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PORTLAND OPHTHALMOLOGY
The concerns form part of the peak body’s submission to a Senate inquiry earlier this year into the way the Australian Health Practitioner Regulation Agency (Ahpra) – and related entities under the Health Practitioner Regulation National Law –handles registrations and complaints, otherwise known as ‘notifications’.
OA has also raised concerns over the current framework for optometrists requiring supervision to practie, stating it is “difficult and stressful” to navigate, and a lack of support services specifically for optometrists subjected to a complaint.Theinquiry, undertaken by the Senate Community Affairs References Committee, was established in 2021 due to persistent issues with the administration of Ahpra registrations and notifications. Significantly, it found health practitioners and notifiers continue to experience delays, disappointment, confusion and stress with regulatory processes and outcomes. However, it did note the difficult job of Ahpra with “an inherent tension” between potential community safety risks and health practitioners’ livelihoods.
Harvey has continued working in Mt Gambier, South Australia, where around 75% of his Portland patients are now seeking care, travelling over 100km. Others are attending clinics in Warrnambool, 98 km away. “My colleague in Mt Gambier has now written to his local MP to say that cross border ophthalmology services in South Australia are struggling because so many patients are coming from Portland,” Harvey“Somesaid.Portland cases are urgent and semi-blind. One person recently gave herself an insulin overdose because she couldn't see the syringe clearly. We’re having to give these people priority and hence Mt Gambier patients are now finding their waiting times are increasing.”
PROBLEM SHIFTED
INTERVENTIONS – CPD Spectacle lens-based myopia management has many advantages. But as these technologies evolve, BHVI's Prof Padmaja Sankaridurg believes it’s becoming more important for practitioners to understand how they work and when to prescribe.
CALL TO
page 27
AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 2022 Optometry Australia (OA) has called into question the agility of the national registration and accreditation system, including Ahpra’s time to respond to serious complaints like sexual misconduct, while also taking issue with tightened CPD requirements making it harder for optometrists to obtain exemptions while on parental leave.
Limited support for practitioners subjected to complaints was cited as an issue.
A regional Victorian hospital is yet to find a replacement for an ophthalmologist who resigned in frustration after trying to expand the service. Now patients are driving long distances for eyecare, placing pressure on services in neighbouring towns. Dr Robert Harvey, 69, an ophthalmologist nearing retirement, worked his last day in his salaried position at Portland District Health (PDH) on 31 March. He resigned after the hospital turned down his request for a contractual change that would have seen him become a visiting medical officer (VMO), allowing him to seek and train a successor.Awareof the difficulties in finding ophthalmologists to work in regional areas, he was concerned about thousands of patients that attended regular clinics for chronic eye conditions at PDH, and more than 150 people on his surgical wait list. Two months since he left, PDH confirmed to Insight on 5 July it had not found a replacement, despite initially hoping the disruption would only last for the month of April.
continued page 8
Harvey said Portland patients wanting to see him in Mt Gambier are also required to obtain a new referral from a GP, adding to their burden. He also said some patients weren’t aware that ophthalmology services were unavailable at PDH until they rang to arrange an appointment.
The public OA submission focused on seven areas for improvement, beginning with amended continuing professional development (CPD) standards introduced in December 2020, affecting parental leave. Prior to this, it said the Optometry Board of Australia (OBA) granted automatic CPD exemption of up to 12 months for planned parental leave, enabling optometrists to fully take leave from their career and professional obligations for up to 12 months, without leaving the profession“However,entirely.from1 December 2020, the OBA guidelines advised that exemptions would be considered on a case-by-case basis and only granted if the practitioner met the criteria of ‘exceptional circumstances’ that would not include parental leave (except potentially in the case of a multiple birth),” OA stated. With an increasingly femaleIMPROVE OPTOMETRY COMPLAINTS AND REGISTRATION REGULATORY ISSUES
After a disruptive two years, Specsavers Clinical Conference is returning with a distinctly 2022 look.
Not only that, but there will be a variety of compelling on-demand CPD content for you to access when and where you want, as well as in-person networking experiences in each state, allowing you to enjoy some social time with your peers.
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To find out more and to register, go to SCC2022.com.au
SCC is one of Australia and New Zealand’s best-attended optometry professional development events on the industry calendar and with a jam-packed agenda, this one is not to be missed!
Now in its eleventh year, this year’s two-day SCC will offer live CPD content from an incredible line-up of industry-leading speakers over a state-of-the-art, custom built virtual platform –it’ll be just like being in the room!
The two-day ophthalmology-led educational event will include a stellar line-up of industry leaders presenting on myopia control, anterior eye therapeutics, ocular lesions, paediatrics, glaucoma, diabetes, age-related macular degeneration, neuroophthalmology and vitreoretinal.
10 – 11 September 2022 20 hours of CPD content all in the one place! 2020 OOptometristsptometrists 2021 OOptometristsptometrists 2022 OOptometristsptometrists isConferenceClinicalSpecsaversback
43 BLIND SPOT Why it's time to re-think the Medicare payment for optometry domiciliary services.
THANKLESS WORK Let’s take a moment to acknowledge the optometrists who roll up their sleeves to perform the under-appreciated work in aged care facilities.
35 WORKFORCE SHORTAGE How optometry practices can attract and retain front-of-house staff amid a recruitment squeeze.
MYLES HUME Editor 07 UPFRONT 09 NEWS THIS MONTH 53 OPTICAL DISPENSING 54 ORTHOPTICS AUSTRALIA 55 MANAGEMENT 56 PEOPLE ON THE MOVE 57 CLASSIFIEDS/CALENDAR 58 SOAPBOX EVERY FEATURESISSUE AUGUST 2022 INSIGHT August 2022 5
With a Medicare rebate that Optometry Australia (OA) says “grossly under-recognises” the cost of providing domiciliary services, it’s a tough gig for these practitioners, motivated more by altruism than anything else. Under Medicare, benefits are payable to optometrists providing domiciliary services under 10931 to 10933 in the form of a loading, in recompense for “travel costs and packing and unpacking of equipment”. OA modelling suggests the current fee ($24.20) fails to acknowledge the true cost, discouraging optometrists from providing the service. It's a fair point. A recent study of senior Australians revealed that within the first year of entering residential aged care, 46% with an eye condition accessed an eye health service. Yet, 70% used at least one ophthalmic medication.
STOCK MANAGEMENT A new ProVision system is drastically reducing the time it takes to introduce new frames.
4022 COMBINED TREATMENTS
IN THIS ISSUE
CPD content (0.5T) by Dr Pauline Kang about combining orthok and atropine for myopia control.
From pages 43-48, two optometrists detail the realities of providing domiciliary care in Australia. Driving to facilities, unpacking and packing equipment, RAT tests and unprepared patients can create a lot of non-income-generating time. Dealing with family members for consent and quotes also causes headaches. To visit one resident in aged care, one optometrist estimates he needs to allocate at least two hours. It’s hard to make a business case on that basis for typical optometry businesses.Thankfully, the industry is pushing for change. OA is advocating for a more realistic domiciliary loading ($85.00 per visit), but even some think this is modest. Stronger incentives could lead to a 10% increase in the provision of such services. At just $500,000 per annum, OA points out it will come at a minimal federal budget cost due to the infrequency of domiciliary care. If successful, it will be interesting to see what such a small government investment could do for the eye health of some of Australia’s most vulnerable.
At OPSM, we are obsessed with eye care and offering our customers the confidence in how they see the world. Our advanced technology enables us to look deeper to ensure we give the best care to every customer. When you join OPSM, you work with world class technology including the Optos Daytona ultra wide field scanner. You have many opportunities for continuing professional development through financially supported industry training, mentoring, graduate induction, peer learning communities and product training. You are rewarded with a competitive salary and bonus scheme to recognise your contribution. You have career flexibility through our extensive store network. Most importantly, you can make a real difference in the way people see the world not only from your consulting room but also by participating in our OneSight outreach program. #DoWhatYouLove
LEARN MORE OPSM.COM.AU/CAREERS VISIT US ON LINKEDIN CONTACT OUR PROFESSIONAL SERVICES MANAGERS TO EXPLORE YOUR NEXT OPPORTUNITY: NSW/ACT – Judy Kwan Judy.Kwan@opsm.com.au QLD/NT – Brendan Philp brendan.philp@luxottica.com.au VIC/TAS – Melissa Downing melissa.downing@luxottica.com.au SA – Sophie Pym Sophie.Pym@luxottica.com.au WA – Mario Basso mario.basso@luxottica.com.au NZ – Jonathan Payne jonathan.payne@opsm.co.nz WORKING AT OPSM BIGGER.OFYOU’REMEANSPARTSOMETHING SEE YOUDOINGYOURSELFWHATLOVE
FINALLY, a former flying optometrist in Western Australia with Lions Outback Vision is now behind the wheel of New Zealand’s first custom-built mobile optometry service. Mr Veeran Morar is driving Vision Bus Aotearoa. The initiative launched at the University of Auckland, where Morar is now teaching optometry and vision science. “Our bus is vital for education, not only for our optometry students but for school kids in the community who are being touched by optometry,” Morar said. “That should lead to more kids coming to study with us. We are keen to have more Maori and Pacific students. To be sustainable in the equity fight, we need to have a diverse group of optometrists.”
n WACKY
n WEIRD
Just as Insight went to print, AUSTRALIAMYOPIA , a new organisation established by NSW paediatric ophthalmologist Dr Loren Rose, is hosting a one-day conference in Sydney on 3 September. A comprehensive management plan for myopia progression in children, panel discussion of difficult cases and guidelines on referral recommendations will form part of the conference. “Eye health professionals are invited to learn and interact with the latest research-proven methods for monitoring and intervening in myopia progression in children,” Rose said. “There is now a need for clarity and safe treatment guidelines, which should include how to best monitor progression, when to treat and when to change treatment.”
The Bendigo Advertiser reported that an Australian man has lost his place on an eye transplant waiting list because he was in prison for a violence incident on a woman. The 24-year-old appeared in Bendigo Magistrates Court where it was revealed he missed his chance for the corneal procedure.
WHAT’S ON NEXT SCCMONTHHYBRID 2022 10 – 11 SEPTEMBER The Specsavers Clinical Conference is returning as a virtual two-day, ophthalmology-led event across Australia, with 20 hours of CPD. anz.cpd@specsavers.com THIS AUSMONTHCRS 3 – 6 AUGUST The Australasian Society of Cataract and Refractive Surgeons’ yearly meeting is returning to its ‘home-away-from-home’, Peppers, Noosa. julie@outstandingdisplays.com.au Complete calendar page 57. insightnews.com.au STAT Published by: 11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreative.com.au Chief Operating Officer Christine christine.clancy@primecreative.com.auClancy Group Managing Editor Sarah srah.baker@primecreative.com.auBaker Editor Myles myles.hume@primecreative.com.auHume Journalist Rhiannon rhiannon.bowman@primecreative.com.auBowman Commissioning Editor, Healthcare Education Jeff Megahan Sales Manager Andrew andrew.morrison@primecreative.com.auMorrison Client Success Manager Justine justine.nardone@primecreative.com.auNardone Design Production Manager Michelle michelle.weston@primecreative.com.Westonau Art Director Blake Storey Graphic Design Michelle Weston, Kerry Pert, Aisling McComiskey Subscriptions T: 03 9690 subscriptions@primecreative.com.au8766ThePublisherreservestherighttoalteroromitanyarticleoradvertisementsubmittedandrequiresindemnityfromtheadvertisersandcontributorsagainstdamagesorliabilitiesthatarisefrommaterialpublished.©Copyright–Nopartofthispublicationbereproduced,storedinaretrievalsystemortransmittedinanymeanselectronic,mechanical,photocopying,recordingorotherwisewithoutthepermissionofthepublisher. VALUING DOMICILIARY EYECARE Optometry Australia has proposed the domiciliary Medicare loading be increased to $85.00 per visit, up from $24.20, with an assumed 10% increase in services. Page 43. INSIGHT August 2022 7
A US woman who suffered eye damage when a rubber bullet fired by police struck her in the face during a 2020 protest over George Floyd's murder has filed a federal lawsuit against officers involved. She suffered a broken right eye socket, nerve damage to that eye and a 20-stitch gash to her forehead that left a scar, Associated Press reported.
WONDERFUL
An independent UK optometrist has released a picture book for children. Ms Stephanie Lipsey-Liu, from Nottingham, created We love our glasses to educate young patients about glasses and provide easy explanations for parents. The clinical aspects have been checked over by Hoya, who will help to market the book, Optometry Today reported.
n
UPFRONT
IN OTHER NEWS, Glaucoma Australia (GA) has appointed Mr Richard Wylie as its new CEO. Wylie, who commenced on 4 July, replaced Ms Annie Gibbins. GA said Wylie was an experienced senior executive leader who is passionate about the ‘for purpose’ sector. “He brings significant experience and a passion for driving positive health outcomes for Australians. He is committed to leading the organisation in improving the lives of people with glaucoma and those at risk of the disease,” the organisation said.
“We question whether practitioners would pursue these avenues for support in this context,” OA added.
• Ahpra and the national boards introduce a more flexible re-registration model across professions that would enable health practitioners to more easily re-enter the workforce after a period of absence.
“We know how important high-quality ophthalmology services are for our community and will ensure all community members continue to receive the care they need. We hope to have an update on returning ophthalmology services to Portland in the coming weeks.
KEY RECOMMENDATIONS:
• Ahpra and the national boards undertake education and awareness activities, explaining notifications and other complaints pathways, with health practices and services.
OA“Further,explained.thetime between submitting an initial supervised practice application and receiving the board’s verdict can be lengthy, in some cases extending over months.”
8 INSIGHT August 2022
SENATE COMMUNITY AFFAIRS REFERENCES COMMITTEE –
• The Ministerial Council should consider reforms to the National Law to enable health practices and services to be referred low risk notifications to be dealt with in the first instance, and that Ahpra and the national boards have discretion to refuse these matters on that ground.
It said initial notification communications list “generic” mental health support services such as BeyondBlue which practitioners, like the rest of the community, may access.
Additionally, Harvey is yet to see a woman who requires monthly injections for macular disease. Because she can only travel short distances before becoming motion sick, he is concerned she is not receiving the sight-saving care she requires. He said the 150 people on his Portland surgical wait list face uncertainty about the timing of their surgery and likely increased wait times. Some have been waiting for more than a year – and they don't know what's“Managementhappening.have advertised for a locum but not had any interest,” Harvey added. “At the moment we've got an expensive operating microscope, OCT and phaco machine, all lying idle in an operating room, and nursing staff who are keen andHarveyready.”and other doctors at PDH have previously expressed concerns about the erosion of specialist services in Portland with other medical specialties affected in a similar However,way.PDH has denied the hospital is being closed, downgraded or amalgamated.Inastatement, PDH said it was dominated and youthful profession (58% female vs 42% male), OA said many in the profession were impacted by these changes.“Whilstan evolving profession, best practice standards do not typically change significantly for optometry within a 12-month period, and there is no reason to believe, or historical data to suggest, that an up to 12 months exemption from completing CPD presents any danger to the general public. Rather, we believe such exemptions are an appropriate approach that aligns with modern workforce standards and supports the health and wellbeing of new parents. It can also prevent unnecessary loss of highly trained and skilled professionals from the profession.”Theinquiry also sought feedback on the timeliness of Ahpra’s response to complaints. OA said there continued to be unacceptable delays, which can cause mental distress for practitioners who are subject to complaints. OA also has major concerns over Ahpra’s “agility” to respond to serious complaints that could place the public at risk. “We are aware of a case of alleged sexual misconduct reported in 2021 where Ahpra took two months to undertake what they termed ‘immediate action’ to suspend the practitioner as they felt there was a serious risk to the public while an investigation was launched. We believe this is a gross dereliction of Ahpra’s mandate to protect public safety,” OA said. And when practitioners are required to work under supervision as a condition of their registration, OA said the process remained “complex, confusing and inefficient” for affected individuals.
