eyecare & professional services, she will work across both businesses, and be responsible for the continued development and implementation of best practice clinical standards across the practice network. The role will also oversee ongoing professional development and recruitment. “I’m incredibly excited to be part of this next phase of the alliance between NOC and EyeQ,” Wegrzynowski said. “To be able to play an integral role in continuing to strengthen the clinical outcomes across our growing practice community is something I am extremely passionate about.” Wegrzynowski is a registered optometrist with significant experience in both clinical and management roles. She has held senior positions with independent and corporate optometry businesses across Victoria, New South Wales and Western Australia, including with EyeQ Optometrists since joining in 2010. She has also served on the Optometrist Association Board (WA Division) for more than 10 years, including three years as president, plus the Optometrists Registration Board of WA and joined the Deakin Optometry Advisory Board when the new school opened in 2012. NOC CEO Mr Jason Gowie added: “We are excited to have Lily play such an important role, as we strengthen our eyecare-led model of optometry across our growing group of practices.” n

INSIGHT August 2021

ESSILORLUXOTTICA TO GO AHEAD WITH GRANDVISION DEAL The EssilorLuxottica board has voted to complete the acquisition of optical retail giant GrandVision “without further delay”, ending uncertainty sparked by a legal ruling that granted the eyewear giant the option to walk away from the €7.3 billion (AU$11.2 billion) deal. On 29 June, EssilorLuxottica announced it would complete the purchase of HAL’s majority 76.72% stake in GrandVision. The deal took place on Thursday 1 July as per the terms of the original agreement signed almost two years ago. “After assessing all our options, we have made the decision to proceed with the completion of the deal without further delay. The strategic rationale of the transaction remains strong and unchanged, and after two years of efforts and relentless work, we are now ready to turn a page and start a new chapter of EssilorLuxottica’s history, with GrandVision,” EssilorLuxottica CEO Mr Francesco Milleri and deputy CEO Mr Paul du Saillant said. “In doing so, we will use the learnings and experience gathered over the past years to ensure GrandVision and its 37,000 talented employees are integrated

EssilorLuxottica CEO Mr Francesco Milleri.

successfully. As the industry returns to growth following the pandemic, we believe this is the perfect time to expand our retail network, so that we can engage more effectively with consumers.” By acquiring the shares owned by HAL – a Dutch investment group – EssilorLuxottica is expected to increase its footprint by around 7,000 stores in 40 countries. The confirmation ended weeks of uncertainty after a tribunal ruled EssilorLuxottica could terminate the deal “due to GrandVision’s (earlier) material breaches of its obligations to EssilorLuxottica”. EssilorLuxottica will purchase HAL’s interest for €28.42 per share. n

ZEISS VISION CARE APPOINTS NEW HEAD TO LEAD ANZ BUSINESS Zeiss has announced former managing director of Carl Zeiss Vision South Africa Ms Gail Giordani will head its vision care business in Australia and New Zealand, taking over from Ms Hilke Fitzsimons. Giordani is a medical scientist specialising in haematology who arrives at her new posting in Adelaide with more than two decades’ experience within the company. Fitzsimons, who became general manager for vision care Australia/New Zealand in 2017 after several other leadership roles within the company, has taken on a new role within the global organisation. Giordani began her career at Zeiss South Africa in 1999 as a member of the microscopy division focusing on the market development of fluorescent and confocal microscopy. In 2014, she was appointed to lead Carl Zeiss South Africa. She has now relocated to Adelaide where she will be based at the company’s

Gail Giordani is the new head of Zeiss Vision Care ANZ.

site in the Tonsley Innovation District. “I am excited to be making a big life and professional change and look forward to travelling around Australia and New Zealand meeting with our customers and industry role players,” she said. “We would like to thank Hilke for her contribution to the successful growth of the Zeiss ANZ Vision Care business over the years and wish her every success in her new global role.” n

RESEARCH

NEW RESEARCH PAPER SHEDS LIGHT ON MYOPIA CONTROL AXIAL LENGTH TARGETS A new paper comparing axial elongation differences among untreated myopes, myopes treated with a contact lens and emmetropes has helped further the understanding of myopia control efficacy in the context of normal childhood eye growth. The study titled ‘Axial length targets for myopia control’ has been accepted for publication in Ophthalmic & Physiological Optics, the peer-reviewed journal of The College of Optometrists (UK) and is now available online via Open Access. Because young eyes grow, even when not myopic, the paper compares axial elongation among children who remain emmetropic, children with untreated myopia progression, and myopia children managed with CooperVision MiSight 1 day contact lenses. The comparison uses data from the three-year MiSight 1 day clinical study, the Orinda Longitudinal Study of Myopia

(OLSM) and the Singapore Cohort Study of the Risk Factors for Myopia (SCORM). The analysis revealed the predicted three-year axial elongation for emmetropic children (0.24 mm) is similar to the mean three-year elongation in MiSight 1 daytreated children with myopia (0.30 mm). In contrast, the axial elongation (0.63 mm) observed in the control group in the MiSight 1 day clinical study was much higher, and similar to virtual cohorts based on the OLSM (0.70 mm) and SCORM (0.65 mm) models for myopia development.

Young non-myopic eyes continue to grow.

According to the study, this observation suggests that while abnormal myopic eye growth may be managed with MiSight 1 day in age-appropriate children, normal, physiological eye growth may continue as the child ages. It supports the hypothesis that myopic axial elongation “may be superimposed on underlying physiological axial elongation”.

“Some eye growth as part of the aging process is normal – myopic axial elongation is not,” Mr Paul Chamberlain, the paper’s lead author and director of research programs for CooperVision, said. “Our work further validates that evidencebased interventions can be highly effective in slowing that myopic eye growth.” Co-author Professor Mark Bullimore added: “In assessing treatment effectiveness, we caution our industry away from applying arbitrary correction factors to account for normal, physiological eye growth until this has been better understood. Efficacy percentages may seem higher presented in that light, but it complicates understanding and valid comparisons. Eyecare professionals must be able to rely on the ever-growing body of myopia literature to make evidence-based clinical decisions.” n

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THE

r a e y d Mi e s a c w sho With 2021 marking a near full return to normality for the ophthalmic market, Insight is bringing together a host of Australia’s leading suppliers to showcase their latest releases.

Over the next eight pages, eyecare professionals will find trending frame designs, cutting-edge ophthalmic lenses, enhanced imaging capabilities, and contact lens innovations, among other technologies, to ensure they can continue delivering world-class care to patients.

INSIGHT August 2021 23

BAUSCH + LOMB'S LATEST ENVISTA PRELOADED IOL This year Bausch + Lomb (B+L) introduced the enVista preloaded IOL with SimplifEYE delivery system in Australia. According to the company, its 165-year legacy of innovation, quality, and craftsmanship can be seen in the unique optical and physical properties of the enVista premium monofocal IOL, which it says delivers superb visual acuity and consistent performance. The enVista family of lenses – monofocal and toric – are said to have a unique set of features that help compensate for the eye’s natural imperfections and deliver outstanding visual outcomes to a wide range of patients. “Now you don’t have to choose between image quality and depth-of-field. With its advanced aberration-free optic, enVista provides a desirable compromise between depth-of-field and image quality,” B+L stated. “And the benefits of enVista and enVista toric are now preloaded with the SimplifEYE delivery system, streamlining loading and intuitive operation for procedural efficiency.” B+L will be showcasing this technology at the RANZCO Congress in November. Email: Customer.Service@bausch.com

AUSSIE-DEVELOPED OCT Cylite is an Australian-based company developing the next generation of diagnostic OCT systems for ophthalmology and optometry. The company’s hyperparallel OCT (HP-OCT) is said to be a world-first, capturing volume data and overcoming the eyemotion limitations of previous OCT generations. “HP-OCT has been engineered to give industry-leading A-scan speeds (over 300,000 a-scans/sec) to assist you with your patient management by providing accurate OCT measurements in one easy-to-use instrument; improving workflow efficiencies and reducing your equipment footprint requirements,” the company stated. “In one scan, the HP-OCT captures full white-to-white and beyond topography and elevation maps (anterior and posterior cornea), true 3D volume data for detailed anterior segment OCT imaging, and complete biometry measurements including axial length. The HP-OCT also images the retina.” Cylite’s overall aim is to provide whole eye diagnostics, superior imaging quality, and accurate analytics to enable clinicians to make more informed decisions for better patient outcomes. Email: info@ cyliteoptics.com

HOME-BASED GLAUCOMA MANAGEMENT Designs For Vision is now supplying the iCare HOME2 tonometer, which it says revolutionises glaucoma care by enabling patients to capture their own intraocular pressure (IOP) at different times of the day and night. The company says the device, intended for home use under medical supervision, may also help reveal IOP peaks that might have passed unrecognised, had measurements only been taken during office hours at a clinic. The treating practitioner is then provided with relevant IOP data to support treatment decisions. A range of features are said to make HOME2 easy for patients to operate. Measurements can be taken at any angle. It features Android/iOS connectivity and results can be viewed by the practitioner via cloud software. Learn more about iCare HOME2 from Designs For Vision at stand B01, O=MEGA21. Email: orders@dfv.com.au

KOALI GOES BACK TO THE FUTURE 2021 sees French eyewear maker Morel pay tribute to the confident woman by designing feminine frames made just for ‘her’. Distributed locally by Eyes Right Optical, Koali's bold, elegant shapes and deep, glamorous colours are said to allow the wearer to express individual style with complete freedom. More than a simple fashion accessory, eyewear has become a wardrobe must-have. “This final touch not only completes your outfit but makes sure you are putting your best foot forward,” Eyes Right says. “Let’s flashback to the 1970s with oversized round acetate frames. Morel had a blast revisiting these shapes with a feminine, modern twist. Round is back, on-trend, and we are thrilled to share them with you.” Koali 20098K (pictured) is an elegant frame that gives a nod to the 1970s trend with its oversized shape. The translucent powder pink acetate makes for a soft, ultra-trendy look which expresses sensuality. It’s the perfect frame for those who want to stand out in style. Email: sales@eyesright.com.au

INSIGHT August 2021

The new HEINE OMEGA 600 indirect ophthalmoscope The new HEINE OMEGA 600 is the lightest^ high-end indirect ophthalmoscope, offers high wearing comfort and provides you with high quality optics, providing an incredibly sharp image and reliable colours. Along with the capability to explore the whole retina, including the far periphery. New visionBOOST for cataract patients: proven to deliver up to 20 % better view of the retina in patients with cataracts*.

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

EXPLORE

1300 DEVICE (338 423)

customers@device.com.au

www.device.com.au

RA:01072021FS

Discover more. With less weight.

EIGHT TIMES THINNER THAN CONVENTIONAL BLISTER PACK Designed with the contact lens wearer in mind, Menicon’s Miru 1day Flat Pack offers wearers easy handling and cleaner, more comfortable wear. At barely 1mm thick, each foil blister pack is developed with the company’s Smart Touch Technology to reduce the likelihood of contamination of the lens inner surface, so contact lenses can be worn with confidence and comfort. “Not only does the Miru 1day Flat Pack require signiﬁcantly less force to open than a conventional blister pack, it is also eight times thinner than conventional blister pack – resulting in 80% less raw material required,” Menicon says. “The thoughtfully designed ultra-slim, lightweight packaging is easy to store taking up little space, great when travelling or for sport and comes with a convenient 30-lens storage case – made from recycled mould plastic.” It is available in single vision and toric contact lens designs. Email: mail@menicon.com.au

INTRODUCING THE B.I.G. PRECISION HUB Everything eyecare professionals need to know about Rodenstock's B.I.G. Vision and its journey towards biometric precision is in the B.I.G. Precision Hub. It includes the most important information about the company’s journey, challenges and achievements in producing lenses based on a complete biometric model of each individual eye. “At Rodenstock, we are constantly striving to pioneer how precisely progressive lenses can be crafted. On our journey we have faced some major challenges including measuring biometric parameters, creating a biometric eye model and using biometric data to craft lenses,” the company says. “With Biometric Intelligent Glasses, Rodenstock ensures that the lenses are tailored to fit the biometrics of the individual eye to optimise vision sharpness. This is done by implementing a complete biometric eye model in the manufacturing of the lens. The vision benefits are clear.” When progressive lenses are produced using the biometric input from Rodenstock’s DNEye Scanner, nothing is left to chance, the company adds. Visit Rodenstock at O=MEGA21, stand D04B. Email: Meryll.Harper-Smith@ rodenstock.com.au

DIGITISE YOUR REFRACTION LANE Package Deal! 25% off*

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Computerised Lensmeter Automatic Lens detection, PD measurement Colour touch screen control

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Send Lens script to CV-5000 to begin subjective test, & compare Old vs New refraction at the press of a button

*Purchase this package and receive a 25% discount oﬀ all three products. Or contact us today for a great deal on any of these individual items.

... more than meets the eye! The Eye Doctor Premium®

The Eye Doctor Premium® hot eye compress features the patented Sterileyes® technology. Sterileyes® is an antibacterial shield on the compress, clinically proven to kill 99.9% of bacteria tested. The patented solution is bound to the fibres of the fabrics to protect the eyes from potentially harmful bacteria.

The Eye Doctor Allergy

A reusable cold eye compress that uses thermo-regulating and self-cooling technology fabric to deliver an effective treatment for irritated, sore or tired eyes caused by allergies. The Eye Doctor Allergy helps to relieve; hay fever, puffy eyes, headaches, migraines, itchy eyes and swelling.

THE BORDEAUX BY MODSTYLE MAKES 2021 COMEBACK The Eclipse ‘Bordeaux’, one of the most popular frames in the 1990s, has been brought back by Australian eyewear company Modstyle. The timeless piece pictured here in colour 1, which has been launched back in the collection after 20 years, helped put Modstyle on the map as a supplier of quality affordable eyewear to the Australian market. “Constructed from stainless steel with a block hinge created by Modstyle and cast by one of our specialty partners in South Korea, the unique rim is rounded in its make-up which is aesthetically pleasing to the eye,” the company stated. “This method isn’t commonly used in the construction of frames today. Most other manufacturers would use a flat metal rim as it is easier to source and create.” The ‘Bordeaux’ is designed as a unisex frame, which the company says suits ‘on-trend’ and style-conscious consumers.

The Eye Doctor Antibacterial Stye Relief Compress Microwavable eye patch for the treatment of Styes, Chalazions (Eyelid Cysts) & Cysts. Moist heat generated by the Antibacterial Stye Relief Compress relieves the symptoms of swelling / redness, irritation, stinging and burning.

Email: info@modstyle.com.au

OLD TEMPLES MEET NEW AS SAFILO MARKS MAJOR CARERRA ANNIVERSARY

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The individually sealed Eyelid Wipes are pre-soaked with preservative and detergent free physiological solutions for daily eyelid hygiene (0.9% Sodium Chloride solution). The Eyelid Wipes are excellent for gently cleaning away debris from the eyelid and eye lashes after using your hot eye compress or use cold directly from the fridge.

The Eye Doctor LID Cleanser

The Eye Doctor LID Cleanser is recommended to gently clean sensitive eyelids & lashes without irritation. Alcohol & Fragrance Free. Contains: ARGAN OIL - Skin conditioning properties, high vitamin E and fatty acid content, an ideal ingredient to give skin a natural boost. MICELLAR WATER - Cleanser & make-up remover, gentle & hydrating. COCONUT OIL - Soothing to the skin with anti-bacterial properties.

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A REUSABLE instant hot eye compress that does not require an oven or microwave to heat up. Designed to be used anywhere, instantly, great for travellers. The Eye Doctor Click & GO® is activated by simply clicking the disk inside the compress to generate the heat that stays warm for over 20 minutes. Following use the mask can be reset to its original state by placing in boiling water. It can also be used cold directly from the fridge.

As part of a 65th anniversary celebration of its proprietary label Carrera, Safilo has launched the ICONS project which combines the brand’s heritage with new design. Through a new collection, the company is presenting a reinterpretation of Iconic Bestseller styles of the Carrera brand, revising them with new design language and adding value through technical innovation and craftmanship. “As part of the ICONS project, Carrera is presenting also new optical styles, offering both fashion vintage and easy-to-wear shapes,” Safilo says. “Carrera heritage is expressed in the new reinterpretation of vintage temples pulled out from the archives and combined with fresh and modern fronts to give life to unique design pieces.” The new collection is available by contacting local Safilo area managers, and will be on display at O=MEGA21, stand E05. Email: sales.orders @safilo.com

The Eye Doctor Click & GO®

Our antibacterial and antiviral face masks with filter protection are designed to provide optimum protection from particles in the air. With our AB Masks, you’ll find a range of supporting products, such as replacement filters and our new reusable Anti-Fog Cloth designed to prevent fogging of glasses during mask wear. Each use will provide 48 hours of anti-fog and protect your lenses.

orders@goodopticalservices.com.au

P: +61 3 9645 1066 www.goodopticalservices.com.au

TOPCON REVOLUTIONISES REFRACTION In a bid to “reinvent refraction”, Topcon has released the Chronos system. It’s the company’s latest technological breakthrough, combining binocular auto-refraction keratometry with binocular subjective refraction and visual acuity, into a single instrument that occupies minimal amount of space and optimises workflow. Featuring SightPilot software, the examination is simplified for the operator. Its tablet-driven interface provides step-by-step guidance through the refraction process facilitating delegation of the subjective refraction to support staff, according to Device Technologies. “Chronos reduces the number of conventional refraction lanes and offers the versatility to critical for growing your practice,” the company says, adding that refractions can be carried out in three and a half minutes. Email: eyes@device.com.au

IMAGING WITH INTEGRATED OCT Monaco is an exciting way for eyecare professionals to enhance their clinical exams, according to its manufacturer Optos. The system is the only ultra-widefield retinal imaging device with integrated spectral domain OCT. It produces a 200° single-capture optomap image in less than ½ second and provides cross-sectional 40° OCT views of retinal structures. According to the company, Monaco enables a rapid multi-modality capture featuring colour, autofluorescence and OCT scans, for both eyes, in as little as 90 seconds. It can quickly capture a six-image, multimodal overview of both eyes. Visualising multiple image modalities at the same time enables the practitioner to detect pathology in the various views, improving clinic flow and efficiency. Optos states that optomap has been shown to enhance pathology detection and disease management, and to improve clinic flow. The integrated OCT further contributes to this capability. With optomap, OCT scans are precisely registered to corresponding optomap images facilitating detailed examinations, follow up scanning, and visit to visit comparisons. Email: AUinfo@optos.com

INDEPENDENTS CAN CURATE THEIR UNIQUE FRAMES RANGE Creating customer loyalty and differentiation in an environment of price comparison and increasing margin pressure inspired Mr Brian Hill, of SeeMe Eyewear, to join forces with an Italian company to manufacture bespoke eyewear for independents. The collaboration with Mazzucelli, a world-leader in acetate production, has resulted in a liquid acetate that produces lighter and stronger frames than traditional acetate. With Italian craftsmanship and high quality finishes, the frames can be produced in small quantities allowing independents to design their boutique brand without huge expenses. Eyecare Plus Tamworth optometrist and owner Mr Andrew Greer is among the first in Australia to undertake the process. Becoming a designer of his own collection has allowed him to curate a brand and frame range unique to the practice. “I was excited to choose from 25 models, 50 surface treatments and over 250 colours,” he says. “Having handmade Italian frames with our brand that cannot be sourced elsewhere and dispensed at a quality price is a game changer for the practice. The quality of the finished product is beyond all expectations and our patients are loving them.” Email: brian@seemeeyewear.com.au

INSIGHT August 2021

BLUE LIGHT PROPERTIES BUILT INTO LENS MATERIAL Zeiss Vision Care has introduced a new generation of blue light blocking lenses called Zeiss BluePro, as patients seek greater eye protection from digital devices, modern LED light exposure and during outdoor activities. In its latest design, the company has incorporated the blue light blocking properties into the lens material itself. This is said to overcome common disadvantages in many blue light blocking solutions, including irritating reflections on the lens surface. Compared to the current blue light coating DuraVision BlueProtect from Zeiss, the reflections of digital blue light are reduced by up to 50%. As a result, Zeiss says the BluePro lens design offers excellent lens clarity and can block up to 40% of the potentially harmful and irritating blue light in the wavelength between 400 and 455nm, which it says has known links to digital eye strain. BluePro lenses also come standard with Zeiss DuraVision Platinum UV, offering full UV protection up to 400nm. Email: elmarie. pretorius@zeiss.com

NEW AURORA IQ HANDHELD FUNDUS CAMERA BOC Ophthalmic Instruments is the Australian distributor for Optomed Oy Finland, a market leader specialising in hand-held fundus imaging. According to the company, its Aurora hand-held fundus camera has a sleek modern design and delivers high quality imaging with 50 degrees field-of-view with easy use. The latest Aurora IQ model, with new high contrast optical design, further enhances image quality to detect early phase retinal changes. Additional features include autofocus and autoexposure, integrated image quality analysis, and optional AI service. The Aurora IQ features a clear four inch high-quality screen display, dual charger, eye surface imaging module, and an intuitive interface with simple icons. Its portable compact size with wireless or USB connectivity makes it ideal for hand-held or slit lamp mounted use for fundus and anterior eye imaging anytime, anywhere. BOC will display the Aurora IQ at O=MEGA21. Email: sales@bocinstruments.com.au

ACCESSORIES COMBINE FASHION WITH FUNCTIONALITY With glasses cases now considered as much a fashion statement as handbags, clutches or wallets, Good Optical Services has introduced the Sorella Double Take case. The collection has been split into two styles – Milan and Glam – and seeks to combine contemporary design, fashion and functionality – with each case able to carry two pairs of glasses that can double as a clutch bag. The Milan collection is oval-shaped and available in red, black and brown leather with plain black or animal print lining. It was inspired by the styles of Melbourne and Milan where Good Optical Services sourced a manufacturer skilled in handmade craftmanship and a range of top grain leathers. Sorella Glam is a round-shaped collection that adopts a glamourous, luxury approach; available in a luxe rose gold, silver or black – all with a soft grey suede fabric lining. Separately, the company has a rectangular Quad Case for travelling, which can hold four pairs of glasses or can store jewellery in one half and glasses on the other. Finally, Good Optical is supplying OptiPets – creative and collectible eyeglass holders. Originally introduced to spice up storefronts and frame counters, they have become popular with consumers, particularly children and pet owners. Email: goodopt@ozemail.com.au

Stand out with your own range of bespoke frames! • Affordable way for independents to design a boutique frames collection. • 25 models, 50 surface treatments and over 250 colours. • Small quantities. • Traditional Italian craftsmanship, with lighter, stronger acetate.