'A GROSS
When it came to the supports available to optometrists subjected to a complaint, OA said there was no services available like there are for dentists and midwives.
“Our staff are working hard to ensure any delays to service are minimal and that we provide continuity of care for patients,” the hospital stated.
REGIONAL HOSPITAL STILL SEEKING REPLACEMENT
“We ask everyone in our community to continue to be courteous in their interactions with our staff.” n
• Notification accepted by Ahpra be limited to clinical issues relating to patient safety.
“For example, currently an optometrist seeking to return to provide eyecare to their community needs to research and find a suitable supervisor before knowing what level of supervision (in-person, or on the phone) will be accepted by the [OBA]. This obviously makes it challenging to arrange a supervisor, who does not have clarity on what will be required from them,”
continued from page 3 continued from page
• All supervisors should have a direct point of contact within Ahpra that should be made available prior to any contractual arrangements being made, as well as throughout the entire supervisory period.
NEWS
• Ahpra undertakes urgent and immediate action for supervisory failures and ensure that individual cases are not indicative of a systemic failure.
• Ahpra and the national boards undertake an analysis of the cause of protracted notifications timeframes and identify ways to further improve timeliness.
• Ahpra and the national boards develop and fund a comprehensive strategy for providing tailored support for the notifications process to practitioners in all regulated professions.
OA’s submission was one of 144 lodged as part of the initial inquiry process to address the Terms of Reference set by the committee. A final report with 14 recommendations was published 1 April, and the Federal Government is now required to respond within three months. n DERELICTION OF AHPRA'S MANDATE' 3 Dr Robert Harvey. continuing to search for a replacement ophthalmologist to resume the service.
With the award, the winner will win a trip to Silmo 2023. n renowned optics expert Professor Mo Jalie, is a lecturer at UNSW and is currently a doctoral candidate under the supervision of Professor Nicola Logan at Aston University UK,” she wrote. “Win or not, we all know how hard you’ve worked from humble beginnings." The ODA was also elated its inaugural CEO had been nominated and shortlisted as one of only four finalists worldwide.
Prominent Australian optical dispensers Ms April Petrusma and Mr Grant Hannaford have been named among the four finalists in the Silmo IOA International Optician of the Year Award 2022. Petrusma, CEO of recently-formed organisation Optical Dispensers Australia (ODA), and Hannaford, co-founder and director of the Academy of Advanced Ophthalmic Optics, were both shortlisted, alongside Ms Wendy Buchanan from Canada and Mr Jean Francois Porte from France.
The finalists were announced on 27 June, with the winner to be revealed at this year's Silmo show in Paris, taking place on 23-26 September 2022. On Linkedin, Hannaford’s wife and business partner, Ms Thao Hannaford, said his career spanned over two decades beginning with optical dispensing, to becoming an ophthalmic physicist and researcher. “He’s done aid work recognised by the Australian Government, held key roles on several industry boards, became a fellow of ABDO UK under the tutelage of world DISPENSERS SHINE BRIGHT ON GLOBAL STAGE
“The finalists will now have the chance to supply a dossier of evidence to back up their achievements in the eight areas of expertise we are looking for. I hope that showcasing these outstanding opticians will inspire the whole profession,” IOA president Ms Fiona Anderson said.
LOCAL OPTICAL
“April [Petrusma] is a present and consistent professional voice of the dispensing profession,” ODA, which is affiliated with the International Opticians Association (IOA), stated. “Whether it is presenting at industry events, engaging as an on-call optical dispenser for her long-term practice affiliation, as a senior trainer for Australasia’s largest optical dispensing training organisation, the Australasian College of Optical Dispensing (ACOD), using her immense knowledge to contribute to industry publications or as the spearhead of Australia’s newest memberbased support network for the optical dispensing industry – ODA, April gives this industry all of herself.”
NEWS
Margaret Lam. Fiona Moore. Tori Halsey.
BRIEF
“The changes are designed to bring the federation closer together; to strengthen strategy and operations for the benefit of our membership nationally. We are confident that all current member services including CPD, support, PII, advocacy and other initiatives at the national and state levels will continue uninterrupted.”LamsaidOA must continue to be the voice to guide the future direction of the profession as it will enable optometrists to have a strong, united and uniform approach to government, healthcare and sector advocacy.
“Optometry Australia employs highly talented and skilled staff and we are fortunate to have staff that work exceptionally hard for our members. Every single one of our team performs vital and essential services, and I look forward to working with them more closely to lead our sector forward in the year ahead.”
OPTOMETRY AUSTRALIA APPOINTS NEW PRESIDENT AS STATE DIVISIONS VOTE TO REFORM
“This is mostly a procedural matter and is designed to ensure the divisions and national have far greater clarity in decision making for the ultimate benefit of all members,” Hampton said.
While Lam is only the third female optometrist to be appointed president of Optometry Australia in the organisation’s 103-year history, never before has there been three women simultaneously in the roles of president, deputy president and treasurer. She was humbled to lead an organisation in challenging times, and has been impressed by initiatives in member support seeing the national and state organisations come together, particularly during COVID. “I have seen the national board oversee these many challenges and responsibilities to lead this organisation, and the national board will always remain fiercely member focused to future proof our profession in all of our decision making,” she said.
n MENTAL HEALTH
Although OA and the state divisions did not wish to provide details after a 29 June meeting, prior to this Optometry Victoria South Australia CEO Ms Ilsa Hampton said the organisation had been in discussion with the other state divisions to develop “a few changes to the OA constitution”.
n BLINK RATE HALVED Smartphone gaming induces dry eye symptoms and reduces blinking in schoolaged children, researchers at UNSW have found. Associate Professors Isabelle Jalbert and Blanka Golebiowski and PhD candidate Ms Ngozi Charity Chidi-Egboka studied children playing games on a smartphone continuously for one hour. They found symptoms worsened following one hour of smartphone gaming, but tear film remained unchanged. Blink rate reduced from 20.8 blinks per minute to 8.9 blinks per minute. Interblink interval increased from 2.9 seconds to 8.7 seconds within the first minute of gaming relative to baseline conversation, and this effect remained unchanged throughout one hour of gaming.
IN n MYOPIA SPECS DATA Spectacles with SightGlass Vision Diffusion Optics Technology were shown to reduce both axial length and cycloplegic spherical equivalent refraction (SER) progression in six- and seven-year-old children. The average reduction in axial length was 0.27 mm, and 0.77 dioptres (D) in cycloplegic SER progression vs control. The research involved 256 children across 14 clinical trial sites in the US and Canada and was presented at the 2022 Dutch Contact Lens Congress in June. Founded in 2016, SightGlass Vision is a joint venture of Cooper Companies and EssilorLuxottica to accelerate commercialisation opportunities in the the myopia management category.
NOTE: Turn to page 50 to read about the life and career of new Optometry Australia president Dr Margaret Lam. n
“As highlighted by Murray, we are delighted that the state divisions have committed to structural reform and we look forward to working with them in the spirit of genuine consultation and collaboration so that together, we can continue to provide services that are of value to our members, and to the profession of optometry,” she said.
NEWS 10 INSIGHT August 2022
Smith – a Victorian optometrist – was elected president in November 2021, but resigned effective immediately on 27 June. “I have reached the conclusion that my family, my health and wellbeing must come first,” he said.
Although a separate matter, Smith’s departure came as state divisions of the federation voted on a new model to fund OA. The national body receives a portion of its income from the fees state divisions collect from optometrists, under a constitutional fee agreement.
A new study, published in the peer-reviewed journal Ophthalmology by eyecare nonprofit Orbis International, found children with myopia experienced significantly higher levels of depression and anxiety than those without vision impairment. In addition, findings indicated that surgery to correct strabismus significantly improved symptoms of depression and anxiety. The study posits the mental health of children with vision impairment may be adversely affected because they tend to participate in fewer physical activities, have lower academic achievement and are more socially isolated. Further, common vision conditions like strabismus can also negatively impact children's development and maturation, affecting not just their appearance, but also their ability to carry out certain activities and their state of mind. Following Mr Murray Smith’s sudden resignation from the national presidency, Optometry Australia (OA) has appointed Ms Margaret Lam as his replacement. She will now spearhead a trio of female optometrists in top leadership roles within the organisation. On a separate matter, state divisions have voted on a new funding model for the national organisation. Lam, a George & Matilda (G&M) Eyecare partner optometrist who was previously the OA deputy president, was promoted after a national board meeting on 28 June. It came immediately after Smith resigned seven months into the job to focus on his family, health and wellbeing. At the same meeting, Mrs Fiona Moore became deputy president and Ms Tori Halsey was re-appointed treasurer. Moore, with her husband Tom, are the owners of Moore Eyes in Rockhampton with a sister practice in Yeppoon, both in central Queensland. Halsey is employed at Look of Australia, a Hobart-based independent practice.
Prominent international researchers have shown the AREDS2 formula, using the antioxidants lutein and zeaxanthin instead of beta-carotene, not only reduces risk of lung cancer, but is more effective at reducing risk of AMD progression.Thestudy,published in JAMA
AREDS2 FOLLOW UP CONFIRMS BEST SUPPLEMENTS FOR AMD OLYMPIC
Ophthalmology by US medical research agency National Institutes of Health (NIH), followed up 3,883 of the original 4,203 AREDS2 participants to analyse 10 years of data. After a decade, the group originally assigned lutein/zeaxanthin had an additional 20% reduced risk of progression to late AMD compared to those originally assigned beta-carotene.
The original AREDS study, launched in 1996, showed that a dietary supplement formulation (500 mg vitamin C, 400 international units vitamin E, 2 mg copper, 80 mg zinc, and 15 mg betacarotene) could significantly slow the progression of AMD from moderate to lateHowever,disease.two concurrent studies also revealed people who smoked and took beta-carotene had a significantly higher risk of lung cancer than expected. In AREDS2, commenced in 2006, Chew and her colleagues compared the beta-carotene formulation to one with 10 mg lutein and 2 mg zeaxanthin instead.
Even though all the participants had switched to the formula containing lutein and zeaxanthin after the end of the study period, they reported that the follow up study continued to show that beta-carotene increased risk of lung cancer for people who had ever smoked by nearly double. There was no increased risk for lung cancer in those receiving lutein/ zeaxanthin.Inaddition, after 10 years, the group originally assigned to receive lutein/ zeaxanthin had an additional 20% reduced risk of progression to late AMD compared to those originally assigned to receive“Thesebeta-carotene.resultsconfirmed that switching our formula from beta-carotene to lutein and zeaxanthin was the right choice,” Chew added. n and what Emma stands for as an athlete. Intensely focused, committed, determined and proudly Australian, Emma radiates those values and attributes we strive to have as an organisation.”McKeonisa four-time world record holder, with a total haul of 11 Olympic medals in her swimming career to date, five of which are gold. She became the most successful Australian athlete at a single Olympics, and the one of only two female athletes in the world to win seven medals at one Olympics.
“This 10-year data confirms that not only is the new formula safer, it’s actually better at slowing AMD progression,” Dr Emily Chew, director of the Division of Epidemiology and Clinical Application at the National Eye Institute (NEI), and lead author of the study report, said.
The beta-carotene-containing formation was only given to participants who had never smoked or who had quit smoking.
The Age-Related Eye Disease Studies (AREDS and AREDS2) originally established that dietary supplements can slow progression of AMD. But because beta-carotene increased the risk of lung cancer for current smokers in two NIH-supported studies, the AREDS2 study aimed to create an equally effective supplement formula that could be used by anyone, regardless of whether they smoked.
that lutein and zeaxanthin did not increase risk for lung cancer, and that the new formation could reduce the risk of AMD progression by about 26%. After the completion of the five-year study period, the study participants were all offered the final AREDS2 formation that included lutein and zeaxanthin instead of beta-carotene.
The partnership with G&M took immediate effect. n
At the end of the five-year AREDS2 study period, the researchers concluded George & Matilda (G&M) Eyecare and Australian swimming great Ms Emma McKeon are joining forces to champion eye health in new ambassador partnership.Thefive-time Olympic gold medallist has joined the fast-growing Australian optometry company in a quest to put vision first in competitive sport and beyond.Thepartnership comes on the eve of the Commonwealth Games which sees McKeon on the cusp of becoming Australia’s greatest Commonwealth Games athlete. As an ambassador, McKeon’s presence and personality are expected to drive awareness of better vision and optometry needs in competitive sport, something overlooked in training and performance at both an amateur and elite level, G&M stated However, a long-term collaboration will see McKeon be the voice of eye health on a much larger scale when she transitions from her illustrious sporting career. “We’re thrilled and humbled to have Emma as part of the G&M family and join us in our mission to help the world to see better, one person at a time,” G&M CEO and founder Mr Chris Beer said. “We believe there’s a symbiosis between who we are as a company SWIMMER BECOMES GEORGE & MATILDA AMBASSADOR
Those originally assigned lutein/zeaxanthin had an additional 20% reduced risk of progression to late AMD.
In the new report, the researchers followed up with 3,883 of the original 4,203 AREDS2 participants, an additional five years from the end of the AREDS2 study in 2011, collecting information on whether their AMD had progressed to late disease, and whether they had been diagnosed with lung cancer.
NEWS 12 INSIGHT August 2022
See more, Treat more The ONLY single-capture ultra-widefield image in less than ½ a second. Enhances practice efficiency and patient experience.2 Helps diagnose pathology earlier.3 Differentiate your practice and increase revenue.2 1. Tornambe, The Impact of Ultra-widefield Retinal Imaging on Practice Efficiency, US Ophthalmic Review 2017. 2. Successful interventions to improve efficiency and reduce patient visit duration in a retina practice, Retina. 2021. 3. Kehoe. Poster 19. Widefield Patient Care. EAOO 2016 Optos’ satisfaction.patienttechnologyretinalultra-widefieldlatestimagingincreasesflowand1 Optos.com T: +61 8 8444 6500 E: auinfo@optos.com Image: Hemi Retinal Vein Occlusion Autofluorescence optomap image
DAVID KOCH JOINS GLAUCOMA
Fitzpatrick is currently a Civil Aviation Safety Authority Credentialed Optometrist (since 2014) and a member of the Lady Cilento Children's Hospital Alignment Program. He was a councillor for the then Queensland Optometry Association from 1974-1981 before serving as state treasurer for the Optometry Queensland/Northern Territory Division from 1981 to 1999, and then a board member of Optometry Australia from 1998-2000. An ophthalmologist in Tamworth since 1991, Moore established his own practice there, North West Eyes, in 2003 and has been recognised for his service to ophthalmology. He is currently a member of the Australian Society of Ophthalmologists, a clinical lecturer at the University of New England, and a clinical tutor with the Geoffrey Fitzpatrick (left), Professor Graham Barrett (top), Dr David Moore (bottom) and Professor Stephanie Watson (right).
Australian TV presenter Mr David Koch, who was diagnosed with glaucoma three years ago, has joined Glaucoma Australia (GA) as an Nicknamedambassador.‘Kochie’,he is one of Australia’s best-known personalities, having co-hosted Seven Network's breakfast program Sunrise for the past 19 years. He’s also the founder and executive chairman of Pinstripe Media, a specialist small business digital agency, and a former chairman of the Port Adelaide Football Club. Koch had no symptoms when he was diagnosed with glaucoma. “My diagnosis of glaucoma came completely out of the blue and was a real wake-up call about the importance of eye checks. My eyesight has never really changed – I’ve had the same strength glasses for 40 years – so I assumed there was nothing wrong with my eyes. Little did I know I had glaucoma,” Koch said. Koch’s glaucoma diagnosis required him to have each eye lasered twice to reduce the pressure in his eyes. He now has regular checks every nine months as part of his glaucoma management plan. “When I visit my ophthalmologist for a visual field test, I can see the cloud at the edge of my vision. It’s not something you see normally because your eye compensates, and the damage is happening slowly without you knowing,” he said. “It really makes me reflect on the possibility of losing my sight. I wouldn’t be able to see my grandchildren growing up, or go travelling with my wife, Libby, all the Three ophthalmologists, including the inventor of intraocular lens (IOL) formulae, and an optometrist, are among leaders in the eyecare profession to be recognised in the 2022 Queen's Birthday Honours.
Watson is also chairperson of Australian Vision Research and Professor of the Faculty of Medicine and Health at the Save Sight Institute. n
“David’s experience shows that glaucoma can easily go under the radar. We hope that sharing his story and sight-saving message to get tested will result in early intervention for many Australians,” Hopkins said. “David’s glaucoma, like that of many Australians, has a hereditary link. That’s why it’s important he shares his story with his children and siblings, so they too can be tested.” n RANZCO Vocational Training Program at Tamworth Hospital.
TV PERSONALITY
FIGHT AUSTRALIAN EYECARE PROFESSIONAL QUARTET RECOGNISED IN QUEEN'S BIRTHDAY HONOURS LIST 2022
Professor Graham Barrett and optometrist Mr Geoffrey Fitzpatrick were awarded Member (AM) in the General Division of the Order of Australia, while Dr David Moore and Professor Stephanie Watson were recognised for their service to ophthalmology with a Medal (OAM) in the GeneralBarrett,Division.whodeveloped the Barrett toric IOL lens calculator in the 2000s as well as other formulae, has been recognised for significant service to ophthalmology, and to professional organisations.Heisfounding president of the Australasian Society of Cataract and Refractive Surgeons, a position he has held since 2000, a former board member of the International Society of Refractive Surgeons and was president of the International Intra Ocular Implant Club from 2014 to 2016. An internationally renowned ophthalmologist, Barrett was involved in the development of the first foldable IOL in the late 1990s, and is currently clinical professor at the Centre for Ophthalmology and Visual Science, University of Western Australia, and a consultant ophthalmologist at St John of God hospital in Subiaco. Fitzpatrick, founder and director of Wilson Fitzpatrick Family Optometrists (now Fitzpatrick Family Optometrists) in Queensland, has been recognised for significant service to optometry, and to the community. He established his practice in 1974 and continued to expand, offering eyecare in Nambour since 1984, Maroochydore since 1986, and the Sunshine Coast and Kingaroy since 1987.
A volunteer pilot and optometrist, he has also been involved in the Trachoma Program run by Fred Hollows Aboriginal Medical Service from 1990-2000.
GA marketing manager Ms Gillian Hopkins said Koch’s story complemented the organisation’s key community awareness campaign, ‘Treat Your Eyes’, which encourages Australians to book in for an eye check, whether or not they’re experiencing problems with their sight.
Moore is director and co-founder of Eye Openers International and director of Go Medical in North Korea. Listed in The Ophthalmologist’s Top 100 Global Power List last year, Watson continues to gain recognition for her service. She is head of the corneal unit at Sydney Eye Hospital, Sydney Children's Hospital and Prince of Wales Hospital, and is cofounder of Save Sight Keratoconus Registry, and co-founder of RANZCO’s Women in Ophthalmology Group in 2018.
things I love doing and seeing. That is the big incentive to ensure I stay on top of my eye health and to share my diagnosis.”
NEWS 14 INSIGHT August 2022
RETINAL DISORDERNEURODEVELOPMENTALSTUDYFIRSTOFITSKIND
Guymer’s team is now working on more objective ways to determine if there is an association between those who do drop their oxygen levels at night and AMD. n Electrical activity of the retina in response to a light stimulus could signal common neurodevelopmental disorders, according to new research from Flinders University and the University of South Australia. In the first study of its kind, researchers found recordings from the retina could identify distinct signals for both Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), providing potential biomarkers. Using an electroretinogram (ERG) – a test that measures the electrical activity of the retina in response to a light stimulus – researchers found children with ADHD showed higher overall ERG energy, while children with ASD showed less.
NEWS 16 INSIGHT August 2022
Guymer said the two conditions may have a physiological link. In sleep apnoea, the throat muscles relax which obstructs airflow and reduces the amount of oxygen the body is able to absorb during the night. As oxygen plays a key role in the restorative process the retina goes through overnight, sleep apnoea could accelerate the progression of AMD. “If we are able to find an association between having sleep apnoea and AMD then currently available treatments for sleep apnoea, such as continuous positive airway pressure (CPAP), may be a potential treatment,” Guymer said. “This is opposed to having to develop a new drug, for example, which takes years.”
Research by Guymer, with medical student Ms Wendy Fang and visiting researcher Dr Palaniraj Rama Raj, has already uncovered some early indications of a link based on patient surveys.
“Retinal signals have specific nerves that generate them, so if we can identify these differences and localise them to pathways that use different chemical signals also in the brain, we can show distinct differences for children with ADHD and ASD and potentially other neurodevelopmental conditions. n
A Tasmanian independent optometry practice that was nominated in several categories in the Telstra 2022 Best of Business Awards has been named state finalist in two categories and crowned state winner in one. Martin’s Eyecare, established by Mr Martin Robinson in 2009 in Glenorchy, near Hobart, was the only optometry practice to feature as a state finalist, state winner and national finalist in the awards.
Robinson, who was appointed a member of the Optometry Board of Australia (OBA) in late 2021, has been the Tasmanian state president of the Cornea and Contact Lens Society of Australia (CCLSA) since 2017, and national vice president since 2018.
PATIENT NOMINATES PRACTICE IN BUSINESS AWARDS
He attended the awards presentation in Sydney in April, where Martin’s Eyecare was announced as the Tasmania state winner of the Championing Health Award and named as a national finalist in the same category. The practice was also a state finalist in Building Communities.
Prof Robyn Guymer (right) and Wendy Fang with a pulse oximeter. Image credit: Anna Carlile.
I attended many lectures and conferences from my computer, read so many publications and articles,” he said. n
“I was advised by a patient that they nominated us, so I went to the [Telstra Business Awards] website and accepted. We were nominated in four categories and accepted and responded to three –Championing Health, Building Communities, and Embracing Innovation and Technology. Of these, we were state finalists in two and state winners in one,” Robinson said. Robinson said the awards process took nearly 12 months, from the initial nomination to the time winners were announced, and involved recorded video statements, a written essay and a video interview with a panel – for each category.
Sleep apnoea is an often undiagnosed condition that is believed to affect as many as a quarter of Australians over 65 years of age. “Sleep apnoea is a very common, often undetected problem in our community, and it’s common in the same group of people who develop age-related macular degeneration,” said Professor Robyn Guymer, CERA deputy director and head of the macular research unit. “We don’t currently ask questions in our eye clinics about sleep apnoea, which seemed like a missed opportunity.”
“The 2020 shutdown due to the initial COVID outbreak led to ceasing all my dry eye consultations and treatments. It led me to search for educational material online with regard to dry eyes,” he said.
Optometrist Martin Robinson (centre) with wife Natalie and a Telstra representative.
“ASD and ADHD are the most common neurodevelopmental disorders diagnosed in childhood. But as they often share similar traits, so diagnoses for both conditions can be lengthy and complicated,” Dr Paul Constable, of Flinders University, said. He hopes their research can demonstrate differences between ADHD and ASD.
POTENTIAL LINK BETWEEN AMD AND SLEEP APNOEA? Discovering new risk factors for agerelated macular degeneration (AMD) has led Centre for Eye Research Australia (CERA)'s macular research unit to investigate links between sleep apnoea and AMD.
He was praised by the Telstra judges for his ability to adapt to the everchanging optical landscape and his philosophy of taking the time to offer tailored care.
“As vice president of the CCLSA I had lengthy discussions with Dr Art Epstein, a dry eye practitioner in Phoenix, while we planned and co-presented the CCLSA Masterclass. All dry eye practitioners worldwide were facing the same problems.
zeiss.com.au NEW ZEISS PhotoFusion X Photochromic lenses perfected. • Sunglass-level darkness outdoors • Up to 2.5× faster to clear** • Unique blue light and full UV protection – outside & indoors. *Compared to previous generation ZEISS PhotoFusion. **Compared to a well-known photochromic brand’s latest generation. perfected.Performance Faster clear. Faster dark.* Lucas Wilson, professional parkour and freerunning athlete, wearing ZEISS PhotoFusion X Grey in clear state.
First time visitors can use registration code: TransPlus. n CooperVision has acquired EnsEyes, the leading supplier of orthokeratology and scleral contact lenses in the Nordic region. The company will operate within the CooperVision Specialty EyeCare group. Headquartered in Kolding, Denmark, EnsEyes has partnered with customers in Denmark, Sweden, Norway, and Finland for the past decade, providing customised lenses and professional education. The acquisition is expected to help accelerate the growth of specialty lens adoption across these markets.
The campaign, called ‘From Screens to Sun. Face the Light’, reinforces how Transitions lenses help to enhance wearers’ vision experience, as screen time and exposure to harsh lighting – both indoors and out – continues to rise for spectacle wearers.
The company said, as a consequence, glasses wearers are becoming more aware of the role lenses play in helping protect and preserve eye health, with 75% agreeing lenses should help to protect from both UV light and blue light. Eyecare professionals have also taken note, with more than 70% agreeing their patients have become more sensitive to eyecare and protection since the pandemic began.
The day after his death, the EssilorLuxottica board met and appointed Mr Francesco Milleri as its new chairman for the remaining duration of his mandate. Milleri will also carry on assuming his term as CEO of EssilorLuxottica.DelVecchiowas still actively involved in the industry, meeting Facebook founder Mr Mark Zuckerberg in Milan in May when he was shown a prototype of Zuckerberg’s neural interface wristband that will eventually let wearers control their glasses and other devices. n ACQUIRES LEADING SPECIALTY LENS SUPPLIER
“Our new campaign promotes Transitions lenses as a light management solution to help glasses wearers to face the intense light situations they encounter in their daily lives,” said Mr Adam McMahan, Transitions Optical key account manager for ANZ. ‘From Screens to Sun. Face the Light’ is featured in large scale outdoor advertising across Victoria, NSW and Queensland. New in-store materials and marketing assets – including window posters, wall posters, counter cards, static and animated visuals, videos and social media posts – will communicate how Transitions lenses: block 100% of UVA and UVB rays, filter blue light from digital devices and screens indoors to bright sunlight outdoors, and help reduce glare by optimising the amount of light eyes receive. Point-of-sale materials and marketing assets are available for free from Transitions Plus www.transitions-plus.com.
A new Transitions Optical campaign highlights how its lenses help to protect eyes from ultraviolet rays and blue light, in response to consumer feedback.
NORDIC
GLOBAL EYEWEAR ‘VISIONARY’ AGED 87
The company’s directors paid homage to Del Vecchio who passed away peacefully on 27 June 2022. “He will forever be remembered for his values, robust leadership, passion, exceptional character as well as his dedication toward the company and its employees,” an EssilorLuxottica statement said. Essilor Group stated: “The world has lost a visionary: an entrepreneurial genius, a good friend to many, and an all-round incredible man.”
Leonardo Del Vecchio, 87. Image: EssilorLuxottica. CooperVision is one of the world’s leading contact lens companies.
DIES
The new ‘From Screens to Sun. Face the Light’ campaign.
Dr Juan Carlos Aragón, president of CooperVision Specialty EyeCare, said the company has collaborated with EnsEyes for years, including its MyProcornea system for lens ordering. “Joining CooperVision will give [EnsEyes'] highly respected team more resources for growth, further build the expertise of our organisation, and support eyecare professionals’ soaring enthusiasm for specialty fitting," he said.
Born in 1935, Del Vecchio founded Luxottica at the age of 26, during Italy’s economic boom of the 1960s, in a small mountain town in the Veneto region, where the local administration offered land to anyone willing to start a business. Luxottica went on to merge with French lens manufacturer, Essilor, in 2017 in a €50 billion (AU$76 b) deal. That year, he established the Leonardo Del Vecchio Foundation to support charitable and non-profit initiatives.
EnsEyes founder – optometrist and former CooperVision executive Mr Esben Nørregaard Sørensen – will remain with the company. n
18 INSIGHT August 2022 COMPANY NEW CAMPAIGNTRANSITIONSFOCUSES
ON UV AND BLUE LIGHT
COOPERVISION
A recent Transitions study found since the beginning of the pandemic, 66% of prescription glasses wearers said they spend more time in front of digital screens and 22% of consumers report spending more time going outside into bright sunshine.
EssilorLuxottica chairman Mr Leonardo Del Vecchio, who was raised in an orphanage and went on to become Italy’s second-richest man through his optical business empire, has aged 87.
*95-100% of children expressed a preference for contact lenses over glasses at each visit over 36 months. †’How much do you like wearing your contact lenses?’ 87/97 (90%) Top box ‘I like contact lenses the best’ Subjective response at 60 months. ‡Compared to a single-vision, 1-day lens over a three-year period; rate of progression maintained out to 6 years. On average, there was no indication that accumulated treatment effect gained following 3 or 6 years of MiSight® 1 day wear was lost during a 12-month cessation study in children aged 8-15 at initiation of treatment. Instead, eye growth reverted to expected, age average myopic progression rates. References: 1. Sulley A et al. Wearer experience and subjective responses with dual focus compared to spherical, single vision soft contact lenses in children during a 3-year clinical trial. AAO 2019 Poster Presentation. 2. CooperVision® data on file, 2019. 3. Chamberlain P et al. A 3-year randomized clinical trial of MiSight® lenses for myopia control. Optom Vis Sci 2019;96:556–567. 4. Chamberlain P et al. Myopia Progression in Children wearing Dual-Focus Contact Lenses: 6-year findings. Optom Vis Sci 2020;97(E-abstract):200038.
5. Chamberlain P et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7 year findings. Optom Vis Sci 2021;98:E-abstract 210049.
children prefer MiSight® 1 day to glasses1,2*† 10
-10.00D
Proven by 7 years of clinical data to significantly slow myopic progression with no rebound effect Supported by the Brilliant Futures™ myopia management program
Further information at childmyopia.com and coopervision.net.au / coopervision.co.nz
9/
6. Hammond D et al. Myopia Control Treatment Gains are Retained after Termination of Dual-focus Contact Lens Wear with no Evidence of a Rebound Effect. Optom Vis Sci 2021;98:E-abstract 215130. For instructions for use refer to https://coopervision.net.au/patient-instruction. MiSight®, Brilliant Futures™ and CooperVision® are registered trademarks of the Cooper Companies, Inc. and its subsidiaries. EMVCOO0841 ©2022 CooperVision. UP TO
In light of this, RANZCO pays particular attention to the importance of outdoor light exposure. It suggests the adoption of a more nuanced public policy for sunlight exposure that aims to optimise UV exposure to reduce skin malignancy, but not to the level that results in vitamin D deficiency. And, importantly, maintains exposure to sufficient high-intensity sunlight to minimise myopia progression.