SeeMe Eyewear 0475 085 935 brian@seemeeyewear.com.au

THE MOST LIGHT-WEIGHT HIGH-END INDIRECT OPHTHALMOSCOPE German medical device manufacturer Heine recently launched its newest indirect ophthalmoscope, the OMEGA 600, with an all-new design making it the lightest high-end device of its kind on the market. Available in Australia and New Zealand since July, the company says several innovations set the OMEGA 600 apart, including a new ultralight lithium polymer battery that allows the eyecare professional to work more comfortably and reduces strain on the spine. Despite the instrument’s extremely compact design, the battery achieves eight full hours’ operation on average, depending on the light intensity used. Other features include new visionBOOST technology, which the company says significantly improves retina exams for cataract patients, with up to 20% better view. A sophisticated surface design with few openings and dustproof seals allow for easy cleaning and disinfection. “As a result, the OMEGA 600 is ideal for both the provider and the patient. Heine offers a five-year guarantee on the quality of its materials, workmanship, and design,” the company, a global leader in the manufacture of primary diagnostic equipment for the past 75 years, says.

BLENDING MODERNITY AND CLASSIC DESIGN These retro-inspired sunglasses by Azur, available in ‘on-trend’ colour ways, are the ultimate fashion revival on offer from Australian sunglass supplier Sunglass Collective. Pictured here in the 80056A TN11 model, the exciting acetate front with detailed metal work on the temple creates the ideal blend of modernity and classic design. Stylish materials and colours highlight sun-kissed skin and add a sophisticated edge to the wearer’s wardrobe. “For the Azur sunglasses collection, Morel calls on the ultimate leader in the development and production of high-quality lenses, Divel Italia,” Sunglass Collective says. “All models are equipped with category 3 polarised lenses to guarantee optimal performance and offer the best of the best in functional yet fashionable accessories.” Email: info@sunglassco.com.au

Email: info@heine.com.au

ZEISS OCT TECHNOLOGY AIMS TO STREAMLINE WORKFLOW To combat the daily challenges of imaging various patient types in a fast-paced environment, Zeiss is aiming to empower clinicians with the CIRRUS 6000. Offering high speed image capture, larger field-of-view and highdefinition scans, the company says its latest performance OCT reveals microvascular details of the retina over a larger area while allowing the practitioner to spend more time with patients. “Early adopters of the CIRRUS 6000 have noted the new 100kHz scan speed offers significant workflow improvements with OCT cube scans now captured in as little as 0.4 seconds. This brings an improvement of 270% on previous models and acquisition success even for the more difficult patients,” Zeiss says. The system also allows clinicians to image a larger field-of-view up to 12mm and a depth up to 2.9mm in a single scan. NSW ophthalmologist Dr Kong-Chan Tang says he’s had positive comments about the speed of the acquisition from patients. The speed of the machine has also improved workflow in a busy clinic. A CIRRUS 6000 AngioPlex scan. “I was very dubious

of the previous OCT-A which I felt was not ready for ‘prime time’. This version has been vastly improved. It appears to acquire consistent OCT-A images. They appeared to be more easily acquired compared to the previous system,” he says. “Our staff are thrilled with the CIRRUS 6000. The transition to the new machine from the CIRRUS4000 was seamless." Email: med.au@zeiss.com

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Learn more at Rodenstock’s B.I.G. Precision Hub at https://www.rodenstock.com/com/en/bigprecision.html

OPTICAL

Heron Eyecare was the first in Australia to install the Zeiss Visufit 1000.

w lo f k r o w g in is im t p O

FOR PRECISE RESULTS

Independent optometrists discuss their decision to harmonise the end-to-end patient journey with the latest ophthalmic lens technology from a single manufacturer, and the value it’s creating for their businesses and patients.

hen Heron Eyecare embarked on a practice renovation in 2019, it presented a double-edged opportunity. The 32-year-old independent practice, which operates out of a Queenslanderstyle building in Toowoomba, could create much-needed space for a third consulting room. But, more importantly, it presented the chance to completely rethink its equipment configuration. It was an opportunity director and senior optometrist Dr Hugh Bradshaw couldn’t afford to squander. He joined the practice in 2009 when it was owned by husband-and-wife Henry and Miriam Heron, before later taking over and continuing their legacy as a leader in technology and optometry innovation. “With a long-standing practice like this, which was established by the Herons in 1989, often technology and equipment is added and doesn’t always perfectly fit with all other current equipment and software,” he says.

Dr Hugh Bradshaw, Heron Eyecare in Toowoomba, Queensland.

Mr John Fitzgerald, Fitzgerald Optometry in Williamstown, Melbourne.

In 2019, the practice became the first in Australia to install the Zeiss Visufit 1000 digital 3D centration system. It also invested in an i.Profiler plus wavefront aberrometer, Visulens 550 digital lensmeter, and three Visuphor 500 digital phoropters and accompanying Visuscreen 500 digital charts for each consulting room.

“When we did a small renovation two years ago it was the ideal moment for us to upgrade to the Zeiss suite of equipment so the whole workflow matched from end-to-end to greatly improve the patient experience.”

As the optometrist, Bradshaw can now manage the entire patient journey using the Visuconsult 500 software platform, which displays all test results and measurements on a single iPad screen in real time. As well as connecting to each device, it integrates with the practice’s Optomate system, which automatically populates the patient’s information into each device and stores the prescription in their records.

Heron Eyecare’s relationship with Zeiss Vision Care began around eight years earlier when it switched from its original lens supplier due to ongoing quality issues. Over the years, it incorporated Zeiss equipment like the i.Terminal mobile centration system, but it still used existing refraction systems from another manufacturer. A major advocate for Zeiss lenses, Bradshaw felt he could do more to get the best out of them.

The practice has also benefitted from technology called i.Scription, which, according to Zeiss, uses the wavefront measurement to determine the exact “fingerprint” of the eyes, taking into account the effects of low and high order aberrations on retinal image quality by measuring up to 1,500 points. As a result, Bradshaw says he’s able to fine-tune the refraction to 1/100th of a diopter, offering precise individualised lenses.

INSIGHT August 2021

“We then take the patient to the final step, which is dispensing of the frames,” he explains. “We’re very fortunate to be the first practice in Australia to use the Visufit 1000, which is the most high-tech digital dispensing tool on the market. Most use a single camera that takes a front and side shot, but this has nine cameras in a semi-circle which takes a simultaneous shot and creates a 3D avatar of your face. Using 45 million reference points, we’re able to create the most accurate measurements to effectively customise each pair of lenses for the particular frame for our patients.” DIFFERENTIATION AND LOYALTY Bradshaw believes the future prosperity of independent optometry lies in delivering first-class service. It’s a mantra he adopts in order to build and maintain his patient base, knowing he probably won’t compete on price with his corporate contemporaries. “If you're producing a product for the lowest possible price people aren’t going to be loyal to your service, they will be loyal to the lowest price, and they’ll continually seek it,” he explains. “The more we have increased and improved our services, whether this be through technology, our sales training or conducting more procedures and treatments in areas like dry eye and myopia, the more our patients appreciate they are getting the best care they possibly can, meaning they’re more likely to return.” By adopting the full suite of Zeiss technology, Bradshaw says the practice can now exploit the full potential of the company’s lenses. Patients are happier, and it’s also allowed the business to become more efficient due to a reduction in dispensing errors. There are several reasons for this, with the first being consistency. Because Heron Eyecare is using a single platform that automatically links with all measurement devices and its patient management system, it is eliminating basic transcription errors during the patient journey, including for processes like lens ordering. And when issues do occur, it has allowed them to get to the root much faster. “Every month we generate a report on each remake and pull them to pieces to find the reasons behind them,” he says. “It’s shown us that very few are non-adapts now, the lens quality is excellent, so it may be that someone – for whatever reason – needs an adjustment. But we’re now far more intuitive as to why patients are having problems so we can fix them. It’s also allowed us to accumulate additional knowledge with each lens design so we can fit them better each time.” WHAT’S THE ROI? Like many independent optometry practices, Heron Eyecare is a small business, so large investments require due diligence.

Heron Eyecare director and principal optometrist Dr Hugh Bradshaw using a Zeiss Visuphor 500 digital phoropter in his practice.

thousands and thousands of frames they can try on digitally,” he says. “This will open up the potential for not necessarily having fewer frames stocked, but getting around issues such as requests for different colours, or patients who need larger frames. And for frames you don’t have in stock, the patient can still order it through your practice – this is the way of the future.” SHOWCASING TECHNOLOGY TO PATIENTS Fitzgerald Optometry is a medium-sized practice with two consulting rooms, three optometrists and five support staff. It also considers itself an early adopter of technology. For principal optometrist Mr John Fitzgerald – who has owned the business in the Melbourne suburb of Williamstown for 25 years – a practice refit meant they were able to bring their Zeiss equipment out of hiding and proudly display it. “The use of Zeiss equipment was a natural fit for us. Their focus on product, innovative technology and customisation to create a memorable patient experience mirrors with our values,” he says. Since 2015, Fitzgerald Optometry has introduced the Visuphor 500, Visuscreen, i.Profiler and Visulens 500. This is in addition to diagnostic equipment such as the Cirrus 6000 OCT system and a reconditioned IOL Master. Last year, it purchased the Visufit 1000, which has created several benefits, including the ability to social distance from patients during COVID-19. “In the past we would discuss lens design and recent advancements in technology only then to grab a texta and put a dot on the patient’s lens to mark it up – a very low-tech solution for a high-tech lens,” he says.

For Bradshaw, he says the return on investment could easily be justified by taking a long-term view. He implemented a modest 5-10% price increase on premium individualised multifocal, vocational and single vision lenses.

“Patients see the Visufit as a positive experience and are impressed with the technology. But importantly the measurement is performed without the need of a clip-frame, which previous digital centration devices require. These clips invariably altered the fit of the frame.”

“Because you’re offering better lens solutions, you can therefore calculate what the increase needs to be to compensate for the investment,” he says, adding that patients haven’t found the small increase unreasonable.

With the i.Profiler autorefractor, Fitzgerald has found it useful for explaining why some patients are seeing well during the day but less so at night or in poor contrast. The practitioner can also look at Rx as function of pupil size.

“If you break the investment down over a five-year period it makes it seem more affordable. Working out how many lenses you're doing each year within that period, and the cost per patient, it actually works out to be very little, it's a good way of itemising it,” he says.

“With the Visuphor, we’ve found it creates a ‘wow factor’ – patients are impressed with technology. Preconfigured workflows make it easier and faster to determine subjective results, and it’s easy to operate from an iPad,” he says.

State-of-the-art technology that is upgradable via software improvements also helps justify the investment. This means practices can purchase the equipment for the next five to 10 years without the fear of it quickly becoming outdated. An example is a new virtual try on tool feature that will soon be released for the Visufit 1000. Bradshaw is excited by this development, which will allow patients access to a catalogue of frames beyond what’s available in the practice. “When the Visufit takes an image of the patient’s face, they will have

“Another great benefit is the ability to operate away from the patient to maintain social distancing. We can then switch between prescriptions easily highlighting differences between current and new Rx. As it interfaces with the Zeiss focimeter as well as i.Profiler it can directly import and load the data from each device.” As for the future of independent optometry, Fitzgerald says it will require greater collaboration and co-management, and increased need to specialise. “Rapid change in technology is making it more critical to keep up-to-date and develop long-term partnerships with equipment suppliers,” he adds. n INSIGHT August 2021 33

Aaron Henry Optometry in Muswellbrook, NSW, part of the ProVision independent network.

OPTOMETRY

LEVELLING THE

playing field

With the largest network of optometry practices in Australia, ProVision possesses significant buying power. But as CEO STEVEN JOHNSTON explains, it’s doing much more to ensure independents can continue to flourish, especially amid a record trading period. hether independent practices are winning, losing or holding their ground in the face of intensifying corporate competition remains one of the most elusive questions in Australian optometry today.

among consumers to shop local. This has played into the hands of independents who commonly populate community shopping strips or operate out of convenient standalone premises.

It’s a conundrum the sector may never truly quantify, but with 450 fullyfledged independents within its network (the largest nationally), ProVision could arguably provide one of the most accurate barometers.

“We have been a great beneficiary of that shift,” he says. “The other aspect is a significant increase in the average transaction value of patients coming through practice.

CEO Mr Steven Johnston isn’t one to base his opinions on anecdote and assumptions. Each year he tracks the retail sales of the same 210 practices to obtain a like-for-like comparison of performance. The numbers are in, and 2021 is undoubtedly going to be the strongest ProVision optometrists have seen.

“Because people have been unable to go on overseas holidays and the like, patients have more disposable income, so they are spending more on their eyewear than they were two years ago. When you put these two trends together, it compounds the dollars going through the practice.”

“For the past six years we have seen like-for-like growth, except for fiscal year 2020 where we were heading for a great year until March and ended up dipping 2.7% compared to fiscal year 2019,” he says. “Since then, for the year-to-date May 2021 we are up 19% on fiscal year 2020, so members have not only made up what they lost in the back quarter of last year, they’ve shot the lights out, and fiscal year 2021 is going to be the best that most members have ever had by a long way.” Compared with 2019 – when market conditions were “normal” – retail sales in the 2021 financial year are around 16% stronger. The success of ProVision members through COVID-19 can be tied to two factors. The first, Johnston says, is a greater propensity

INSIGHT August 2021

Johnston believes ProVision’s activities through the pandemic have also created greater adhesion between the organisation, its optometrists and product suppliers. The volume of frames purchased through its ProSupply online ordering system have increased 46% year-on-year. With sales reps unable to visit practices for extended periods, more suppliers subscribed to the system that facilitates 24/7 ordering capability. “I think we have come out the other side in better shape than we went in. I’m talking at a membership and ProVision level, and I will broaden that to suppliers, because by-and-large they are better versions of themselves than they were 15 months ago; they have had to adapt quickly to the changing circumstances.”

DISCOVERING AND CREATING EFFICIENCIES While much has changed in just 12 months, the fundamentals of operating a successful independent optometry business – and ProVision’s role in that – have remained constant. Johnston is under no illusion the corporates have a distinct advantage when it comes to the operations of their practices and back-office support. ProVision exists to “level the playing field” by offering expertise, services, and tools across every business discipline that independents can use to run their practices just as efficiently. “In the corporate world, they need to provide a return to investors, owners and franchisors. That's completely different in the independent space where our members are driven by helping patients to have healthier eyes and better vision, but unfortunately don’t have the time to look for those efficiencies, so we need to find them on their behalf so they can provide fantastic clinical care to patients,” he says. “That is why we have developed systems and technology to help practices with the fundamental business processes like recruiting staff, working out their exit strategy, dealing with invoices from suppliers – these are things that are done in a back office in corporates, but are done by the practice owner in our world.” One of ProVision’s most successful platforms has been ProSupply, which is now in its eighth year and offers members access to the largest frames database in Australia, with over 24,000 products including more than 20,000 supply and fit options. The organisation also recently released several new resources, including LaunchPro – for optometrists about to own or establish their first practice – and RecruitPro for staff recruitment, which will be detailed later in this article. But Johnston is even more excited about ProAccounts2 because he says it has the potential to radically reduce manual data entry. Nearing the conclusion of development, the software will soon be piloted in three practices, with plans for a staged rollout before the end of the year. To appreciate this technology, it’s important to understand the existing ProAccounts system first launched in 2020. It aimed to have all suppliers provide electronic invoices in a standardised format and on a more frequent basis. With ProVision acting as the intermediary between practice and supplier, invoice consistency streamlined its own internal processes, and effectively allowed it to monitor purchases (and by extension sales) in real-time. For practices, it meant statements and misplaced invoices could be accessed on-demand in an online portal, which also translated into fewer headaches for suppliers. The new ProAccounts2 has been developed purely with the practice in mind. Johnston says the beauty of the system is that frame information can be downloaded into the practice management system, meaning staff at the practice don’t have to manually enter data for every frame introduced into their range. “With ProAccounts2, information such as the supplier, brand, cost, dimensions, material, colour etc will be available electronically, the practice just needs to search for that item in their product file in ProSupply and download it into their practice management system,” he says.

Steven Johnston, ProVision CEO.

REBRAND ON THE HORIZON For more than 30 years, Johnston says ProVision has been helping optometrists – “both old school independents and new school entrepreneurs” – turn a passion for providing the best clinical care, into a successful business. From start-up to sell-up, it supports independents at each step with business coaches, innovative systems, contemporary marketing and buying power that comes with the largest network of practices in Australia. Johnston says this multi-pronged approach is why the organisation will soon be reframing its brand to communicate that ProVision isn’t a buying group, but offers “success as a service”. A recent example is RecruitPro, introduced earlier this year to help practices recruit staff. It advises employers that looking beyond the skillset is a better long-term strategy. “If you don’t have the right people, it doesn’t matter how good your equipment, product range or optometrist is, it’s all wallpaper compared to how the patient is made to feel by people within the practice,” he explains. “It's been a journey to educate our constituents that it’s better to get someone with the right personality and train them on the hard skills later, and so RecruitPro is a workflow to help members understand exactly what they are looking for and go through the process of recruiting, questioning and selecting with that in mind.” Elsewhere, ProVision has reinvigorated its Associate Membership program, reserved for early career optometrists considering ownership. It has existed for a decade – usually with around 10 members – but now comprises 50. It features practitioners working in various settings and companies.

Currently, 10 out of ProVision’s 18 frame supplier partners are providing data of sufficient quality. Another quarter are expected to get over the line shortly, while the remainder require more work.

“We are growing this at the rate of about five per month,” Johnston says. “This is because a lot of smart young optometrists realise if they want to have a fulfilling career it is probably in an independent practice where they get to call the shots. We have 50 folks who are ready, willing and able to take on a partnership or consider an outright purchase and I think it is a wonderful part of what we are doing.”

“Overall, we are in good shape, we could switch this on tomorrow and have 75% coverage of all product coming into the practice. By the time we release it, I’d like to think that number would be close to 80%,” Johnston says.

Associate members are also benefitting from another new ProVisiondeveloped resource: LaunchPro. It is for optometrists looking to establish a greenfield practice or acquire an existing business, and

“We estimate this is going to save an enormous amount of time, especially in busy practices doing this day in, day out.”

INSIGHT August 2021 35

OPTOMETRY

THINKING ABOUT SUCCESSION? More often than not, Johnston says optometrists looking to sell their business want to do so in a gradual fashion, rather than at the mercy of the open market. Such considerations form part of its SuccessionPro program, which connects aspiring independent owners with mature operators before mapping an orderly transition of power, in a process that can take three to five years.

ProVision business coaches (from left) Kate Hall, Julius Maloney, Kelvin Bartholomeusz, Joanne Scott-Dostine, Karen Harmsen, Margarida Faustino, Glen Fickling, Jim Colley and Julie Hocking (absent: Tina Adel).

features a 100-point checklist detailing each step and corresponding lead time, allowing them to follow an 18-week prioritised plan. “It’s about ensuring they tick all those boxes and think everything through, all the way down to a budgeting template that we will then independently verify to ensure they are setting themselves up for success,” Johnston explains. “And maybe they’ll get to the end and think it’s too hard to do it themselves. In that case we may be able to marry them up with someone in SuccessionPro who’s coming to the end of their career and wants to talk to someone who is just starting out.”

“If owners leave it too late, they narrow their options,” Johnston explains. “With SuccessionPro we are trying to make members aware of considerations such as leasing and practice fit out, and the approach that will work best for them.” Increasingly, Johnston says older optometrists are concerned about the legacy of their practice, staff and continuity of care for patients. As such, succession planning should commence five to 10 years out from the desired selling date, which also allows room to gradually ease their workload. “There’s a couple of key reasons, it’s unlikely you’ll find the right partner to take over your practice at the first attempt,” he says. “And once you do, typically it is not going to be easy for them to find the cash you want. It takes some time to transition ownership from old to new, and we have seen this work best somewhere in the three to fiveyear timeframe, so you might actually need a couple of years before that to find the right partner.” In any event, Johnston says that "genuine independent practices are absolutely thriving". n

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BUSINESS

CALL TO ACTION:

s r e d n i m e r t n ie t a P How a practice approaches patient recalls can determine their success from both a clinical and business perspective. It is also a field that’s ripe for innovation, writes RHIANNON BOWMAN.

eminding patients they are due for their next eye health visit – and ensuring it results in an appointment – has become its own science, bridging the gap between data management and psychology.

Many factors can influence a patient’s decision to re-visit the practice, with more businesses adopting personalised reminders to motivate their clientele to take control of their eye health and vision. Discussing the benefits of attending a health-related appointment can be more effective than simply providing basic information like the date, time and location of their next appointment. With the modern-day practice also demanding innovations that eliminate manual processes which take valuable time away from patients, technology providers are responding with automated systems and data collection methods to help measure the effectiveness of their communications. What do optometry practices need to consider when inviting patients to confirm and attend their next eye health appointment, and how do they cutthrough to keep existing patients returning?

FOSTERING THE RELATIONSHIP Ms Paula Sadler is general manager of marketing and managed services with relative newcomer, National Optical Care. She brings with her five years’

INSIGHT August 2021 37

BUSINESS

experience in the same role serving more than 100 practices in the veterinary industry.

“Although I’ve recently come across to the optical space, the same discipline and methodology in patient recalls and reminders works across all sectors.” The reason for that, she says, is because patient communication is datadriven. “Data is everything in 2021. Regardless of the size of a practice, the lead person responsible for marketing needs to; one, understand patient lifestyle; and two, understand performance of communication activities, knowing what works and what doesn’t.” Sadler says being agile and flexible to adapt communications to patients is essential. Keeping a finger on the pulse of trends in the ‘patient recall’ space and shifts in patient behaviours are also vital. “Patients of a certain age are still attached to receiving hardcopy notices, and don’t have the ability to connect digitally, so recall letters for certain patient demographics, like those over 75, is still essential but there are outliers,” she explains. “You need to have an understanding of the type of person who is comfortable with digital communication. There has been a shift in the ability of those in their 50s and 60s to connect via digital channels like SMS, and they are becoming more engaged.” While email, SMS and letters are the mainstays of direct-to-patient communication, a practice’s social media channels and websites can also be utilised to keep existing and prospective patients abreast of information. Sadler recommends using a multi-channel approach to communicate with patients. “But don’t stop there – measure the results. Look at the open rate of communications and what happens off the back of that. Look at the practice’s online bookings, the call volume/rate, and specs sales,” she says. “Maximise email and SMS because of their inherent speed of delivery and cost-effectiveness but don’t disregard patients who rely on, and expect, a letter in the post. You need to take a selective approach.” Despite the conveniences of fast, low-cost modern text-based communication technology, Sadler says there is still a need to simply call patients at times, which can offer an efficient, personalised resolution to communication black holes. “We take a segmented approach via a smart CRM (customer relationship management) system, segmenting by life-stage, tailoring communications to those in their 20s to those in their 40s. We rely on the strong capture of data to tailor our patient communications,” Sadler explains. How frequently patients need to visit their optometrist depends on their individual needs and their age, with some needing to return every two to three months, while others only every two to three years, which is why fostering the relationship between appointments is important, to guide them through their eyecare journey. Patient communications can go beyond simply stating the date, time and place of their next appointment, to showcasing new frames in the practice, or new equipment and its clinical applications, Sadler explains. “If you understand the patient, what they’ve been in for (the purpose of their visit/appointment), and what they’ve purchased, you can tailor communications to be eyecare-led without being retail-focused. “If you’re not engaging with patients outside of the face-to-face consultation, you’re losing the opportunity to be their local eye health care expert and owning that space. That’s why you need to have a strong capture of the patient’s contact details, so you’re in touch outside of their one, two or three visits a year.” According to Deloitte’s 2021 global healthcare outlook, consumers are helping to accelerate the pace of change in healthcare, showing greater activity and engagement, using virtual visits more than before (not yet mainstream in eyecare in Australia), and using technology for health monitoring. 38

INSIGHT August 2021

Sadler says research shows what modern patients are looking for, pointing to the 2019 Healthcare Consumer Trends Report from US-based NRC Health. It found patients don’t just want excellent care, but are seeking excellent service, too, which means care delivered with more ease, convenience, and choice. “We need to understand what people want in 2021, which is different even to 2020. We know consumers are becoming more sophisticated, engaging pro-actively,” she says. “People look for convenience – it trumps everything else. Once you have a patient, retaining them is easier than attracting new patients.” Technology is absolutely key, Sadler says. “Understanding your data and patient behaviour is essential. You need to engage your patient database more frequently than issuing a recall every two to three years. It’s about nurturing the relationship in between recalls to trigger their engagement.” National Optical Care announced in April this year it was launching Optical Growth Partners, a new division of its business that offers independent optometry practices new subscription-based buying group and managed services opportunities.