How much outdoor light should children be getting to avoid myopia progression, and to what level? RANZCO addresses this issue in a recently-released position paper on methods to tackle progressive myopia.
SUNLIGHT’S ESSENTIAL ROLE IN slowing myopia
“In adulthood myopia can be managed using contact lenses, refractive laser surgery, implantable contact lenses and lens exchange surgery, especially for people who have distortions from their glasses or want to undertake activities not conducive to wearing glasses.”
However, expert consensus highlights the importance of involving an ophthalmologist.RANZCOstresses that myopia is not confined to children, and it is possible for adults to develop it later in life.
“In recommending children increase outdoor time, a child’s subsequent risk of skin cancer and UV-related eye diseases, including periorbital skin cancers, ocular surface tumours including limbal squamous cell carcinomas, pterygium, cortical cataract and increased risk of age-related macular degeneration, must be balanced with their risk of myopia,” the college states.
W hile acknowledging the multitude of effective product-based interventions, RANZCO’s new position paper on progressive myopia focuses on the importance of a natural remedy – outdoor light exposure. In fact, it’s advocating for a more nuanced public health policy that incorporates increased outdoor time to limit progression in children while protecting against UV light exposure.
“By increasing the exposure of the paediatric eye to an increased lux of visible light and limiting a child’s exposure to UV radiation, it should be possible to limit both UV-related eye diseases and myopia.”
“Patients and their families must understand that any attempt to prevent or slow myopia is ‘playing a long game’, and the potential benefits are largely some decades in the future.” n
A COLLABORATIVE APPROACH TO MYOPIA MANAGEMENT
“The minimisation strategies, signs and steps to management remain the same. It is more common in families with myopia, but with increasing prevalence we all can be affected and need to be aware,” the paper says. “Glasses are the most common tool for managing myopia, allowing images in the distance to become focused. Drops can be prescribed to slow myopia progression and reduce the risk of developing severe myopia.
RANZCO recommends children spend at least two to three sun-protected hours outdoors, per day.
The college board approved its RANZCO Position Statement: Progressive Myopia in Childhood on 25 May to coincide with Myopia Awareness Week (23-28 May). It works to provide guidance to RANZCO Fellows and other health professionals regarding best practices for diagnosis and treatment.
Furthermore, spending less than 40 minutes outdoors per day was associated with more rapid axial length progression. “Hence, it is recommended that at least two to three hours of outdoor of bright light to maintain normal untreated eyes in a hyperopic state. Instead, their data suggest that the ability of light to retard the development of deprivation myopia is driven by intensity-dependent increases in retinal dopamineRANZCOrelease.”alsopoints to a Singaporean study that used child mannequin heads with sunglasses and a hat for UV protection to assess the effect of different outdoor environments on the lux of light reaching the eye. Even with UV protection, the light levels were still 11 to 43 times higher than indoors.“Thislight level was considered sufficient for myopia control if outdoor exposure was undertaken for at least two hours per day,” the paper added.
Overall, it says only relatively short-term outcomes of treatment exist and there is little data concerning the value of additive treatments, such as combining environmental, optical, and pharmacological interventions. However, the college paper highlights various studies such as ATOM2 (out to five years) and LAMP (out to three years) in atropine, and five-year data on dual focus spectacles (Hoya just published six-year data for its lens), and six-year data on novel design contact lenses.
WHAT THE STUDIES SAY The paper noted a meta-analysis by Ho CL et al assessing the doseresponse relationship between outdoor exposure and myopia indicators that found more than 120 minutes of daily outdoor light exposure decreased myopia incidence by 50%, spherical equivalent refraction by 32.9% and axial elongation by 24.9% for Asian children aged 4–14 years.
20 INSIGHT August 2022 MYOPIA
RANZCO also states that co-management, collaborating with optometrists and orthoptists for ongoing care, is considered the best-practice approach.
Noting that by 2050 10% of the global population is predicted to have high myopia – defined as myopia of ≥ -6.0 D and axial length of ≥ 26.0 mm or more in either eye – RANZCO acknowledges the impact of various interventions such as defocus spectacles and contact lenses, as well as orthokeratology and atropine.
Finally, RANZCO states that any treatment initiated in childhood aims to reduce the burden and incidence of high myopia.
All the options for myopia management DV1294-0722 Call 1800 225 307 dfv.com.au The OCULUS Pentacam® family expands its diagnostic capabilities with integrated optical biometry available on the Pentacam® AXL and AXL WAVE The optional Pentacam® Corneal Scleral Profile (CSP) scan offers tear film independent corneal-scleral tomography, generating sagittal height measurements and enabling custom scleral lens design and fitting. The NIDEK AL-Scan offers fast and easy 3D-tracked keratometry, optical biometry (axial length), pupil size, horizontal visible iris diameter (HVID), central corneal thickness (CCT) and anterior chamber depth (ACD). Also available with optional PC NAVIS database software and Barrett II IOL calculation. OCULUS Myopia Master® combines the most important parameters to make Myopia Management easier than ever. It measures refraction, axial length and keratometry in one stylish unit, backed by the most comprehensive myopia software suite. Exclusively powered by the latest Brien Holden Vision Institute data, you can create personalised reports detailing current myopia status and the likely outcome in adulthood, plus track the progress of any treatments prescribed. 1 2 3 4 Myopia progression moderated - treatment effectiveness verified
Following clinical trials demonstrating the myopia control effects of orthokeratology, the lenses are increasingly prescribed to children for the treatment of progressive myopia. Meta analyses, which pool data from various clinical trials, have reported an overall 41-45% reduction in myopia progression in children treated with orthokeratology compared to the single vision correction.5-7 It has been hypothesised that changes in the retinal optical profile (induction of myopic defocus) following orthokeratology lens wear may be responsible for the myopia control effects.8
ATROPINE Atropine is also becoming an increasingly popular treatment for progressive myopia, with large randomised controlled trials demonstrating myopia control effects with low concentration atropine.9-11
• Identify patients best suited for combination orthokeratology/ low-concentration atropine treatment for myopia
• Understand the elements of a thorough baseline assessment of myopic patients
• Gauge efficacy of combination treatment in myopia management
CPD 22 INSIGHT August 2022
Orthokeratology involves the overnight wear of specialised rigid contact lenses. The lenses incorporate a reverse geometry lens design that gently reshapes the anterior cornea to correct ametropia, most commonly myopia.4
A xial elongation underlying myopia development and progression predisposes the eye to various sightthreatening complications including myopic maculopathy, retinal detachments, tears and degeneration and glaucoma.1 The persistent and progressive nature of excessive axial elongation underlying myopia has prompted the investigation of various optical and pharmacological interventions to slow or stop childhood myopia progression including orthokeratology and low concentration atropine eye drops.2, 3
The first prospective study to investigate the IS TWO BETTER THAN ONE?
Study 1: combination treatment effective in cases with low baseline myopia
CLINICAL STUDIES ON COMBINED TREATMENTS
If orthokeratology and atropine induce myopia control effects through different mechanisms, combining treatments may result in a synergistic effect and improve overall treatment efficacy. Although limited, some studies have started to investigate the effects of combining orthokeratology and atropine monotherapy treatments.Despitethe fact that the LAMP study indicated 0.05% to be the ideal atropine concentration for myopia,9 recent studies exploring combining orthokeratology with atropine treatment have included 0.01% atropine and positive outcomes have so far been reported.
COMBINING TREATMENTS FOR MYOPIA CONTROL
• Review a case study exemplifying the adoption of combination treatment LEARNING OBJECTIVES: efficacy of combined orthokeratology and low-concentration atropine treatment involved 73 Japanese children aged eight to 12 years who were randomised to either a combination (orthokeratology plus 0.01% atropine; n=43) or a monotherapy (orthokeratology; n=37) treatment group.15 After two years of treatment, there was a significant difference in overall axial elongation between groups with less myopia progression in the combination treatment group (combination 0.29 ± 0.20 mm, monotherapy 0.40 ± 0.23 mm; p=0.03). The greatest change in axial elongation occurred during the first year of treatment.15 As greater differences in treatment groups were found in children with lower baseline myopia (-1.00 to -3.00 D), the study authors suggested combination treatment may be effective in children with low baseline myopia.15
ABOUT THE AUTHOR: Dr Pauline Kang B Optom (hons) GradCertOcTher PhD FAAO School of Optometry and Vision Science, UNSW, Sydney, Australia
The recent Low-Concentration Atropine for Myopia (LAMP) study investigated three concentrations of atropine (0.01%, 0.025% and 0.05%) and monitored myopia progression in 350 children aged four to 12 years over a twoyear period. Defined by both axial length and refractive error changes, a dose-dependent effect was reported with higher concentrations of atropine resulting in greater reduction of myopia progression.9
Vision-related quality of life was also found to be similar between the three concentrations.9 Atropine is hypothesised to induce myopia control effects through blocking of muscarinic receptors in the retina and/or sclera,12, 13 or potentially stimulating α2-adrenoceptors involved in axial elongation.14 However, underlying treatment mechanism remains overall poorly understood.
As myopia rates soar globally, the search for optimal clinical interventions continues. A new avenue of research suggests there is a synergistic effect to a combined atropine and orthokeratology management approach. DR PAULINE KANG outlines when this may be an appropriate intervention. At the completion of this CPD activity, optometrists will have developed their knowledge of myopia management.
ORTHOKERATOLOGY
Including:
The study authors proposed 0.05% atropine concentration to be optimal, as it demonstrated the greatest myopia control effect over the twoyear treatment period – approximately 64.5% reduction in myopia progression compared to a predictive myopia progression model when defined through spherical equivalent changes.
To assess the efficacy of treatment, clinicians need to compare the patient’s eye growth rate to that expected from an emmetropic child of comparable age.22 There have been large population-based studies reporting axial length growth curves which can be used in assisting clinical decision making.23-25 Overall, axial length growth is faster in younger (approximately less than 10 years) compared to older children. Emmetropic axial length growth of approximately 0.1-0.2 mm/year have been reported in younger children and approximately 0.1 mm/year in older children.23-25 Axial eye growth greater than these values may indicate myopia progression and poor treatment response. However, these are simplified average values and clinicians must take into factors such as baseline axial lengths, gender and ethnicity, which will also influence axial eye growth.
• Myaapia: www.myopia.care/public_ myappia
Myopic children who have multiple risk factors20 for myopia – including family history of myopia, longer baseline axial lengths, young age of myopia onset, spend little time outdoors and conduct significant periods of near work – may also be suited for combination treatment.
Currently, the only orthokeratology lens approved by TGA ‘to control myopia’ is the Menicon Night Bloom. If prescribing other orthokeratology lens designs or concentrations of atropine other than 0.01%, clinicians may consider creating patient information and consent forms highlighting the off-label nature of myopia control treatment, and to highlight potential treatment sides effects and risks. Patients should be informed of appropriate orthokeratology lens wear and atropine use
AND
A clinical trial underway Currently, there is a randomised controlled multicentre clinical trial under way involving a group of children treated with orthokeratology and 0.01% atropine and another treatment group of orthokeratology and placebo eye drops which will be investigated over a two-year treatment period.19
Other clinical considerations
Study 2: increased treatment efficacy –in first six months
• One day • Four to seven days
Current studies have mainly investigated 0.01% atropine concentration for combination treatment. With the recent Therapeutic Goods Administration (TGA) approval of EIKANCE 0.01%, Australia’s first low-concentration atropine eye drop for myopia control, this may be an ideal concentration to initially prescribe.
ASSESSING EFFICACY OF TREATMENT
• One month • Three months
• Accommodation and vergence functions
CONTINUING TO
TREATMENT.” DR
• Then six monthly Review consultations will typically include part of the assessment conducted at baseline including refraction, ocular health, corneal topography and axial length measurements.
BE
• Corneal topography
• BHVI Calculator: calculator-resources/bhvi.org/myopiaARE DEMONSTRATE MYOPIA PROGRESSION ON TREATMENTORTHOKERATOLOGYORMYOPICCHILDREN HAVE LOW BASELINE MYOPIA MAY BEST SUITED TO ORTHOKERATOLOGY LOW CONCENTRATION ATROPINE COMBINATION PAULINE KANG UNSW
WHILE
• PreMO – risk for developing myopia website.pdf)file/0011/826184/PreMO-risk-indicator-for-(www.ulster.ac.uk/__data/assets/pdf_
Preliminary one-year results were published with similar outcomes; combination treatment resulted in better myopia control (combination 0.07 ± 0.16 mm, monotherapy 0.16 ± 0.15 mm; p=0.03).16 The efficacy of myopia control increased from 57% to 81% reduction in myopia progression when atropine was added to orthokeratology treatment when compared to the historical control group from the previous Reduction in Myopia in Orthokeratology (ROMIO) clinical trial. However, the difference in myopia progression was evident during the first six months of treatment only.16
A thorough baseline assessment of patients is imperative in myopia management. As recommended by the International Myopia Institute Clinical Guidelines,21 assessment should
ASSESSMENT OF PATIENTS UNDERGOING COMBINATION TREATMENT
• Ocular health including intraocular pressure and pupil responses
• MyoCal: www.myopia.care/public_eye_ length
WHO
Based on the outcomes of recent clinical trials, myopic children who are continuing to demonstrate significant myopia progression while on orthokeratology treatment17 or myopic children who have low baseline myopia may be best suited to orthokeratology and low concentration atropine combination treatment.15
Free online tools and calculators to help clinicians determine if adequate myopia control has been achieved with treatment using both axial length and refraction values…
To monitor treatment safety and efficacy of combination treatment and fit of orthokeratology lenses, regular review schedules should be arranged according to the following schedule:21
• Axial length (ocular biometer, if available)
Study 3: significantly-reduced progression with combination treatment
If patients continue to demonstrate significant myopia progression while on combination orthokeratology and atropine treatment, clinicians may consider increasing atropine concentration although future studies to determine the ideal concentration of atropine are required, as well as the longer term treatment effects. Current studies suggest that treatment effects may only occur during the initial six to 12 months of treatment.15, 16
Another retrospective study investigated combining orthokeratology with different concentrations of atropine: 0.025% and 0.125%. Patients were stratified as having myopia <6 D or ≥6 D and self-selected to either be treated with orthokeratology lenses alone, or in combination with atropine, and treatment over two years was evaluated.18 Adding either concentration of atropine to orthokeratology treatment was found to have a positive effect although differences in treatment effect between the lower and higher concentrations of atropine were not assessed.18
Study 4: OK with different concentrations of atropine
SELECTING PATIENTS FOR COMBINATION TREATMENT
SIGNIFICANT
A retrospective study investigated the impact of adding 0.01% atropine treatment in 60 Chinese children under the age of 12 who had experienced myopia progression of greater than 0.25 mm/year while undergoing orthokeratology treatment for one year. Treatment efficacy was compared to a historical control group (n=29).17 In agreement with previous studies, authors reported significantly-reduced myopia progression during the second year with combination treatment compared to the first year with orthokeratology monotherapy and to the control group.17
The Atropine with Orthokeratology (AOK) study also investigated the additive effect of combining orthokeratology with 0.01% atropine over two years. The study involved six to 11-year-old children in Hong Kong who were randomly allocated to a combination (orthokeratology plus 0.01% atropine; n=29) or a monotherapy (orthokeratology; n=30) treatment group.16
INSIGHT August 2022 23 "MYOPIC CHILDREN WHO
•include:History taking • Refraction (non-cycloplegic and/or cycloplegic as indicated) and visual acuity
21. Gifford KL et al. IMI - Clinical management guidelines report. Invest Ophthalmol Vis Sci 2019;60:M184-M203.
14. Carr BJ et al. Alpha2 -adrenoceptor agonists inhibit form-deprivation myopia in the chick. Clin Exp Optom 2019;102:418-425.