"IT’S ABOUT NURTURING THE RELATIONSHIP IN BETWEEN RECALLS TO TRIGGER THEIR ENGAGEMENT" PAULA SADLER NATIONAL OPTICAL CARE

Sadler says it has the capability to offer a more sophisticated patient journey, tailoring multiple patient communications based on life-stage. “It’s about how we communicate pre-appointment, what do we do during an appointment, and how we communicate post-appointment. The service includes internal processes to follow-up with patients who miss appointments, to understand the why, and keep the door open.” Rather than issuing cancellation fees for missed appointments, Sadler says its more valuable for patients to understand they’re always welcome. A NIMBLE PLAN REGARDLESS OF BUSINESS SIZE Mr Aaron Kangisser, general manager of The Optical Company and its 42-store portfolio, says technology and automation have made a significant difference to the recall process for both store teams and customers. “Now it is all about customised messaging, set recall times, frequency and delivery method,” Kangisser says. Beyond SMS, email and letter, he says more sophisticated advances in tailored recalls are imminent. Outside the automation, he says the industry has seen examples of customer-journey mapping to schedule a communications calendar to the individual based on the type of recall. The value of accurate data and a scientific approach to planning also lends itself to an area of engagement that focuses on the customer and their needs. From a purely business perspective, Kangisser says patient recalls are critical. “Recalls are a reminder for patients to have their eyes checked and form a key part in their eye health journey. The response to a recall and subsequent visit in-store is an opportunity for store teams to engage with that patient and deliver them with a great experience supporting retention.”

Conversely, recalls are equally important for patients leading busy lives. “Life is busy, so offering the ability to remind them rather than rely on people just remembering is a benefit. Many consider vision the most important of their five senses – so the optometry industry’s contribution to the management and improvement of vision is important,” he says.

"IT'S AN OPPORTUNITY FOR STORE TEAMS TO ENGAGE WITH THAT PATIENT AND DELIVER THEM WITH A GREAT EXPERIENCE SUPPORTING RETENTION"

Kangisser believes a few different factors might influence the future of patient recalls. “With the increasing rate of myopia and more people entering the optical market, establishing a nimble plan to respond to customer demands for the ways they wish to be managed or contacted has never been more important,” he says. “This is equally essential for a single-location business and groups. A recall strategy and platform to store data prompts important health reminders and rely less on busy optometrists and store teams to be across every detail, delivers results and supports important store tasks accordingly.” THE ROAD TO AI-ACTIVATED RECALL Specsavers director of professional communications across Australia and New Zealand Mr Charles Hornor says traditionally, the optometry sector has always been strong across the board with regards to patient recall. “Early detection is key to avoiding vision loss and blindness for so many eye health conditions, so it has always been imperative to ensure patients are reminded to attend regular eye checks,” he says. While SMS, postal letters and email reminders are staples of modern recall programs, other forms are also playing a vital role. “The biggest difference in recall now is the mix of channels used to communicate with patients. Whereas letters and telephone calls used to

AARON KANGISSER THE OPTICAL COMPANY

be the primary mode of communication, the advance and adoption of technology means electronic channels such as eDMs (electronic direct mail) and SMS’ play a far greater role in recall,” Hornor says. “There will always be a percentage of patients who do not action a recall reminder, therefore follow-up eDMs provide a gentle reminder of the importance of regular engagement with optometry. When a patient does book an appointment, SMS is a very effective and efficient channel for confirming appointments and subsequent information.” The bottom line, Hornor says, is that the most effective response to recall will always occur when it is a channel and mode that complements the patient’s lifestyle. Looking ahead, he is in no doubt we’re yet to see the best in patient recall technology, especially given AI is often talked about as a gamechanger in so many areas of patient care.

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“However, no matter what advances are made, the core element of a successful recall program is the quality of the data. Ensuring patient data is up-to-date, appropriate, and managed properly will ensure the right communications can be shared with the patient at the right time and place for them,” he says. “Get the data right and the recall not only becomes more effective in managing patient care but will be the foundation for building the road to valuable AI linked recall.”

room, the business has expanded into the neighbouring shopfront and now employs 10 staff – and has secured a strong patient base. When optometrist and business partner Ms Genevieve Hastings spoke with Insight, Victoria had entered a seven-day lockdown in June, and Canterbury Eyecare was limited to providing emergency and essential care only, in line with government restrictions. Lockdown, Hastings says, makes for an “interesting time” for patient recall processes.

From an eye health perspective, patient recalls are vital for early detection of structural changes in the eye and the presence of eye diseases, as well as preventing avoidable blindness caused by eye conditions.

“We can’t issue normal recalls during lockdown – we have to dissuade people from making routine appointments, triaging only emergency and essential care.”

“With Medicare funding a comprehensive eye test every one to three years depending on age, it is critically important patients are reminded to attend eye checks so a comprehensive history can be tracked, monitored, managed and, if needed, treated,” Hornor says.

Canterbury Eyecare takes a unique approach to patient recalls, mostly sending messages directly to patient’s mobile phones, and it doesn’t measure responses.

"NO MATTER WHAT ADVANCES ARE MADE, THE CORE ELEMENT OF A SUCCESSFUL RECALL PROGRAM IS THE QUALITY OF THE DATA" CHARLES HORNOR SPECSAVERS

“We send out recalls, and although we don’t specifically measure how patients respond, our recalls are certainly effective because our appointment book is full – it’s a busy practice,” Hastings says. “We use SMS mostly, because it’s cost effective, it’s easy to activate with a bulk number of recalls at any one time, and it’s extremely effective because patients can book directly online through MyHealth1st. Our SMS messages include an activation link, making it handy and convenient for patients to book.” Hastings says there is a small percentage of patients, particularly older patients, who prefer a letter or phone call. “We don’t use email for patient recall at all – our preference is SMS. We seek the patient’s permission to send SMS for future patient reminders,” she says. During an appointment, the optometrist selects when and why they want the patient recalled in Canterbury Eyecare’s practice management software. Hastings says the practice usually batch-processes recalls.

“It is just as important to remind a healthy 30-year-old patient to attend regular eye checks as it is a patient with diabetes, as there’s every chance that visit may be the time an optometrist picks something up they weren’t aware of on their last visit. It could be the difference in saving sight.”

“We normally send out recall reminders monthly. However, when we were exceedingly busy at the end of last year – after the lengthy COVID lockdown in metro Melbourne – we processed recalls weekly because of the large volume of patients requiring appointments,” she says.

While AI might bring the next revolution in patient recalls, tailoring messages to individuals will remain paramount. Patients with, for example, glaucoma and diabetes receive specific recall communications that are relevant to those conditions and are reminded of the need to make their next appointment on a timely basis. A combination of email, SMS and letters are used based on patient preference, available contact details and appropriateness. The personalised messaging clearly identifies the reason for the recall and, as the notices continue, whether the patient’s assessment is due or overdue. This personalised, condition-specific messaging continues to be a point of focus for Specsavers, which has found through ongoing testing that there is more effective engagement when the messaging is specific to a patient’s needs, as compared to standardised communications. “As we understand more about eye conditions and clinical technology and processes improve patient outcomes with early detection, so the focus will be on personalising and tailoring recalls to a patient’s specific eye health status,” Hornor says. “This is much like the KeepSight program that is targeted at encouraging and reminding patients with diabetes to attend regular eye checks due to the nature of the disease and its impact on vision. This personal touch will help recall messages cut through patients’ busy lives and ensure eye health is a priority.” ALL IN THE TIMING Independent practice Canterbury Eyecare sits among a vibrant local commercial centre on Maling Road in the inner Melbourne suburb of Canterbury. Established in 1996 with one optometrist and one consulting

INSIGHT August 2021

"OUR SMS MESSAGES INCLUDE AN ACTIVATION LINK, MAKING IT HANDY AND CONVENIENT FOR PATIENTS TO BOOK" GENEVIEVE HASTINGS CANTERBURY EYECARE

During the most recent lockdown, the practice has phoned patients directly to reschedule appointments. “We’ve called patients because it’s more personalised, rather than sending batch SMSs, but it’s also because we want to discuss with them whether we need to triage their appointment or reschedule it. We have their patient record on hand for that conversation, allowing us to pre-empt the desire for an appointment.” Hastings says Canterbury Eyecare has no plans to change its recall processes, as all indicators point to a successful, seamless operation. But the practice is selective about exactly when recalls are sent. “We try to send SMS recalls at a specific day and time when we are not overrun. Not first thing Monday morning, for example.” n

OCULOPLASTICS

SKIN, MUSCLE AND FAT: PULLING BACK THE LAYERS OF

y r e g r u s c i t s oculopla A sub-speciality that bridges ophthalmic and plastic surgery and interfaces with brain surgeons, oncologists and dermatologists is a unique vocation with a specific skill set, as RHIANNON BOWMAN discovers.

culoplastic, lacrimal and orbital surgery is a niche discipline in ophthalmology, recognised relatively recently as a sub-speciality in Australia, with about 60 surgeons specialising in the field.

Although ophthalmologists can perform some oculoplastic procedures, the specific set of skills required in this field often mean that ophthalmologists and plastic surgeons leave certain cases to those with advanced training in ophthalmic plastic surgery. Surgeons Dr Rodger Davies, Dr Thomas Hardy and Dr Charles Su are among only 12 ophthalmologists who specialise in oculoplastic surgery in Victoria. All three are members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS), which formed in 1994 to embody and reflect the medical and surgical sub-specialty of ophthalmic plastic surgery, and now has more than 50 members. Hardy is on the executive board and Su is immediate past president. The trio are also consultants to the Orbital, Plastic and Lacrimal unit at the Royal Victorian Eye and Ear Hospital (RVEEH). They were scheduled to speak about updates in oculoplastic surgery at the Australian Society of Ophthalmologists Expo in Melbourne in June, but the event was postponed due to COVID-19. They spoke with Insight about how their surgical techniques have remained relatively stable over the past two decades. However, new developments in drugs and biologic agents and alterations to Medicare items are reshaping their niche sub-speciality.

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OCULOPLASTICS

WELL-ESTABLISHED TECHNIQUES Davies graduated from the University of Melbourne, completed his ophthalmic training at RVEEH and a fellowship in oculoplastic and orbital surgery at the Mt Sinai Medical Centre in Cleveland, Ohio (US). He operates a private clinic in Hawthorn, Victoria and performs day surgery at Epworth, Freemasons, and Manningham Private Hospital. “In the mid 2000s I was doing about nine cases per day, one or two days a week. Now I do about five cases a day, two days a week. Now I am doing more surgery on each patient on average,” Davies says. Oculoplastic surgery was a relatively new specialty when he started in the late 1990s and most procedures have remained unchanged. However, one procedure that has changed is an endoscopic brow lift, a minimally invasive procedure performed under general anaesthesia, when a patient has droopy brows, impinging on visual fields, then done for visual improvement, or done for cosmetic improvement. “I make a series of small incisions in the hairline, so you don’t see the scars, peel the lining of the bone up, cut it along the eyebrows, then pull it up,” Davies says. “The techniques for holding the brows up have changed a bit. When I started 15 years ago, I used screws. Then I used endotines, fitted into holes in the bone, with spikes to secure the periosteum. These dissolve in about one year but are tender lumps during that time. Now I use a glue made from blood products which pterygium surgeons use. This is fibrinogen and factor XII which are mixed together and sticks in three minutes.” Davies also performs blepharoplasty (blepharo is ancient Greek for eyelid), an operation to remove excess skin and fat from upper or lower eyelids, which is considered ‘cosmetic’ surgery. He also performs surgery to correct ptosis (ancient Greek for droop), when the upper eyelid droops over the eye, impinging on vision, which is considered ‘functional’ surgery. While some techniques have changed slightly, it does not always equate to faster, painless procedures. “When performing blepharoplasty on lower eyelids, rather than just cutting bulging fat out, I reposition the fat, to meet the cheek. This reduces the bulge and gives smooth transition in contour to the cheek. It gives a better result but takes longer and is more painful,” he says. Davies also meticulously explains procedures to his patients – who can be referred from GPs, optometrists, or ophthalmologists – to manage their expectations, gain their consent, and document their discussion. “On a piece of paper with diagrams of the eyelid, tear duct and orbit, labelled with the patient’s name and date, I go through the medical issues, such as loose skin or fat bulging. I draw to demonstrate the problem and how I repair it, and describe and list day-surgery, post-op care, painkillers, and complications. The patient keeps this after we make a copy. Patients seem to appreciate having it all explained,” Davies says. “Then it’s up to them to decide.” Like Davies, Dr Thomas Hardy graduated from the University of Melbourne and trained as an ophthalmologist at RVEEH, before undertaking five years of post-graduate fellowship training in eyelid, orbital and lacrimal surgery in the UK. “When I was doing my ophthalmology training, I assisted Dr Alan McNab [an ANZSOPS past president] with private surgery, and I enjoyed seeing what he did, and the variety of procedures.” Hardy says his overseas training made him certain of pursuing this surgically oriented sub-speciality. He is now one of five ophthalmologists – alongside McNab – at Eye Surgery Consultants in East Melbourne and is the oculoplastics consultant for the ophthalmology department at the Royal Children’s Hospital in Melbourne. He recently performed surgery at the Royal Children’s Hospital on a patient with a very extensive tumour of the skull base invading the eye

INSIGHT August 2021

socket, which he described as a very rare case, whose treatment involved a multidisciplinary team. The patient’s prognosis was yet to be determined at the time of writing. Hardy enjoys the multidisciplinary nature of oculoplastic surgery. “There is a lot of crossover with other specialties, including brain surgery, sinus surgery (ear, nose and throat), plastic surgery, and overlap with vascular and interventional radiology,” he explains. “There is an overlap between the fields of plastic surgery and oculoplastic surgery, with plastic surgeons also performing blepharoplasty, and reconstruction of fractures of the orbit, or eye socket. But there are some areas they won’t delve into, such as watery eyes and tear duct surgery,” he says. Hardy completed his training in the UK between 2001 and 2005, and says the surgical techniques are generally well-established, and remain predominantly the same today as they did during his training. “We use various techniques from our toolbox when performing blepharoplasty which involves a combination of removing skin, removing muscle, removing orbital fat, repositioning orbital fat, and reforming skin creases to be more stable and better defined. Some surgeons inject fillers to fill a space, and Botox, which is a chemical neurotoxin, may be used in modifying the periocular region,” Hardy says. ANZSOPS immediate past president Dr Charles Su is a consultant at the RVEEH and in private consulting rooms in East Melbourne, but he also sees patients at Box Hill Eye Surgeons, and Springvale Eye Clinic. Having rotated through the oculoplastic unit at RVEEH as part of his ophthalmology training, he found it appealing and subsequently completed fellowships at the Royal Brisbane and Women's Hospital and the University of Michigan (USA).

"WHEN PERFORMING BLEPHAROPLASTY ON LOWER EYELIDS, RATHER THAN JUST CUTTING BULGING FAT OUT, I REPOSITION THE FAT, TO MEET THE CHEEK" DR RODGER DAVIES

“My slightly more favoured area in oculoplastic surgery is the lacrimal system, and DCR surgery,” he says. Dacryocystorhinostomy (DCR) surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora (watery eyes). “As the term implies, DCR is made up of three parts: Dacryo (tear), cysto (sac), and rhinostomy (nose). When a patient’s tear drainage is blocked in the lacrimal system, they have watery eyes, which can be debilitating as it can affect driving, and reading,” Su says. “Repairing tear drainage is ‘bread and butter’ in our profession, and the technique has not changed in recent years.” Acquired blocked tear ducts is common in the population aged 60-70+, while inborn blocked tear ducts effect a much smaller proportion of the population (mainly newborns). “Worldwide, DCR is one of the most performed oculoplastic procedures. External DCR was the most commonly used technique about 20 years ago,” Su says. “Endoscopic DCR – performed inside the nostril – has become

more popular in the last five to 10 years, particularly in the US, where 60% of DCR is done endoscopically. Here in Australia, the majority of cases are done using the traditional, external technique. The shift to endoscopic DCR here is slower. Both methods are highly effective and have their place. Endoscopic DCR requires more equipment, which not all hospitals have, for example.” RECENT MEDICARE CHANGES In 2018, when he was ANZSOPS president, Su was involved in an administrative review of MBS items for various plastic surgery procedures, including oculoplastic surgery.

Before surgery: bilateral ptosis and lower eyelid dermatochlasis.

“I went through discussions, on behalf of ANZSOPS, to help RANZCO form a position on certain MBS item numbers, including an eyelid skin reduction, known as blepharoplasty, which general ophthalmologists do fairly regularly,” Su says. (In 1987, before ANZSOPS was formed, RANZCO appointed an oculoplastic committee to provide sub-specialist input). Medicare announced changes to eyelid surgery (MBS item 45617), effective from the 1st of November 2018. The change meant that in order for a patient to access a Medicare rebate (MBS item 45617) from their surgeon for blepharoplasty, an optometrist or ophthalmologist must demonstrate that excess eyelid skin is obstructing the patient’s visual field (or satisfy other clinical need criteria as outlined by item 45617). Many in the profession understood that this was to ensure that the procedure was being undertaken for a functional, and not only cosmetic, purpose.

After surgery: bilateral ptosis repairs and lower blepharoplasties.

“There was some concern when the item descriptor wording was slightly changed, and some ophthalmologists were unsure if they had to do anything differently,” Su says.

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

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

A first choice for glaucoma management1

✔

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

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

OCULOPLASTICS

oculoplastics and treating orbital disease,” Su says.

"THE OCULOPLASTIC SURGEON’S ROLE [IN THYROID DISEASE] IS TO RELIEVE THE SWELLING, WHICH CAN COMPRESS THE OPTIC NERVE AND THREATEN SIGHT" DR CHARLES SU

“Essentially almost all ophthalmic surgeons were already making decisions according to these criteria in practice, so the spelling out of the vision effects of skin hooding would have been more relevant to non-ophthalmologists.” Because of the complexity of oculoplastic, lacrimal and orbital surgery, and the corresponding complexity of MBS item descriptors, Hardy keeps a reference guide within arm’s reach. “The change to MBS item 45617 a few years ago meant that surgeons had to have documentation from an optometrist or ophthalmologist of visual field interference, or prove there was a clinical need to remove excess eyelid skin as a result of thyroid eye disease, facial palsy, or scarring after trauma, in order to claim the MBS rebate,” Hardy says. “Before visual fields were introduced as a criteria for eyelid surgery, the criteria was purely if the upper eyelid skin was resting on the lashes,” he says, adding it was a smooth transition to the new criteria. Hardy says there have also been changes to billing skin lesion treatment and biopsy items under Medicare, but it isn’t clear if these changes include reconstruction and repair of the affected area. “The main issue which mainly relates to basal cell carcinoma and squamous cell carcinoma, is whether repair is included in the item number, depending on the size of the lesion,” Hardy says.

Vismodegib, Su says, has proved useful for treating skin cancer around the eye, as Hardy points out, but another new drug to treat thyroid eye disease – a less common condition where the muscles and fatty tissues behind the eye become inflamed, causing the eyes to bulge outwards – is also making its mark. “Thyroid eye disease sits broadly within auto immune diseases and starts attacking parts of the body – it starts attacking the thyroid, and tissues around the eye in the orbit, or eye socket. It makes the thyroid over-active, it produces more hormone, and ramps up the body’s metabolism,” Su says. Thyroid disease is managed by an endocrinology specialist, but because the disease can affect eyes, oculoplastic surgeons also become involved. “Released antibodies attack soft tissue around the eye socket, and they cause tissue to be more thick, rigid, and swollen. A patient has a typical alarmed appearance, and look as if they are staring, as their eyes are bulging because there is more flesh to fit into the eye socket. The eyes are pushed outward, and the patient suffers double-vision,” Su says. “The oculoplastic surgeon’s role is to relieve the swelling, which can compress the optic nerve and threaten sight, by performing repair surgery on the orbit, or eye socket.” Su says thyroid eye disease is a debilitating condition with no cure, and strikes young, middle-aged females, and can be cosmetically devastating. “Up until now, treatment options typically involved multiple invasive surgeries and/or a combination of drugs (steroids) to reduce swelling. But now, biologic agents such as Teprotumumab, combined with surgery, are having life-changing results. Australians are active in clinical research in thyroid eye disease. In fact, Dr JJ Khong, who organised the group speaking at the cancelled ASO Expo event, is one of the leading Australians in this line of research.” Teprotumumab (brand name Tepezza) received breakthrough therapy designation from the FDA in 2016 and was approved by the FDA in January 2020 for the treatment of thyroid eye disease. It is the first drug ever approved for the treatment of same.