19. Yuan Y et al. Efficacy of combined orthokeratology and 0.01% atropine for myopia control: the study protocol for a randomized, controlled, double-blind, and multicenter trial. Trials 2021;22:863.
The patient was unable to seen at the UNSW Myopia Clinic throughout the first half of 2020 due to the first NSW COVID-19 lockdown during which he experienced myopia progression (axial length increase RE 0.17 mm and LE 0.16 mm in approximately seven months). He was then monitored closely during the second half of 2020 where he demonstrated further progression (axial length change RE 0.12 mm and LE 0.16 mm in approximately 5 months). This prompted discussion of adding low concentration atropine treatment to his myopia management.Thepatientdid not opt for atropine treatment and was unable to seen again during the first few months of 2021 due to the second NSW COVID-19 lockdown. Adjunct 0.025% atropine treatment was then initiated in May 2021 (red arrow in Figure 1) after which axial length was stable for the remainder of the year. The higher 0.025% atropine concentration was selected as the patient had several myopia risk factors including positive family history, longer baseline axial lengths and regular long periods of near work. n
5. Si JK et al. Orthokeratology for myopia control: a metaanalysis. Optom Vis Sci 2015;92:252-257.
CASE STUDY
18. Wan L et al. The synergistic effects of orthokeratology and atropine in slowing the progression of myopia. J Clin Med 2018;7.
15. Kinoshita N et al. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Sci Rep 2020;10:12750.
including instillation of drops at least five to 10 minutes prior to wearing orthokeratology lenses at night.15, 16 Multiple modes of instruction including verbal, written or visual (video) are recommended.
NOTE: Optometry Australia members can scan the QR code or visit the online version of this article at insightnews.com.au/cpd/ to enter their details to have their CPD hours automatically updated to their Learning Plan. Event ID: 90004298, Session ID: 10838. 2022
REFERENCES
8. Kang P, Swarbrick H. New perspective on myopia control with orthokeratology. Optom Vis Sci 2016.
Case study - refractive error changes Year Right EyeLeft Eye May 2016-1.25/-0.50 x 100 -1.25/-0.25 x 130 2016-1.50/-0.50 x 95 -1.75/-0.50 x 165 2017-2.00/-0.50 x 100 -2.00/-0.75 x 155 2018-3.75/-0.50 x 94 -3.75/-0.75 x
11. Chia A et al. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia control with atropine 0.01% Eyedrops. Ophthalmology 2016;123:391-399.
13. Arumugam B et al. Muscarinic antagonist control of myopia: evidence for M4 and M1 receptor-based pathways in the inhibition of experimentally-induced axial myopia in the tree shrew. Invest Ophthalmol Vis Sci 2012;53:5827-5837.
16. Tan Q et al. Combined atropine with orthokeratology for myopia control: Study design and preliminary results. Curr Eye Res 2019;1-8.
20. Morgan IG et al. IMI - Risk factors for myopia. Invest Ophthalmol Vis Sci 2021;62:3.
152 CPD
3. W ildsoet CF et al. IMI - Interventions for controlling myopia onset and oprogression report. Invest Ophthalmol Vis Sci 2019;60:M106-M131.
June
9. Yam JC et al. Two-year clinical trial of the Low-Concentration Atropine for Myopia Progression (LAMP) study: Phase 2 report. Ophthalmology 2020;127:910-919.
2. Jonas JB et al. IMI - Prevention of myopia and its progression. Invest Ophthalmol Vis Sci 2021;62:6.
1. Haarman AEG et al. The complications of myopia: A review and meta-analysis. Invest Ophthalmol Vis Sci 2020;61:49.
July
A 9-year-old boy presented to the UNSW Myopia clinic in November 2018 with a history of myopia progression as determine by refractive error changes as shown in Table 1. Both parents are moderately myopic (positive family history) and the patient is an avid reader (two to three hours per day). Cycloplegic subjective refraction and axial lengths (ZEISS IOLMaster 700) were found to be RE -4.50/-0.50 x 100 and 24.62mm, and LE -4.50/-0.50 x 155 and 24.59 mm. After discussion of various myopia control treatment options including atropine, orthokeratology and multifocal contact lenses, orthokeratology treatment was selected, and lens fitting was initiated two weeks later. The patient was seen for several follow up visits to finalise orthokeratology lens fit after which myopia progression was regularly monitored as shown in Figure 1. During 2019, axial length measurements in both eyes were overall stable and demonstrated little myopia progression.
Table 1: Refractive error changes of a 9-year-old boy who was eventually prescribed orthok and 0.025% atropine.
April
4. Swarbrick HA . Orthokeratology review and update. Clin Exp Optom 2006;89:124-143.
7. Wen D et al. Efficacy and acceptability of orthokeratology for slowing myopic progression in children: A systematic review and meta-analysis. J Ophthalmol 2015;2015:360806.
24 INSIGHT August
6. Sun Y et al. Orthokeratology to control myopia progression: a meta-analysis. PLoS One 2015;10:e0124535.
23. Tideman JWL et al. Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol 2018;96:301-309.
22. Chamberlain P et al. Axial length targets for myopia control. Ophthalmic Physiol Opt 2021;41:523-531.
25. Sanz Diez P et al. Growth curves of myopia-related parameters to clinically monitor the refractive development in Chinese schoolchildren. Graefes Arch Clin Exp Ophthalmol 2019;257:1045-1053
Figures 1: Patient case study's myopia progression. Adjunct treatment commenced at red arrow point.
10. Chia A et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology 2012;119:347-354.
12. McBrien NA et al. The M4 muscarinic antagonist MT-3 inhibits myopia in chick: evidence for site of action. Ophthalmic Physiol Opt 2011;31:529-539.
17. Chen Z et al. Adjunctive effect of orthokeratology and low dose atropine on axial elongation in fast-progressing myopic children-A preliminary retrospective study. Cont Lens Anterior Eye 2019;42:439-442.
24. Rozema J et al. Axial growth and lens power loss at myopia onset in Singaporean children. Invest Ophthalmol Vis Sci 2019;60:3091-3099.
MYOPIALENSTAR DISCOVER MYAH:DISCOVER LENSTAR MYOPIA: *Lenstar Myopia is supplied by Device Technologies in Australia only. Precise, repeatable and reliable AL Measurements 32 Point Keratometric Assessment Central Corneal Thickness Measurements APS - Automatic Positioning System makes taking measurements EASY! Detailed Software Analysis tools with latest growth curves from Erasmus University Corneal Topography including keratoconus screening and AxialpupillometryLengthmeasurement by Optical Low Coherence ProgressionInterferometryreports for analysing treatment efficacy Comprehensive suite of Dry Eye assessment tools Compact, space-saving, easy to operate BUILD, MANAGE AND GROW YOUR MYOPIA & DRY EYE PRACTICE YOUR COMPANION FOR MYOPIA MANAGEMENT MYAH YOUR MYOPIA MANAGEMENT DIAGNOSTIC SPECIALIST AUS 1300 DEVICE (338 www.device.com.aucustomers@device.com.au423) NZ 0508 DEVICE (338 www.device.co.nzcustomers@device.co.nz423) RA:29062022NR
2Lam CS, et al. Myopia control in children wearing DIMS spectacle lens: 6 years results. Invest Ophthalmol Vis Sci. 63;2022: ARVO E-Abstract 4247.
MiYOSMART spectacle lens with D.I.M.S. Technology reduces myopia progression on average by 60% in children aged 8-13 years, shown by a 2-year randomised controlled clinical trial.1 In a 6-year long-term follow-up clinical study, results in the group of children wearing MiYOSMART spectacle lens showed that the myopia control effect was sustained over time for children wearing the DIMS spectacle lens.2 Children who stop wearing MiYOSMART spectacle lens show no rebound effects when compared to the initial myopia rates of progression during the two-year randomised controlled trial or with the age-matched non-treated population.2 Now you can enhance your practice’s myopia management capabilities by adding Lenstar Myopia by HOYA as a companion to MiYOSMART spectacle lenses.
MiYOSMART is now available for practices who meet accreditation criteria. Lenstar Myopia is distributed by Device Technologies. For more information please contact your HOYA Sales Consultant or call 1800 500 971.
Lenstar Myopia by HOYA
1Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV spectacle lenses.
Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology. Published Online First: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739.
The smart companions for managing myopia, together
MANAGING MYOPIA SPECTACLE LENSESWITH
At the completion of this CPD activity, optometrists will have developed their knowledge of myopia management. Including:
• Understand the rationale behind myopia control through the reduction of peripheral retinal defocus
CPD INSIGHT August 2022 27
Figure 1. Bifocal/Progressive addition lenses Figure 2. Peripheral Defocus spectacles
Excessive near-work promotes accommodative lag or dysfunction which, in turn, results in hyperopic defocus at the central retina. Hyperopic defocus has been considered a stimulus for myopia progression. Therefore, bifocals and progressive-addition lenses (PALs) have been used to reduce accommodative lag/dysfunction and with that, myopic progression (Table 1). Results from multiple, well-conducted clinical trials indicated that the slowing of myopia progression with bifocals and PALs was not clinically-meaningful.2 There have been some exceptions. For example, use of executive bifocals both with and without prisms resulted in significant myopia control effect with higher efficacy in groups with low lag of Myopia-controlaccommodation.bifocalsandPALs are available in the market with pre-specified add power for the near-segment. If these are not an option, then the clinician may customise an existing PAL by selecting/prescribing the add power (clinical trials have used add power ranging from +1.50 to +2.50 D) that best suits the individual. With both bifocals and PALS, the wearer is required to shift their gaze to look through the inferiorly-placed add segment for near tasks. Understandably, compliance becomes a major determinant for the success of these lenses. In addition, off-axis performance of these lenses could be affected due to the distortion and astigmatism induced by PALs. How these might influence myopia control remains uncertain. Although the introduction of newer spectacle lens options has led to a drift hyperopic defocus at the peripheral retina could induce central myopic refractive error and
• Understand the mechanisms of action for multi-segment spectacle lenses
There are many advantages to spectacle lens-based myopia management: they’re easy to fit, affordable and minimally-invasive. But, as PROF PADMAJA SANKARIDURG points out, as these technologies evolve, it’s becoming more important for practitioners to understand how they work and when to prescribe.
BIFOCAL AND PROGRESSIVE ADDITION LENSES
• Understand the use of progressive-addition lenses (PAL) to slow myopia progression
• Understand the rationale for diffusion optic technology (DOT) for reducing axial elongation
LEARNING OBJECTIVES:
additionally, even in the absence of a functioning fovea, the peripheral retina alone could direct commonly incorporated a clear central portion/ zone devoted to correcting the myopic error of the ABOUT THE AUTHOR: Padmaja Sankaridurg BOptom MIP PhD Head, Myopia; Head, Intellectual Property, Brien Holden Vision ConjointInstitute Professor, School of Optometry and Vision Science, University of New South Wales Advisory Board Member, International Myopia Institute
T he art of correcting or neutralising myopic refractive error with a concave optical lens is centuries old.1 This practice remained largely unchanged until approximately 25 years ago when the needle shifted due to the fast-rising global prevalence of myopia and high myopia. The rising burden and improved aetiological understanding of myopia development, primarily from animal experiments, spurred a breakthrough in optical lens designs (spectacles, contact lenses and orthokeratology) that not only correct, but also control, myopia progression.2 Although early-generation myopia-control spectacles showed promise in slowing myopia, their efficacy was limited in comparison to contact lens or pharmaceutical technologies. However, the more recent spectacle lens technologies –lenses with discrete or multiple lens segments – demonstrate high levels of efficacy and hold promise for a new era of myopia control with spectacle lenses.
Figure 3. Defocus incorporated multiple segments (D.I.M.S) Figure 5. Diffusion Technology
AdditionBifocal/Progressivelenses
Peripheral Defocus spectacles Defocus incorporated multiple segments Highly aspherical lenslet technology Diffusion Technology
Table 1: Summary of myopia control spectacle designs. CPD eye. The surrounding peripheral zone is relatively positive compared to the central zone. With these lenses, the wearer is simply required to maintain fixation through the central clear portion of the spectacle lens. The impact of eye gaze and rotation on myopiacontrol efficacy remains uncertain. Furthermore, similar to PALs, the lenses suffer from unwanted aberrations in certain peripheral regions and therefore, they are likely to influence off-axis performance, compliance and myopia-control efficacy. Additionally, in younger children that require a small frame, the exposure to the myopia control region may not be substantial.
MULTI-SEGMENT SPECTACLE LENSES
segment lenses include a clear central zone that corrects for the myopic refractive error. However, in contrast to the peripheral defocus spectacles, where the transition from the central to the peripheral defocus region is a continuous ghly aspherical lenslets (approximately 1.2mm in diameter, aspherical power profile). In clinical studies of one-to-two years in duration, a significant treatment effect was observed with both D.I.M.S and HAL Additionally, in the trial involving HAL lenses, slightly aspherical lenslets (SAL) were also trialled but were found to be slightly less efficacious than HAL.8
The D.I.M.S lens has the segments arranged in the mid periphery (dispersed over 33 cms in a honeycomb pattern with a clear peripheral zone).Incomparison, the HAL lenslets are arranged contiguously in a ring formation surrounding the clear central zone with rings extending up to the periphery of the lens. The power of the aspherical lenslets is said to vary between the rings (all lenslets in each ring have the same power). Both are tailored to induce myopic defocus at the retina. When viewed off-axis through the myopia control elements of HAL, some loss of high contrast visual acuity and loss of contrast Like the more recent myopia control spectacle lens designs, diffusion lenses incorporate a clear central zone, beyond which there are dots that are non-refractive in nature. The underlying hypothesis for the DOT technology efficacy is based on the reduction of contrast differential between neighbouring photoreceptors. High contrast differential is thought to stimulate axial elongation and therefore the technology aims to lower contrast using diffusive dots that scatter light.15
Figure 4. Highly aspherical lenslet technology (HAL)
Clear centralasymmetriczonedesigned to accommodate near viewing: surrounding peripheral zone is relatively positive. The positive power increases towards periphery. Clear central zone: multiple discrete segments of Clear central zone: highly aspherical lenslets in a Clear central zone: peripheral zone with diffuse Schematic
Lens design Upper segment for distance viewing; near segment that is relatively positive compared to distance segment.