"THE CHANGE TO MBS ITEM 45617 MEANT SURGEONS HAD TO HAVE DOCUMENTATION FROM AN OPTOMETRIST OR OPHTHALMOLOGIST OF VISUAL FIELD INTERFERENCE"

“A graft or skin flap was a separate item number but now surgeons can’t use a separate Medicare item to repair a defect. The only exclusion is item 31359, for the removal of one-third of the eyelid in the malignant eye.” Overall, Hardy says, the variety of oculoplastic procedures is not fully reflected in the range of Medicare item numbers, but there is usually a close match. BIOLOGIC AGENTS Both Hardy and Su are optimistic about developments in drug treatments and biologic agents which are having a positive impact on patients with skin cancer and thyroid eye disease, two patient groups who oculoplastic surgeons regularly operate on. “A drug called Vismodegib was introduced six or seven years ago to treat patients with advanced basal cell carcinoma, in a primary location, such as the skin around the eye socket,” Hardy says. Vismodegib is the first systemic treatment for patients with advanced basal cell carcinoma who cannot have surgery or radiation. “Whereas previously surgeons might otherwise need to remove the eye, patients treated with this drug may now be able to preserve or save the eye,” Hardy continues. Su says a whole new class of drugs featuring artificially made antibodies are becoming more prominent, and oculoplastic surgeons are seeing the results. These drugs can be administered intravitreally or orally and prescribed by a patient’s oncologist or dermatologist, depending on what medical condition is being treated. “They have revolutionised cancer treatments – high profile AFL footballer Jarryd Roughead is a case in point – and are often described as wonder drugs but are not as magical as often portrayed. A couple are particularly relevant to

INSIGHT August 2021

DR THOMAS HARDY

THE FUTURE OF OCULOPLASTICS Looking ahead, Hardy says the profession is in good hands. “I think there will be refinements over time that result in safer, faster surgery," he says. “There are a number of up-and-coming oculoplastic surgeons starting and completing their specialty fellowship training programs, and registrars in training that are expressing interests in the field, so I would say the future looks bright for this very surgical subspecialty.” Su concurs: “Oculoplastic surgery encompasses a rich and diverse range of diseases and treatment modalities, and as such, is a popular subspecialty for new graduates to pursue. As healthcare funding becomes more stretched as time goes on, it is probable that there will be more scrutiny applied to surgical procedures which could potentially be seen as cosmetic. But most oculoplastic procedures are for disease states, in Australia, so at the moment I don’t foresee any significant change in requirements applied to surgeons." n

A SUSTAINABLE ORTHOPTIC WORKFORCE A PROSPEROUS ORTHOPTIC PROFESSION DEPENDS ON THE NUMBER AND CALIBRE OF STUDENTS RECRUITED AND THEIR RETENTION IN THE WORKFORCE. PROFESSOR KATHRYN ROSE EXPLAINS HOW UTS FITS INTO THE EQUATION.

KATHRYN ROSE

"ONLINE EDUCATION HAS FOUND ITS PLACE IN THE UTS MASTER OF ORTHOPTICS, WHILE WE CONTINUE TO EVALUATE AND REFINE ITS DELIVERY"

rthoptics commenced at the University of Technology Sydney (UTS) in 2015 with two key aims: to build a sustainable Australian orthoptic workforce and to ensure our graduates were work-ready to meet the challenges of rapidly evolving ophthalmic technologies. This was in conjunction with strengthening core orthoptic specialisation in ocular motility, paediatrics and vision rehabilitation. A sustainable orthoptic workforce depends on the number and quality of students recruited and their retention in the workforce. The UTS Master of Orthoptics has attracted more than 120 applications a year. As one of only two orthoptic courses in the Asia Pacific, around 7% enrol as international students. This reflects an increased awareness of orthoptics as a career and the reputation of the course. Since 2016, an average of 55 students have graduated annually, representing a marked increase compared to the years immediately prior to 2015 and this has remained consistent. We are acutely aware of existing orthoptist shortages in Australian states, territories, rural regions and New Zealand and endeavour to address this through a compulsory out-of-Sydney clinical placement block for senior students. There has been some success in graduates accepting employment in these regions where placements were offered. UTS has maintained a long-term focus on building relationships with industry and this has accelerated partnerships with employers and the ophthalmic industry. Led by the UTS Orthoptic Industry Advisory Board, chaired by Professor Frank Martin, we have been able to better engage industry to educate our students. These partnerships have created a significant advantage for the students and their future employers, by facilitating access to the latest technologies and enriched learning through provision of industry-run educational classes and workshops. In early 2017 the Master of Orthoptics was fully accredited by the Australian Orthoptic Board after receiving favourable

feedback from employers and graduates. In 2019, a three-year evaluation of courses at UTS placed the Master of Orthoptics on the UTS Outstanding and Commendable Courses list based on; low attrition rate, student satisfaction, graduate satisfaction with teaching and graduate workplace success. With the arrival of COVID-19 in March 2020, UTS Orthoptics has been in an almost constant state of change. The orthoptic staff had to simultaneously transition to a new online learning platform coupled with transferring most of our teaching online. Hopefully we are now looking towards a more settled future, however, as I write we are headed into lockdown again. While COVID-19 caused disruption and rapid transformation in ways of working, there have been 100 Broadway in Sydney, home of UTS Orthoptics. valuable lessons learned for the future. Online course content has firstly demonstrated students can learn well using this medium. This was exemplified by student comments about how they liked the ability to re-run videoed lectures to clarify any aspect they didn’t grasp at first viewing. However, there are some caveats. It was found that lecture content was best delivered via short (10 minutes) videos, coupled with online learning activities. Workshops worked well in small groups with students working collaboratively and engaging with casebased learning. However, not all content was applicable to online delivery. The greatest impact was felt on our clinical laboratory sessions that teach and assess practical skills, and placements in external clinical sites. In mid-2020 – after lengthy preparation to ensure compliance with NSW Health regulations mandating social distancing and wearing of personal protective equipment – we could finally welcome back first year students to campus to undertake clinical laboratory classes. Clinical placements remain an essential component of enabling orthoptic students to be work-ready and a big thank you to all those clinicians who provided placements in 2020, allowing all our second year cohort to graduate. The most recent lockdown will challenge

us again but hopefully we are all better prepared. The loss of placement sites also made us look carefully at where our graduates are being employed and extend the scope of placements to include industry partners and the non-government sector. Online education has found its place in the UTS Master of Orthoptics, while we continue to evaluate and refine its delivery. It has given us the advantage of increased flexibility in scheduling course content, giving additional days for clinical placements. This will be a win for all, leading to further improvement in the quality, competency and workreadiness of our graduates. n

ABOUT THE AUTHOR: Professor Kathryn Rose is the Head of Discipline (Orthoptics) at the Graduate School of Health, University of Technology Sydney. She’s a leading international researcher on the development of vision and refractive errors, in particular myopia. She has also published extensively in the areas of public health approaches and evidence-based practice in eye healthcare. 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 August 2021 45

DISPENSING

IMPORTANCE OF ACCURATE MEASUREMENTS THE DECISION TO ROUND KEY MEASUREMENTS TO THE NEAREST WHOLE NUMBER CAN HAVE A COMPOUNDING EFFECT. NICOLA PEAPER EXPLAINS WHY ACCURACY IS VITAL WHEN ORDERING MODERN, HIGH PERFORMING LENS DESIGNS OF TODAY.

NICOLA PEAPER

"WHILST MANUFACTURE, DESIGN AND FITTING ARE ALL IMPORTANT, IT ALL STARTS WITH THE MEASURING" Figure 1: Aberration patterns of a digitally surfaced, optimised lens compared with traditional grind lens. In conventional progressives (left) the visual impressions of the right and left eye vary considerably. In optimised progressives (right), it shows identical visual impressions for both eyes, necessary when glancing sideways through the lens.

n an Insight article last year Grant Hannaford, director of the Academy of Advanced Ophthalmic Optics, compared the accuracy of various methods of measuring and concluded that a measuring tower was the most accurate with claimed precision of 0.01mm and systemic uncertainty of 0.03mm. This compared to using a ruler with claimed precision of 1mm and systemic uncertainty of 3mm. But how accurate do our measurements need to be? I am constantly told that, as a laboratory cannot fit to 0.1mm accuracy why, do we need that accuracy in measuring? We have seen swingeing changes in the optimisation of lens designs to reduce aberration since digital surfacing was developed. Put simply, when a lens design is optimised the angle of incidence of light to the lens needs to be known. The angle it leaves the lens and subsequent angle of incidence at the eye is then calculated. This happens at thousands of points across a lens for all vision points for the eye. The width of usable corridor is increased with careful calculation of aberration to match as the eyes move across the lens (Figure 1). To perform these complex calculations, it is essential to know where the eye sits. If the eye starts in the wrong place the calculations will be off and aberration will be increased. A laboratory may not be able to fit to 0.1mm, but if a practitioner rounds their measurements, then tolerances allow for larger errors to eventually creep in. For instance, if a PD is measured as 31.4mm but ordered as 31mm (rounded), then with a 1mm tolerance the lab could fit at

INSIGHT July 2021

30mm. This would be 1.4mm out. On a progressive lens with a high add of over +2.00 and a corridor length of 14mm, the best the patient can hope for is a lens that is just usable, at worst the intermediate portion may be too narrow to use and reading severely compromised. If we consider a single vision aspheric lens that is not fitted with height dropped for pantoscopic tilt, then the height may be incorrect by 4mm or more. Whilst the lens will still be wearable the patient will not be getting what they have paid for which should be very low aberration clear vision. This then raises the next question. When should we include face form angle (FFA), pantoscopic tilt (PT) and corneal vertex distance (CVD) in our lens measurements and subsequent lens design? This is a question that I am frequently asked and the general opinion I hear is that this accuracy and technology should be used for high scripts only. Certainly, if we tilt a +6.00D lens by a couple of degrees we will induce more aberration than if we tilt a +2.00D lens. However, the congruity of the asymmetrically modified zones will also be affected. In other words, the aberration pattern that is calculated so the right eye and left eye match as they scan the lens will no longer give the required effect and performance will be reduced. By performance we mean corridor width and swim. When a patient complains of swim on a new progressive lens, often changing PT is the first thing trialled. However, it can be seen from Figure 2 on the next page that FFA has

a much larger effect on lens performance. A change from standard FFA (5°) by only 3° will cause a drop in lens performance of 25% and a face form angle of 10°, which is common with today’s larger frame designs, causes a drop to less than 50% in the performance. PT still plays a role. At a PT of 0°, which is not uncommon with small frames or with sports eyewear, lenses calculated with standard parameters have a performance of less than 50%. Finally, CVD needs to be taken into account with lens design and corridor length. More importantly, on higher powered lenses it can cause a significant difference to the power the patient experiences. CVD of the refraction as well as the dispensed frame needs to be given to compensate the final lens. In an article in 2015 Dr David Wilson wrote: “Measuring vertex distance and making the appropriate calculations of the adjusted power is a very important part of the work of an optician, and measuring the vertex distance at test an important part of the work of an optometrist.” Accuracy is vital when ordering modern, high performing lens designs of today. A millimetre here or couple of degrees there will reduce the performance of a lens and subsequent patient satisfaction. Whilst manufacture, design and fitting are all important, it all starts with the measuring. n References are available in the online version of this article at www.insightnews.com.au. ABOUT THE AUTHOR: NICOLA PEAPER spent 20 years working as an optometrist in the UK. For the past 15 years she has worked within the lens manufacturing industry and is currently professional services manager for Rodenstock Australia.

Figure 2: Lens power +2.50D Add +2.00D. Blue line: Digital progressive lens – optimised to both reduce the base curve effect and for actual frame parameters. Purple: Digital progressive lens – optimised to both reduce the base curve effect and for standard frame parameters. Green: Conventional front surface progressive lens – optimised for the standard position of wear.

IMPRESSIONIST 4® IS ABOVE ALL ONE THING: INDIVIDUAL Our innovative measurement terminal, ImpressionIST®4, guarantees optimal individual consulting and adaptation. And, thanks to measuring without bothersome measuring attachment, it is also convenient, contactless COVID-safe for patients, and fast.

MANAGEMENT

PREVENTING SEXUAL HARASSMENT IN OUR JUNE ISSUE, AVANT’S SONYA BLACK EXPLORED EMPLOYERS’ LEGAL OBLIGATIONS WHEN FACED WITH A SEXUAL HARASSMENT ALLEGATION. THIS MONTH SHE HAS 10 TIPS ON HOW TO PREVENT IT FROM OCCURRING IN THE PRACTICE.

he old medical adage “prevention is better than cure” should always be applied to workplace health and safety, especially sexual harassment. We know that sexual harassment is widespread in Australian workplaces, including the medical profession.