Rationale Reduce accommodative lag.11,12 Reduce peripheral retinal defocus.13,14 Simultaneous myopic defocus.7 Induce a volume of myopic defocus at the retina.8 High contrast differential between neighbouring cones drives growth; reduce retinal contrast with diffusive dots.15
Published peer reviewed data is not available but media reports indicate that after two years of lens wear the lenses were able to significantly slow myopia progression in compliant wearers. Not much is known about the performance
KEY QUESTION How do myopia control spectacles compare with other myopia management options and is myopia control rate all that matters? The myopia control efficacy of the newer spectacle lens options is comparable or possibly higher than orthokeratology, dual focus contact lenses or low-dose atropine. However, it should be noted that the efficacy of the multiple segment spectacle category is based on data from fewer trials. In contrast, the efficacy of soft contact lenses, orthokeratology and atropine has been assessed in multiple, independent and randomised clinical trials. A spectacle lens design that has meaningful myopia-control efficacy has significant appeal for use in children. Younger children progress faster10 and there is a general reluctance to fit young children with contact lenses or orthokeratology or introduce them to pharmaceutical options. Therefore, a spectacle lens-based strategy is beneficial. Even if children were to be prescribed with a pharmaceutical agent such as atropine or a myopia-control contact lens, they would need
In summary, over the past couple of decades, significant progress has been made in the field of spectacle lenses for myopia management. The availability of products coupled with the knowledge that any level of myopia is a burden has resulted in a change in the standard of care for the myope. Beyond the availability of the product, the expertise of the practitioner is critical in steering the myope to a successful outcome. n
of these lenses. However, based on the description one might expect some reduction in off-axis vision performance.
NOTE: A full list of references can be found in the online version of this article.
NOTE: Optometry Australia members can scan the QR code or visit the online version of this article at insightnews.com.au/cpd/ to enter their details to have their CPD hours automatically updated to their Learning Plan. Event ID: 90004123, Session ID: 10482. to be prescribed a pair of spectacle lenses that correct for vision when using atropine or when contact lenses are not worn. Furthermore, with higher concentrations of atropine, there needs to be an add power for near viewing. Prescribing an optimised and an appropriate myopia control spectacle lens in combination with atropine or with contact lenses is likely to improve the outcome of either atropine or contact lens alone. However, this area remains to be Withexplored.allmyopia control spectacle lens types (apart from progressive addition spectacles where the practitioner has to choose a target add power), a single product design is available in the market and appears to be based on the best performing design in randomised clinical trials. When it comes to choosing a spectaclebased strategy, in addition to myopia control efficacy, there are other factors that influence the selection of an appropriate lens design. These factors include availability, accessibility, cost, practitioner familiarity with the product, patient-related factors such as progression, age, motivation and so forth. For example, in older individuals, where there is slower or nil progression, one might need to weigh the benefits of a myopia control lens versus cost or visual quality of the products. If a child is active and involved in sport, one may need to consider the impact of off axis performance of the available lens designs.
The first and second generation laser treatments use an excimer laser to change the corneal shape thereby adjusting its refractive power. They’re both highly accurate which is why both PRK and LASIK surgeries give such remarkable results and have such an excellent track-record.
With PRK (photorefractive keratectomy), the epithelium is removed prior to the treatment. This creates a longer visual recovery (taking about a month to settle) and the eyes are very uncomfortable for the first few days. However, PRK gives excellent long-term results and is still an excellent surgical option for patients with irregular or thin corneas. With LASIK (laser-assisted in situ keratomileusis), a flap is created with a femtosecond laser. The flap is folded back prior to the excimer laser treatment. This surgery is pain-free with a quick recovery which is why it’s been the most popular laser treatment for two decades. However, the big drawback is the flap which permanently remains a weaker part of the eye and is therefore at risk of being dislodged by trauma. Because of this risk, patients with active lifestyles and professional sportsmen often opted for PRK over LASIK.
ADVANTAGES OF SMILE:
For the initial four hours post-surgery, the eyes are slightly gritty with mild photophobia yet oral analgesics are rarely required. The majority of patients achieve 6/6 or better the day after surgery and return to work within a couple of days of their treatment.
The learning curve: SMILE surgery is technically more challenging than both LASIK and PRK surgery. Although the learning curve is initially steep, the surgical outcomes are excellent from the start. The patient experience: Bilateral SMILE surgery is quickly carried out by a femtosecond laser in less than 15 minutes. Though the majority of patients don’t elect to have a mild sedative, we do offer one. The whole treatment is carried out with a single laser. Firstly, a lenticule is created in under 30 seconds and this is carefully removed through a keyhole incision. The procedure is painless and well tolerated. The VISUMAX has a curved interface which means less suction pressure and a more comfortable laser experience.
Re-treatments: We have performed enhancements on five eyes post SMILE surgery (0.008% of patients): four of these were treated with thinflap LASIK and one patient with PRK. All of these patients have had an excellent outcome. This is far less than the 2% of enhancements required post LASIK surgery
SMILE has represented a paradigm shift in the way surgeons use refractive surgery to correct the vision of patients with myopia and other conditions.
30 INSIGHT August 2022 MYOPIA
DR ANTON VAN HEERDEN and MR DAVID CROPMAN discuss
OPTIMAL LASER SURGERY APPROACH FOR myopic correction
4) It creates a more stable refraction with a lower risk of regression3
2) There are less dry eyes than with LASIK2
5) Patients can safely return to all activities after three days.
OUR EXPERIENCE Eye Laser Specialists, a practice I operate in Melbourne, has offered SMILE surgery since January 2020 performing over 1,400 safe treatments with excellent outcomes.
Refractive outcomes: Independent analysis of our results shows that 94% of our patients are with less than 0.50 diopters of sphere three months after surgery. Astigmatism correction is excellent with 90% patients <0.50 diopters of astigmatism three months after surgery.
The paradigm shift in laser surgery came in 2014 with the introduction of SMILE (Small Incision Lenticule Extraction). Using the Zeiss VISUMAX femtosecond laser, a lenticule is created within the cornea. This is then removed manually, reshaping the cornea and adjusting its refractive power. SMILE has seen exponential growth over the past decade with more than six million eyes treated globally. The increasing popularity of this technology is due to its precise results, improved biomechanics stability and reduction in dry eyes due to an improved ocular surface. I’ve made it a go-to procedure to correct myopic eyes that are no longer progressing.
1) It produces safe predictable refractive outcomes1
Refractive laser surgery has been carried out since the early 1990s. The initial treatment PRK was followed shortly by LASIK, with the latest technology SMILE introduced just over a decade ago. The goal of all refractive procedures is to achieve a perfect refractive outcome with the least amount of risk, side-effects and complications. We all have busy lifestyles and want a quick, safe and comfortable recovery that fits in with our daily routine.
3) It's a flap-free procedure meaning there is no risk of future flap dislocation
BRAKESAPPLYTHETOSLOWDOWNMYOPIAINCHILDREN
*EIKANCE 0.01% eye drops (atropine sulfate monohydrate 0.01%) is indicated as a treatment to slow the progression of myopia in children aged from 4 to 14 years. Atropine treatment may be initiated in children when myopia progresses ≥ –1.0 diopter (D) per year.1 Scan the QR Code to request Starter Packs# and Support Material #Starter Packs may only be supplied to prescribers Scan the QR Code to visit EikancetheWebsite
ABOUT THE AUTHORS: Ophthalmologist DR ANTON VAN HEERDEN is the director of Eye Laser Specialists in Melbourne and is head of Surgical Ophthalmology Services at The Royal Victorian Eye and Ear Hospital. MR DAVID CROPMAN is the principal optometric consultant at Eye Laser Specialists.
EIKANCE 0.01% EYE DROPS (atropine sulfate monohydrate 0.01%). Indication: To slow the progression of myopia in children aged 4 to 14 years. May be initiated in children when myopia progresses ≥-1.0 D per year. Contraindications: Presence of angle closure glaucoma or where angle closure glaucoma is suspected. In glaucoma susceptible patients, an estimation of the depth of the angle of the anterior chamber should be performed prior to the initiation of therapy. Known hypersensitivity to any ingredient of the product. Precautions: Risk-benefit should be considered when the following medical problems exist: Keratoconus - atropine may produce fixed dilated pupils, Synechiae - atropine may increase the risk of adherence of the iris to lens. Use in Children: atropine sulfate monohydrate should not be used in children who have previously had severe systemic reaction to atropine. Use with great caution in children with Down’s syndrome, spastic paralysis, or brain damage. Limited clinical evidence is available for the longterm safety in children and adolescents. Regular eye health clinical reviews recommended during long-term treatment, including the monitoring of anterior segment development, intraocular pressure, retinal health and myopia progression. Consider careful monitoring of anterior segment development with prolonged use in very young children. EIKANCE 0.01% eye drops should not be used in children less than 4 years of age. If children experience photophobia or glare, they may be offered polychromatic glasses or sunglasses. If children experience poor visual acuity, consider progressive glasses. Discontinuation may lead to a rebound in myopia. EIKANCE 0.01% eye drops are not indicated for use in the elderly. Possible effect on the ability to drive or use machinery due to poor visual acuity should be evaluated, particularly at the commencement of treatment. Pregnancy: Category A. Lactation: distributed into breast milk in very small amounts. Interactions: systemic absorption of ophthalmic atropine may potentiate anticholinergic effects of concomitant anticholinergics. If significant systemic absorption of ophthalmic atropine occurs, interactions may occur with antimyasthenics, potassium citrate, potassium supplements, CNS depressants, such as antiemetic agents, phenothiazines, or barbiturates. Concurrent use may interfere with anti-glaucoma agents, echothiophate, carbachol, physostigmine, pilocarpine. Adverse Effects: photophobia, blurred vision, poor visual acuity, allergy, local irritation, headache, fatigue. See full PI for other ophthalmic and systemic AEs. Dosage and administration: Treatment should be supervised by a paediatric ophthalmologist. Instil one drop into the eye as required for treatment. Minimise the risk of systemic absorption, by applying gentle pressure to the tear duct for one minute after application. Should be administered as one drop to each eye at night. The maximum benefit of treatment may not be achieved with less than a 2 year continued administration period. The duration of administration should be based on regular clinical assessment. Each container is for single use, discard after administration of dose. (Based on PI dated 25 November 2021)
WHAT DOES THE FUTURE HOLD? Zeiss has recently released the VISUMAX 800. This latest upgrade halves the duration of the SMILE laser procedure to less than 15 seconds giving even more comfort to the patient. To silence the early critics, it has better centration and cyclotortion control. Trials are being finalised for hyperopic SMILE treatments and this will be available in the near future.
REFERENCES 2.1. Wong et al: Dry eyes after SMILE. Asia Pac J Ophthalmology. 2019 Sept-Oct; 8(5): 3997-405 3 . Blum et al: Five-year results of SMILE. BJO Volume 100, Issue 9 Eye Laser Specialists is located in the inner Melbourne suburb of Armadale.
References: 1. Approved EIKANCE Product Information, 25 November 2021. 2. Australian Register of Therapeutic Goods. Accessed July 2022. 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. © 2022 Aspen group of companies or its licensor. All rights reserved. Prepared: July 2022 AF06672 ASPPH3010.
This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at https://www.tga.gov.au reporting-problems.
CONCLUSION SMILE surgery has allowed us to give myopic patients precise refractive outcomes without the risk of future flap complications. The surgery is quick and painless with excellent visual recovery. Stable refractive outcomes means we have confidence in the long-term outcomes of our surgery At Eye Laser Specialists, we’re able to treat myopia with all forms of refractive surgery. However, if a patient is suitable for all three laser refractive surgery options, we’ll always recommend SMILE as our preferred surgical procedure n
Before prescribing please review full Product Information available via www.aspenpharma.com.au/products or call 1300 659 646 PBS information: this product is not listed on the PBS WITH THE FIRST REGISTERED LOW-DOSE ATROPINE EYE DROPS *1,2
Refractive stability: Our patients have demonstrated long-term stable post-operative refractions with little or no regression over the two years we’ve been performing SMILE surgery. Complications: SMILE surgery is very safe with only a minimal risk of minor complications or side effects. Suction loss has been considered a concern with the laser system, however, we have experienced only a few incidences of this. All of these patients were able to complete their laser surgery with system guidance. None of our patients have retained lenticule fragments after the surgery. Nor has any patient developed diffuse lamellar keratitis (DLK).
COOPERVISION EXPANDS MISIGHT 1 DAY
Hoya recently unveiled results of a six-year follow-up clinical study on its MiYOSMART lens (pictured), marking the longest study on a myopia management spectacle lens. It builds on an original twoyear, double-blind randomised trial1 concluding that children aged 8-13 years wearing MiYOSMART had 60% less myopia progression compared with single-vision wearers as measured by the axial elongation, and a 59% reduction in spherical equivalent refraction. Subsequent three-year data2 showed the lens continued to slow myopia progression, while patients who switched from single-vision to MiYOSMART had a significant slowdown in their condition. The new six-year data involved 90 children in Asia. Importantly, the company reported MiYOSMART’s myopia control effect was sustained over time. It also confirmed patients who stopped wearing the lens showed no rebound effects compared to the initial myopia rates of progression during the two-year randomised control trial or with the general population. And the average cumulative myopia progression was less than 1.00 D and axial elongation 0.6 mm over six years in the MiYOSMART group.3 – References available upon request.
QUESTIONS
COVERED With two market leading diagnostic solutions for progressive myopia diagnosis and ongoing disease management, Device Technologies has a solution for every practice. For practitioners with existing topography and dry eye diagnostic capacity in their armoury, the Lenstar Myopia (top right) is said to be an ideal solution offering precise, repeatable and reliable axial length measurements, 32 point keratometric assessment & CCT all captured through Haag-Streit proprietary Automated Positioning System. This is combined with the latest graphical data from Erasmus University to detect and track progression and, therefore, communicate treatment pathways effectively with patients and parents.
Myopiaproducts
32 INSIGHT August 2022 DEVICE TECHNOLOGIES HAS DIAGNOSTICSMYOPIA
Myopia Expert 700 is supplied to Australian practitioners through OptiMed.
With axial length being the critical measurement in myopia management, the Myopia Expert 700 delivers a gold standard, noninvasive axial length measurement to help guide myopia management solutions and provide ongoing control. Additionally, the instrument has a complete set of measurements for all myopia solutions. Covering the full spectrum, the Myopia Expert 700 captures key measurements necessary for the application of different myopia solutions, allowing the practitioner to recommend the optimum control solution to the patient. These include: corneal topography, keratometry, fluorescein, pupillometry and white-to-white measurement.
NEW STUDY ANSWERS KEY
Reference: 1. CVI Data on file, 2022. SERE coverage of childhood myopia prescriptions with MiSight® 1 day for 104,810 eyes in Asia (China, Korea) and 116,336 eyes in Europe and USA aged 8-18 years.
MYOPIA EXPERT 700 –A TRUSTED PARTNER FOR MYOPIA MANAGEMENT
CooperVision MiSight 1 day contact lenses are now available in higher prescriptions. The expanded range covers -0.25D to -10.00D (0.50D steps after -6.00D) – meaning MiSight 1 day now covers 99.97% of prescriptions for Asian children and 99.97% for Caucasian children – who have myopia and less than 1 D of astigmatism.1 "The diopter extension for this innovative, specially designed lens will allow even more children to benefit from myopia management. MiSight 1 day contact lenses are backed by the longest-running soft contact lens study among children," CooperVision stated.