SONYA BLACK

"EVERY WORKPLACE CULTURE STARTS AT THE TOP, SO IT IS IMPORTANT FOR PRACTICE OWNERS TO LEAD BY EXAMPLE"

For this reason, practices need to build workplace cultures founded on respect and take a proactive approach to preventing sexual harassment. Tip 1: Develop a policy: Ideally, your practice has a sexual harassment policy, and your staff have access to it. It should be tailored to your workplace and contain: • A definition of sexual harassment, including examples of behaviours that constitute sexual harassment and that it is unlawful under both state and federal law. • A commitment that your practice will not tolerate sexual harassment. • An outline of the process that will be used to manage allegations of sexual harassment. Review and update your sexual harassment policy regularly. Tip 2: Run training and education: Organise regular sexual harassment training and education, including bystander training. You should also keep records of the training that has been undertaken. Tip 3: Talk to your staff: According to SafeWork Australia, sexual harassment is a work health and safety issue, so you need to conduct a risk assessment to identify hazards, assess risk and implement control measures. You should speak with your staff as part of the risk assessment process because they are likely to be the best source of information about the hazards and risks. Tip 4: Address inappropriate behaviour early: Managing inappropriate behaviour at an early stage can stop it from escalating. What you may think is harmless banter, such as sexual jokes or inappropriate nicknames, is unlawful

INSIGHT August 2021

Staff should be helped to address inappropriate behaviour themselves if they feel they can do so safely.

and can escalate to more serious forms of sexual harassment. This type of behaviour can create a culture where staff do not feel safe to report incidents. Tip 5: Encourage staff to manage inappropriate behaviour themselves: You should help staff to address inappropriate behaviour themselves – if they feel able and safe to do so. For example, employees should feel empowered to call out unwelcome sexual comments or jokes. Tip 6: Ensure the same rules apply to everyone: Ensure that your sexual harassment policy applies to everyone working within the practice, including practice owners. Practice owners need to understand their obligations and comply with them. After all, every workplace culture starts at the top, so it is important for practice owners to lead by example. In some cultures, touching, kissing and hugging is common. This is not acceptable in the workplace, even among work friends. Tip 7: Manage social media and social functions: Sexual harassment frequently occurs over social media and at social functions.You should inform staff that they cannot use their personal social media to sexually harass staff or patients. It’s a good idea to remind staff of their obligations before social

functions and to monitor conduct during social functions. Ensure that alcohol is served responsibly and that the “work function” has a clear end time. Tip 8: Respond to complaints right away: Respond immediately to a sexual harassment complaint. You can deal with a complaint informally or formally or, alternatively, you may decide to refer it to an external organisation. As part of the complaint handling process, you need to ensure that staff feel safe in the workplace. If someone makes a complaint, you may need to roster them separately from the alleged perpetrator. Tip 9: Prevent retaliation: Many people are scared to complain about sexual harassment due to fear of retaliation. Ensure that all workers understand that retaliation is wrong, against the law and can lead to disciplinary action, including termination of employment. Tip 10: Don’t make assumptions: Finally, don’t assume that an alleged perpetrator is guilty. You should conduct an independent investigation into any complaint. n SONYA BLACK is Avant’s Special Counsel, Employment. With over 20 years’ experience as an employment lawyer, she advises doctors and medical practices across Australia on a broad range of employment issues.

2021 CALENDAR apots2020.com

AUGUST 2021

FUTURE DIRECTIONS IN OPHTHALMOLOGY Sydney, Melbourne, Brisbane, Perth 4 August mciaustralia.eventsair.com/fdo2021

CHINESE OPHTHALMOLOGICAL SOCIETY CONGRESS Changsha, China 25 – 29 August ccos2021.sciconf.cn

EURETINA 2021 VIRTUAL International 9 – 12 September euretina.org

Melbourne, Australia 2 – 4 September omega21.com.au

SUPER SUNDAY 2021

AUSCRS 2021

Paris, France 24 – 27 September en.silmoparis.com

Noosa, Australia 20 – 23 October www.auscrs.org.au

OSA ANNUAL CLINICAL N AND SCIENTIFIC MEETING Canberra, Australia 30 September – 3 October kathpoon@bigpond.com

OCTOBER 2021 ORTHOKERATOLOGY SOCIETY OF OCEANIA 2021 CONFERENCE

NOVEMBER 2021

Melbourne, Australia 10 October optometry.org.au

SILMO PARIS

SEPTEMBER 2021 O=MEGA21

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

RANZCO ANNUAL SCIENTIFIC CONGRESS Brisbane, Australia 19 – 23 November ranzco.edu

E YECARE PLUS NATIONAL CONFERENCE 2021 Gold Coast, Australia 29 – 31 October eyecareplus.com.au/conference

ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE Brisbane, Australia 20 – 22 November orthoptics.org.au

DECEMBER 2021 EACE 2021 - FUTURE OF P OPHTHALMOLOGY Sydney, Australia 31 October personaleyes.com.au/events

Gold Coast, Australia 1 – 3 October www.oso.net.au

14TH ASIA-PACIFIC VITREO-RETINA SOCIETY (APVRS) CONGRESS Chinese Taipei 10 – 12 December 2021.apvrs.org

SPECSAVERS – YOUR CAREER, NO LIMITS A

ll Graduate Opportunities – Mackay Specsa ve stores rs The Specsavers Graduate Recruitment Team are currently looking for two graduates to join our teams now w it at Specsavers Mackay Canelands and Mt Pleasant. Benefit from our ‘Go with a friend’ bonus, as well as h OCT a generous regional salary and relocation package. Specsavers are the largest employer of Graduate Optometrists across Australia and New Zealand and we have continued to develop our comprehensive twoyear Graduate Program which provides newly qualified Optometrists with a dedicated Mentor, support network and structured program to assist you in your development. Experienced Optometrists can expect to earn more than $250k! Specsavers has an exciting opportunity for experienced Optometrists looking to take the next step in their career. State of the art equipment - including OCT, opportunity to mentor graduates and students, supportive and welcoming teams to help you settle in, loyal patient database’s and mixed demographics including pathology. Not sure partnership is right for you? Why not try before you buy? Permanent or fixed term can be discussed. Relocation support available. Opportunities available in regional QLD and SA. Ready to come home Kiwis? Come home to Specsavers. We have a range of opportunities for NZ optometrists looking to return home. From North to South, we have fantastic opportunities for optometrists at all levels. And as a Specsavers optometrist, you’ll have the chance to advance your skills and become part of a business that is focused on transforming eye health outcomes in New Zealand. Be equipped with the latest ophthalmic equipment (including OCT in every store for use with every patient) and develop your clinical experience across a range of interesting conditions and an ever-growing patient base. You’ll also have the support of an experienced dispensing and pre-testing team, the mentorship of store partners and access to an exemplary professional development program.

Full-time Optometrist Opportunity – Specsavers Grafton, NSW Specsavers Grafton are looking to talk to a patient focused and ambitious optometrist to fill their full-time vacancy within their new store. You will work alongside a new team of experienced and supportive dispensers that provide affordable but clinical eye care. Full-time Optometrist Opportunity – Specsavers Halls Head, WA Specsavers Halls Head are looking for an optometrist to join their supportive and patient focused team. You will be working alongside an experienced optometry and retail team with a flexible roster. This 2-test room practice is equipped with OCT, HFA3 and automated equipment. With an older demographic and state of the art equipment, you will work closely with specialists in the area. You will also be given all the tools required to provide an excellent experience for every patient you see.

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: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134 Australia Employment enquiries: Madeleine Curran – Recruitment Consultant

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader

cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

chris.rickard@specsavers.com or 02 7579 5499 Graduate employment enquiries: apac.graduateteam@specsavers.com

SOAPBOX

CONTENDING WITH A COVID PRACTICE CLOSURE Organising deep cleaning of the practice was also a priority. Understandably, staff were concerned at possible side effects of harsh cleaning chemicals, so I needed to quickly study the methods acceptable to NSW Health and then procure the services of those intensive cleaning crews with the least potential to trigger hypersensitivities in humans.

ortunately, few optometry practices have experienced close contact with a COVID-19-positive patient – and the associated rigmarole. My Sydney city practice HineSight Optometrist, however, did have this experience in early May, which triggered a rabbit-hole journey for my business on several fronts. Within 30 minutes of NSW Health notifying that a patient – who visited us the week before – had tested positive, I and my team were expected to vacate our work premises and immediately proceed to the nearest COVID testing centre. Strangely, this happened to be the annexe at Sydney Eye Hospital. Pressured by hovering authorities outside, I knew my practice was about to shut pending the required testing and deep cleaning and that we were considered possibly contagious. I needed to quickly gather both my wits and whatever I needed to take home and work through the situation. Last year’s lockdowns were a useful guide. I knew I needed a redirection sign on the front door for patients and couriers, access to the computer system and client base for communicating with confused and anxious patients, and to transfer the practice phone system. Because our COVID contact Mr T had travelled far and wide the weekend he visited us, our COVID tests were prioritised and swiftly processed. Within

INSIGHT August 2021

24 hours, NSW Health informed we were all negative. Regardless, all staff working in the practice at the time of Mr T’s visit (my chief dispenser and I), were immediately consigned to 10 days home isolation, pending further COVID testing. Let’s just say my cat was surprised with my continuous company. It was non-stop for at least the first four days at home as I tried to cancel patient appointments, offer reassurance, reorder collections and negotiate with very helpful suppliers. Thank you to ProVision, Johnson & Johnson, CooperVision, Alcon, Seed, Bausch + Lomb, Hoya, Essilor, Shamir, AM Eyewear, Eyes Right Optical and many others for your support with extended terms. On the financial front, it’s vital for others to know that business interruption insurance does not cover pandemicrelated events such as directives to close and isolate. I spent hours pursuing avenues of financial assistance by any government department and learned that no aid exists for enforced COVIDrelated business closure for 10 days or for the compulsory deep cleaning ($800 to $1,000). It’s just our bad luck, it seems. Centrelink may offer a one-off $1,500 payment for home isolating selfemployed workers. However, isolating employees may not be eligible for this pandemic relief to cover wages.

But it was the media battle that took me most by surprise. As a small health practice, we were not equipped to redress the tsunami of disinformation and baseless speculative reporting by television and media. Regardless of the facts, reporters sought to implicate my practice as the “logical” source for Mr T’s COVID 19 infection merely because we are located near a quarantine hotel. Regrettably, their irresponsible reporting also affected neighbouring businesses and other CBD optometry practices too. Unfounded media speculation can cause ongoing damage to public confidence in a business, and I’d like to express my appreciation to Optometry NSW/ACT and my colleagues for their support in reprimanding more blatant media reporting. What happened to HineSight was so random yet could easily happen to any optometry practice. Since re-opening, we still need to reassure patients they are safe because no one in the team tested positive; the media did not bother to report that public interest fact. We continue to observe COVID-safe hygiene regimen to reassure clients and protect everyone because we just don’t know who comes in the door. It's obvious from the lack of new community cases associated with Mr T, that he was actually not infectious the day he visited. But to comply with the best guess of NSW Health at the time, HineSight locked down and took a hard financial hit for the city – “just in case” it now seems in hindsight. n Name: Narelle Hine Qualifications: DipAppSc (optom), DCLP, MSc, FAAO Business: HineSight Optometrist Position: Owner optometrist Location: Sydney CBD Years in profession: 30+ years

AS A SMALL HEALTH PRACTICE, WE WERE NOT EQUIPPED TO REDRESS THE TSUNAMI OF DISINFORMATION AND BASELESS SPECULATIVE REPORTING BY TELEVISION AND MEDIA

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Challenge the limits of imagination

When ZEISS started 175 years ago, we and our customers were inspired by curiosity, passion and precision – new perspectives that shaped how we looked at the world. To see major challenges and turn them into great opportunities. Despite the many ways the world has changed over the past 175 years, one thing will stay the same: Together we challenge the limits of imagination. www.zeiss.com/175