For practices looking to introduce new diagnostic services to their patients in the area of topography and dry eye, the Topcon MYAH (bottom left) with its Myopia Module is the ideal, compact and space saving all-in-one solution. Offering 12mm corneal topography, NIBUT and meibography combined with a dedicated biometry module for myopia management, MYAH improves patient workflow, and reduces upfront setup costs when introducing new technologies to the practice. A fully featured onboard software system allows users to review, diagnose, track and treat various conditions, from complex contact lens fitting applications, to the latest in minimally invasive dry eye diagnostic analysis.
BIOMETRY OCT DELIVERS PRECISE RESULTS B-OCT is an innovative method of using the Optopol REVO OCT device to measure ocular structure along eye axis. OCT biometry provides a complete set of biometry parameters: axial length, central cornea thickness, anterior chamber depth and lens thickness. B-OCT is a software licence feature for the ‘REVO’ OCT available through OptiMed. It is considered an ideal tool for myopia control, with many Australian myopia management key opinion leaders successfully using this technology. All measurement callipers are shown on all boundaries of OCT images provided by REVO. Now, practitioners can visually verify, identify and, if required, make corrections as to which structure of the eye has been measured. With a simple cursor shift, it is possible to precisely set boundaries for every patient.Fromnow, eyecare professionals can eliminate the common uncertainty as to how most optical biometers classify the boundaries in non-typical patients. 3 mm scan allows precise evaluation of retinal conditions. 5 µm resolution gives the highest level of detail.
– An independent research article can be accessed at: www.hindawi.com/journals/joph/2019/9192456/
INSIGHT August 2022 33 MYOPIA INDICATION FOR LOW-DOSE
The OCULUS Myopia Master is said to combine the most important parameters, making myopia detection and management easier and more“Measurementreliable. of refraction, axial length and keratometry in a stylish unit, delivered with the most comprehensive myopia software suite, helps provide clarity of diagnoses,” distributor Designs For Vision “Myopiasays.Master is the only device to incorporate the latest Brien Holden Vision Institute (BHVI) data for estimating future myopia progression, enabling personalised reports detailing a child’s current myopia status and their likely outcome in adulthood.”Professor Padmaja Sankaridurg, head of BHVI’s Myopia Program, added: ”In collaboration with our research partners across the globe, the team at BHVI is continually engaged in expanding the state of knowledge as well as bringing solutions to reverse the rising myopia epidemic.” BHVI’s data sets, with diverse strata of age, gender and ethnicity, improve modelling in a wider patient cohort and enhance parent counselling – giving practitioners confidence without compromise, DFV says.
ATROPINE In February 2022, Aspen Australia launched Eikance 0.01%, the first pharmacotherapy registered on the Australian Register of Therapeutic Goods to slow the progression of Myopia in Children aged 4 – 14 years1#. Atropine treatment may be initiated in children when myopia progresses ≥-1.0 D per EIKANCEyear.1 0.01% single-use ampoules are sealed in foil pouches and are available in packs of 30 x 0.3 mL ampoules. The ophthalmic solution is sterile and preservative-free. EIKANCE 0.01% is a private, prescription only medicine available at community pharmacies across Australia.
For the Minimum Product Information and PBS status, turn to page 31.
MEASURED IN 10 SECONDS
MASTERING CONFIDENCEMANAGEMENTMYOPIAWITH
NIDEK AL-SCAN – SIX METRICS
Myopiaproducts Pack image not to scale.
References: 1. Eikance Approved Product #InformationAustralian Registered of Therapeutic Goods. Accessed 10 Dec 2021. Aspen Australia, St Leonards NSW 2065. Prepared: Feb 2022 ASP 2696 AF 06355
The NIDEK AL-Scan measures keratometry, optical biometry (axial length), pupil size, horizontal visible iris diameter (HVID), central corneal thickness (CCT) and anterior chamber depth (ACD). According to its distributor Designs For Vision, the 3D auto-alignment and auto-capture makes the process fast and easy; an advantage when measuring young myopes who may not always be the most cooperative patients, thereby delivering real benefits to a busy practice. is said to be “extremely precise” because the AL-Scan measures 720 data points on two circles of 2.4mm and delivers,”theameasurementsfast,devicesitawithoutstandalonepractices,“spaceisdiameters.3.3mmAL-Scanalsoidealforchallenged”asitisadevicetheneedforcomputer,allowingtofitwheresomewouldn’t.“Whenyouneedaccurateinsmallfootprint,NIDEKAL-ScanDFVsays.
Eye Laser Specialists is the only refractive surgery centre in Victoria offering all forms of refractive surgery: SMILE LASIK PRESBYOND PRK ICL Refractive lens exchange Our expert refractive surgery team combined with the latest diagnostic and therapeutic devices gives your patients the best opportunity to achieve their refractive surgery goals. SMILE surgery is rapidly becoming the preferred surgical option to treat myopia and myopic astigmatism and is only available in Victoria at Eye Laser Specialists. OUR TEAM: Ophthalmologists: Dr Anton van Heerden Dr Edward Roufail Dr Mohamed El-Nahrawy Optometrists: Mr David Cropman Ms Kathy Nguyen REFERRAL OPTIONS: www.eyelaserspecialists.com.au | Oculo | 9070 0910 | 1209 High Street, Armadale EYE SPECIALISTSLASER One of Victoria’s most sophisticated refractive surgery centres.
According to Ms April Petrusma, CEO of the new professional organisation Optical Dispensers Australia (ODA), no single factor is contributing to the shortage, instead it’s a perfect storm and culmination of some longstanding issues.
Secondly, the high level and multifaceted skills required by an optical dispenser are not always reflected in their wages. “This is damaging to the overall profession and over time, has consequently landed optical dispensing as an unattractive choice to career seekers,” she says. “As a non-regulated profession, our hiring pool often relies on the same candidates as the likes of hospitality and retail. With a lack of backpackers, students and visa holders available to fill the gaps in hospitality due to lengthy border closures – we are all competing for the same staff from a significantly reduced pool.
Some may be questioning why there is a shortage after a major surge
WORKFORCE
“From what I am seeing and hearing, I believe we are experiencing the largest number of job vacancies that our profession in Australia has ever seen,” she tells Insight. “With a number of industrial factors already at play, the very unwelcome arrival of COVID was the icing on the cake.”
“During Australia’s multiple COVID lockdowns, many practices had to reduce their hours, reduce their staff or for a period of time simply closed their doors altogether. This resulted in skilled staff turning to industries where they can work from home which isn’t possible for most optical related jobs.”
INSIGHT August 2022 35
Workforce squeeze:
Attracting and retaining optical dispensers and other front-of-house staff has become increasingly difficult in 2022.
SOLVING THE FRONT-OF-HOUSE STAFFING SHORTAGE
Insight speaks to several industry figures to understand the problem and what employers can do to stand out.
In conversations with optical industry figures in recent months, there’s an issue on everyone’s lips: a major shortage of front-of-house staff. Practice managers, receptionists, retail staff, and especially qualified optical dispensers are in short supply, and employers are now being urged to make the industry a more attractive option.
Firstly, Petrusma says there are more optometry practices than before, requiring more front-of-house staff from a limited pool.
“On top of that, as with many other industries, practices are contending with staff continually having to isolate due to COVID-19 or other illnesses. It’s safe to say that these issues combined are causing stress and limiting the numbers of patients who can be seen,” she
Optometry associations are also acutely aware of the optical dispensing shortage. They say it’s also impacting optometry, but to a lesserOptometrydegree.Victoria
At the coalface, staffing shortages are biting businesses, with optometrists often needing to perform duties they wouldn’t normally.
For George & Matilda (G&M) Eyecare, it has found that it is particularly challenging to find candidates for optical dispensing and practice manager roles in metro areas, while regionally it tends to flip with optometry roles harder to fill.
Hampton, of OV/SA, says staff shortages are presenting themselves in several ways. Not only does a shortage of front-of-house staff mean a reduction in the ability to dispense glasses to patients, and to manage practices, but it is increasing the workload of optometrists who are already experiencing overload in many contexts.
Petrusma says she is receiving emails, phone calls and direct messages weekly from employers asking if she can recommend someone for a job vacancy they have.
South Australia (OV/SA) was alerted to this issue after recently receiving a phone call from a concerned member having trouble recruiting front-of-house staff. The organisation was keen to investigate whether this was a widespread problem and whether it could better support optometrists. It raised the matter in an April 2022 survey that garnered 149 responses.“Difficulty recruiting front-of-house staff seems to be affecting metropolitan practices more than those in regional areas,” OV/SA CEO Ms Ilsa Hampton says. “We were encouraged to see that 80% of members who responded have not had more difficulty recruiting optometrists in the past six months. However, we were concerned by the results which showed that 58% were having difficulty recruiting non-optometry practice staff. “This is mostly affecting practice owners in inner Melbourne (40%) followed by outer Melbourne (28%). A small number of practice owners in regional Victoria and metropolitan and regional SA were also having difficulty. Since conducting the survey, we have been visiting practices in both states, including some regional areas. We tested out the results in conversation and found some regional areas have indeed had difficulty recruiting optometrists, or in getting them to stay beyond two years.”
“Whilst some practices choose to trade this way, with the optometrist dispensing the optical appliances, this was not the norm for this optometrist and has led to a reduction in test availability.”
Petrusma says traditional methods like SEEK are no longer effective, with some employers reporting they have had zero applicants from an ad that was very similar to one they used in the past which had “I have had current dispensers tell me that they are also feeling the pressure, in some cases having to work longer hours and extra days to cover staff shortages in their practices,” she adds.
Hampton says the main reasons cited in the OV/SA survey for the shortage in front-of-house staff is an insufficient pool of suitable workers. It was also mentioned that the pandemic had changed how people feel about public-facing work. For the small amount having difficulty recruiting optometrists, the impact of COVID-19 and general challenges of recruitment in regional and rural areas were cited.
APRIL PETRUSMA OPTICAL DISPENSERSAUSTRALIA
“CAREFULLY CONSIDER THE SALARY ON OFFER. IS THE AMOUNT CONSISTENT WITH SOMEONE THAT IS SEARCHING FOR A LONG-TERM ROLE?”
Optical dispensers are key to the day-to-day operations of optometry practices.
“I had a conversation at OSHOW with an optometrist that explained that they have had to start doing the dispensing themselves because they couldn’t hire anyone and they have never had any dispensing
“I don’t think anyone could have predicted how the detrimental effect of continuing lockdowns and people’s discomfort with publicfacing work, would have presented. The national workforce shortage across multiple industries, of course, means that people who might be interested in this type of work now have more options.”
36 INSIGHT August 2022 WORKFORCE of more than 1,200 people training to become dispensers thanks to the Federal Government’s Boosting Apprenticeships Scheme (BAC) offering wage subsidies for practices that put unqualified staff through a Certificate IV in Optical Dispensing. Petrusma points out that BAC captured people already in the industry that have been doing the job for decades with either no qualification or an outdated qualification. Therefore, the majority of students are existing worker trainees looking to improve their skills rather than new entrant industry trainees.
HOW IS IT IMPACTING BUSINESSES ON THE GROUND?
RIGHTPRACTICESSUCCESSFULWHOFOCUSMOREONGETTINGTHETYPE OFPERSON,THEN TRAININGTHEM” HAMPTON SOUTH AUSTRALIA
“These challenges mean that it is taking longer to recruit replacement roles, putting pressure on the rest of the team who remain with shortages in their team,” G&M’s general manager of human resources Ms Heather Campbell says.
SOLUTIONS TO STAND OUT AS AN EMPLOYER OF CHOICE
• Offer a career not just a job. This means demonstrating that you’re willing to invest in a candidate’s career by offering professional development opportunities.
“Where we are recruiting non-optical team members, there is then pressure on the existing team to ensure they are trained and brought up to speed quickly. Outside recruitment shortages, there is excessive personal leave being taken due to COVID/flu at the moment, which is impacting the team in finding staff to backfill.”
It’s clear the dynamics have changed. Petrusma says it is no longer a case of the employee being lucky to have a job, but, in fact, employers being fortunate to have good staff. This is placing power in the hands of potential candidates, and practices need to think about how theyWhileadapt.there are several policy-level measures that can be undertaken longer term, there are some practical approaches for savvy optical business owners to attract quality candidates. “If your approach doesn’t change, you can’t expect the outcome to. The employer should be adopting a more creative approach,” Petrusma adds, providing the below tips:
ILSA
OPTOMETRY VICTORIA
• Don’t be afraid to spend money during the recruitment process. A small cost incurred for placement of a job ad or enlisting the services of a recruitment specialist will be returned in buckets if the “WE KNOW A NUMBER OF
• Sell the benefits not the ‘must haves’. Think about why someone would want to work for you rather than the practice next door and promote it. Rather than demands like: “Must be available Saturdays” – make it sound positive instead: “Great work life balance with Carefully consider the salary on offer. Is the amount you are offering consistent with someone that is searching for a long-term role that will grow with you and stick around for five to 10 years? Or is the wage symbolic of a stop gap job to pay the bills and nothing more?
philip.rose@eyecareplus.com.auorMultiAwardWinningPractices
Join Eyecare Plus and benefit from the support knowledgeandofexperiencedmembers.
Looking to buy, sell or join contact Philip Rose 0416 807 546
• Think outside the square beyond the mainstream job advertising platforms – in addition to SEEK and INDEED, businesses can advertise on their own social media accounts, on industry forums, on industry specific jobs boards and through industry specific recruitment specialists.
Employers are being encouraged to demonstrate a willingness to invest in a candidate's career, rather than another job opportunity.
38 INSIGHT August 2022 WORKFORCE right employee is found. Doing nothing for fear of spending money will only hinder the outcome. Eyecare Plus national business development manager Mr Philip Rose says the industry saw “the writing on the wall” with front-of-house staffing shortages, but little could be done due to limited representation and advocacy for optical dispensing. He believes that is about to change with ODA launching this year, which he believes will raise the profile of the profession and bring greater public awareness. “It's high time the public is made more aware of the opportunities in dispensing. There are many retail outlet managers who I think would love the opportunity to take their career and salary to the next level,” he“Asays.qualified dispenser can often earn more than a retail worker and a qualified dispenser practice manager can earn more than a retail manager. Many experienced retail workers understand fashion and can talk to all sorts of people. That's one of the fundamental skills of a Rosedispenser.”saysretention of staff is more important than ever – and employers should be thinking about ways to offer opportunities such as upskilling staff through in-house training or enrolling them in courses to become qualified dispensers. Practices could also offer to cover the cost of membership fees to bodies like ODA that offer CPD.
Rose says practices may do better offering performance bonuses for teams and/or individuals. “Employers need to be prioritising staff retention, especially high performing employees because once they leave it is very challenging to find a replacement,” he says. we can take to the state governments, who should be partners in the solution, given the importance of optometry for our communities,” Hampton explains. In terms of what business owners could be doing differently to attract and retain staff, she is encouraging practice owners in metropolitan areas to use opportunities to showcase positions and to think about how they are explaining the importance of the work. “We know a number of successful practices who also focus more on getting the right type of person then training them. This is a great opportunity for personal and professional development that so many people would not be aware of,” Hampton says.
Even though power is now in the hands of employees, Petrusma has some sage advice for those seeking to capitalise on multiple job offers. “Don’t make unreasonable demands and don’t make your decision purely based on renumeration,” she says.
“Think about your short and long term career goals and discuss these with any future employers. Make your decision based on the potential each role has to meet your goals and where you will achieve the best work-life balance for your situation.” n “EMPLOYERS NEED TO BE PRIORITISING STAFF RETENTION, ESPECIALLY HIGH PERFORMINGEMPLOYEES”
PHILIP ROSE EYECARE PLUS
In other industries, businesses are offering entitlements or incentives such as extra annual leave, paid parental leave and birthday leave, however such measures may not be possible everywhere.
“Practices could look at their local area and ask themselves where potential staff might be – for today and the future – then find a way to get the message to them. It’s also a good idea to ensure your is COVID-Safe and that any potential recruits understand what you are doing in the space to ensure their safety, as well as that At G&M, Campbell says the company has been using the recent government BAC wage subsidy to fund and support its team to be Cert IV-trained in dispensing, however this was scheduled to end prior this issue going to print.
“We’re also encouraging our team to share across the G&M community to move team members around and support. Longer term, we are building more flexibility into our workforce,” she says. “So much comes down to engagement, and culture – what is it about your business that entices people to want to work there?”
SEE THE DETAILS. SEE NO LIMITS. ESSILOR.COM.AU FR96202021MayPERSOL®FRAMESINTERNATIONAL.ESSILOROFTRADEMARKSAREVARILUX®ANDESSILOR®–INTERNATIONALESSILOR©RSP.atsalesvalueRetailInternational;Essiloredition;2021Eyewear*Euromonitor,Experience seamless vision with VARILUX® progressive lenses Instantly sharp focus from near to far vision – that’s seeing no limits
40 INSIGHT August 2022
By integrating ProAccounts with Optomate Touch, practices can now simply order frames and enter the stock invoice number into the practice management system. Optomate Touch will sync with ProAccounts to update stock listings. If a product isn’t already in the practice’s catalogue, Optomate Touch will automatically download all relevant product data from ProAccounts including cost pricing, description, quantities and any applicable discounts.
Entering invoices and new frame creation. Ask any independent optometry practice, and these two items will sit near the top of the most time-consuming and tedious tasks on their to-do list. While a necessary chore, these manual data entry processes consume an estimated 15-20 hours per month, at an annual cost of $6,000 to the practice. For years, independents have yearned for an automated system that would take care of this task with a few simple clicks. Now, their pleas have been heard, with Australia’s largest independent optometry network ProVision commencing the rollout of its ProAccounts integration with the Optomate Touch practice management system. Many have already labelled this technology a “game-changer”, with ProVision business systems manager Mr Andrew Parker – who has been with the organisation for 10 years – believing it will become one of the most valuable systems ProVision has developed for members. Practices involved in a four-month pilot have reported saving as much as 67 hours on staff labour. To explain how it works, Parker says the journey began in 2020 when ProVision first introduced ProAccounts, a new member invoice and statement portal. It aimed to have all suppliers provide electronic invoices daily, as opposed to weekly or monthly. With ProVision acting as the intermediary between practice and supplier through a chargeback arrangement, this invoice consistency streamlined its own internal processes, and effectively allowed it to monitor purchases in real-time. For practices, it meant statements and misplaced invoices could be accessed on-demand in an online portal, while avoiding surprises by granting full visibility of frames and sunglasses purchases in real-time, across participating supplier partners. This also translated into fewer headaches for suppliers. Once the ProAccounts portal was launched to members early 2020, the next phase began to integrate the invoice and frame information into practice management systems. It has taken two and a half years to reach this point, with 11 out of 19 frames suppliers now meeting the requirements to be involved with ProAccounts integration with Optomate Touch. Two more will come online soon and ProVision continues to work with the remainder. With a critical mass of suppliers now involved in the ProAccounts integration, Parker says ProVision is now leveraging this technology to drive major efficiencies in the practice.
ELIMINATING THE ADMINISTRATIVE BURDEN OF STOCK MANAGEMENT
ProVision now estimates that entering new stock takes as little as 10-60 seconds.“Itmeans you don’t have practice staff sitting and typing data trying to build new frames in the stock file. The invoice can provide all that frame information and build the frames in the background based on what the practice is buying,” Parker explains.
“There's at least 15 data points to set up a frame, including elements like the barcode which is the unique identifier that we can connect all our systems to – and very rarely would a practice enter. There's a stock supplier code, the model, brand, eye, bridge, temple and material data, as well as the shape and the category it fits into. There’s also the cost price and sell
The time it takes to introduce new stock into the practice management system is the bane of independent optometry. But a new automated software solution under development for the past two years is generating efficiencies many have never experienced before.
BUSINESS
ProVision worked with Optomate’s Australian-based team for six months to develop the software. While Optomate had an existing e-catalogue system, Parker says only a handful of suppliers actively kept it up to date. It also meant practices were uploading many unnecessary frames into their system. He says there was a major focus on making ProAccounts user-friendly for practices, which meant making the technology more sophisticated than originally“Initially,planned.weconsidered designing it so practices would bring frames in through an e-catalogue, and then download the invoice. But then we thought, let's skip that step and only import and generate the frames that they're buying based on all the data attached to the invoice,” Parker says. “And that really resonated with our members; anyone who has used an inventory system knows there's always too many products in the system that you haven't bought or stocked for years.”
“The conference is our showcase event and I want to ensure the independent community knows what ProVision is about and the high quality services we can offer,” she says, noting that it’s also a more subtle way for non-members to inquire about the network.
The first major showing of ProAccounts integration with Optomate Touch will be at ProVision’s biennial national conference Friday 21 to Sunday 23 October. For the first time in its 30-year history, the organisation is inviting non-ProVision optometrists at the Pullman Melbourne, Albert Park.
NEW TWIST ON NATIONAL CONFERENCE
And students can come and understand why there’s such a strong future for independent optometry.”
ProVision business systems manager Mr Andrew Parker says there will be practice management system user groups that will include a demonstration of the ProAccounts-Optomate Touch system.
ProVision has secured Australian of the Year Mr Dylan Alcott AO (The art of taking risks to achieve your goals), business growth thought leader Mr Keith Abraham (Creating the business of your dreams), marketing expert Ms Katrina McCarter (Gen Y & Z: Understanding our consumers of tomorrow), motivational speaker Ms Amanda Gore (The power of joy), and Australian futurist Mr Steve Sammartino (Stand up for your future).
Parker acknowledges ProAccounts is far from the finished product. Simon Hobson, of Young Eyes Optometrists, says the time to enter stock has been cut down to about a tenth. Frances Mirabelli, ProVision CEO.
Mirabelli is also excited by the world class speaker line-up for the conference.
ProVision CEO Ms Frances Mirabelli, who commenced in the role in February and is travelling across the country to meet most ProVision practices, was behind the decision to include non-member independents for the first time. There’s also been strong uptake among ProVision practice owners to bring along new potential members (inviting one non-member entitles them to 50% off the conference fee, two and they can enter for free).
In addition, attendees can subscribe to Practice Management System User Group Workshops, and select from three categories including: future planning, digital marketing and consumer behaviour changes.
Once this was complete, ProVision piloted the program with 12 practices for four months. Among those were Young Eyes Optometrists (NSW) and Gulf and Ranges Optometrists (SA), each reporting substantial resource savings over a four-month period. For Young Eyes Optometrists, it previously estimated spending 68 hours and $1,700 in labour costs to process 409 invoices. After using ProAccounts integrated with Optomate Touch, this was reduced to seven hours and $175 labour, saving 61 hours and $1,525. Gulf and Ranges Optometrists found similar efficiencies, reducing the time spent on 447 invoices from 75 hours to 7.5 hours, saving 67.5 hours or $1,678. “I have these wonderful moments over Zoom calls with practices when we install the software. When they type in the first invoice and push the button, it’s a real ‘oh wow’ moment, because all of a sudden it’s taken care of that box of frames sitting in the corner and saved them so much time,” Parker explains.“It’sonly been available for three months and we’ve got 50 active practices and another 31 that we're talking to. We wanted to gradually roll this out and hold everyone's hand and we've been able to do that, but the phone just hasn't stopped, and the testimonials keep coming.”
INSIGHT August 2022 41
“Importantly, after the last few years, it’s a great opportunity to network with peers and industry leaders at our many social events including coffee catchups, conference welcome event, trade show, awards dinner and afterparty.
“There may be some non-ProVision optometrists out there who have Optomate Touch and think ‘I really need access to this technology to create efficiencies in my practice’. Because we’re opening the conference to non-members, they can visit on that Friday for a chat and demonstration of how the software works," Parker explains.
PILOT EXCEEDS EXPECTATIONS
Delegates can also engage with ProVision's 28 supplier partners under one roof at the conference’s trade show showcasing latest product ranges and offers. To register, visit: optom.provision.com.au/conference/ price, among others. To do this for each frame has traditionally been a timeconsuming manual process. Now they can instantly bring any quantity of frames into their practice management system at the touch of a button.”
“What impressed us is the accuracy of pricing transferred from the e-invoice into Optomate Touch. We no longer spend an excessive amount of time ensuring our pricing/discounts are all up to date to balance the total amount. Sometimes a small error would take a long time to rectify as we needed to go through each line item to find and amend,” she says.
The next priority is bringing more frame suppliers into the tent. To protect the integrity of the system and ensure value for members, ProVision has set a high bar, with suppliers needing to have 95% accuracy between their invoice and own e-catalogue data. Due to the relatively high turnover of frames, Parker says it makes sense to start with this product first. But he hopes ProAccounts integration with Optomate Touch will extend to include ophthalmic lenses, contact lenses, eye drops and other accessories sold in the practice. “It'll be an iterative journey where we will keep developing and broadening the scope of what we can do for practices. It’s just the beginning which is super exciting.”
“I’ve been impressed by the speed of the import and the accuracy of the data – our reports of stock on the shelf are much more accurate – re-orders are much quicker to place,” he says.
“The other impressive feature is the integrated ProSupply link within the spectacle job order. This allows us to stay within Optomate Touch to order a frame and not have multiple windows open, making the process much more streamlined.”
* 1 .Index: 1.60 S0.00 C+4.00 Comparison between spherical lens and SMART TORIC
n
Mr Simon Hobson, practice principle and manager at Young Eyes Optometrists, says time to enter stock has been cut down to about a tenth of the time.
WHAT DO PRACTICES THINK?
Elsewhere, at Gulf & Ranges Optometrists in Port Augusta, South Australia, optical assistant Ms Taneil Nigro says, given the current climate, efficiencies brought about by ProAccounts has allowed the practice to still function in the case of reduced staff capacity due to illness. It also allows the practice to teach new staff members more efficiently because they can grasp the new stock arrival process quicker.
Andrew Parker, ProVision business systems manager.
Special design for astigmatic eyes Scan the QR code for the explanationvisual
For Horsfalls Optometrists, in Echuca, Victoria, the new arrival of frames is now cause for excitement. The practice didn’t realise how much time was spent on data entry until the integration came along. “Now our new stock is sorted in 30 seconds instead of 30 minutes,” practice manager Ms Jess Bussell says. Because the practice stocks 90% of its frames from ProVision’s preferred suppliers, Bussell says staff can now focus on patients without admin tasks piling up. “Corporate dispensing staff get to go to work and have significantly less ‘behind the scenes’ tasks to do in the same day compared to independent dispensing staff, and now we’re seeing that gap closing with this integration,” she adds. “These benefits mean that when we find the need for new ranges in future, we would be assessing if we can fill a market gap from the ProAccounts supplier network prior to looking at other suppliers, simply due to how easy and streamlined it is.”
BUSINESS
According to OA, research indicates that a more realistic domiciliary loading would increase provision of these services at minimal budget cost due to their infrequency. The organisation has proposed that the domiciliary loading be increased to $85.00 per visit (paid proportionally for multiple patients) with an assumed 10% increase in services.
Graveson and Main are a rare breed; they don’t operate a bricks-andmortar practice, and they don’t treat the general population (including children). They only treat patients typically over 65 and in an aged care facility, or occasionally at home. They do differ in one respect; Graveson usually doesn’t bulk-bill, Main does. But they are united in their opinion that the current Medicare Benefits Schedule (MBS) fee payable to optometrists providing domiciliary services is woefully inadequate.
Graveson and Main have been providing domiciliary services for several years and both agree the MB S fees demonstrate how much the Federal Government undervalues eyecare. But they are not lone voices. As part of its federal election platform this year, Optometry Australia (OA) advocated for an increase in the optometric domiciliary loading benefit in residential aged care. OA modelling has shown the current scheduled full fee amount of $24.20 for a domiciliary loading grossly under-recognises the costs of providing domiciliary care, discouraging optometrists from providing eyecare to those at risk and vulnerable patients.
Hobart and Perth may not have a lot in common, but they share something unusual: an optometrist who exclusively provides eyecare to residents in aged care. In Hobart, Mr Paul Graveson regularly visits 12 aged care facilities, while Ms Robyn Main visits about 70 annually in Perth.
Optometrists who provide domiciliary services are compensated for travel costs and unpacking and repacking equipment, but they say it’s not enough. Will the Federal Government increase the MBS benefit to support more optometrists to provide these services to older Australians? RHIANNON BOWMAN reports.
REPORT
BLIND SPOT: The cost of providingdomiciliary care
INSIGHT August 2022 43
However, when the federal budget was delivered on 29 March, there was no mention of a domiciliary loading increase, which OA had estimated would cost the government $500,000 per annum.
Under the MBS, benefits are payable to optometrists providing domiciliary services under items 10931 to 10933, in the form of a loading, in recompense for “travel costs and packing and unpacking ofAequipment.”domiciliary visit performed on one patient at a single location on one occasion (item 10931) attracts a fee of $24.20 and a benefit of $20.60 (85%). A domiciliary visit performed on two patients at the same location on one occasion (item 10932) attracts a fee of $12.10 and a benefit of $10.30 (85%). And a domiciliary visit performed on three patients at the same location on one occasion (item 10933) attracts a fee of $7.95 and a benefit of $6.80 (85%).
Graveson has $40,000 worth of portable equipment and purchased a vehicle, plus insurance cover, specifically for work purposes.
“All of that (equipment, vehicle, preparation, travel, packing and unpacking) is supposed to be covered by $24.20. Although it has increased by 1% per year, it is lower than CPI. In real terms the Medicare rebate goes down a little more every year,” he says. “The dispensing rate in aged care facilities is lower than in private practice. Essentially, you need the consultation to pay in its own right. The consultation fee not only has to cover your time spent in the consultation, but the preparation time before the session.”
“I don’t earn as much income as I would if I worked in a franchise practice, but I do it because I like being my own boss,” he says. “I see patients in the morning through to lunchtime, then I manage phone calls and paperwork at home. I have kids, and I’ve been doing this since they were toddlers, because I value the autonomy, or freedom, it gives Gravesonme.”became
“There is some sitting around, waiting for patients. After examining patients, you then need to pack up your equipment, load it into your vehicle once again, drive back to your practice or workplace, carry your equipment back into the practice, unpack and set it back up. You’re looking at a minimum of an hour in total split between before and after the session. Still, it’s a significant chunk of non-income-generating time though – most practices would see two or three patients in 60-90 minutes, so the ‘opportunity cost’ is high. “You then need to start calling family members to give them a report. You need to organise a referral if required, which is more common in aged care than in the general population. If glasses are required, you need to prepare a quote, send it out, follow-up payment and delivery.”
One of the main ‘sticking points’ preventing optometrists from offering domiciliary services like Graveson is that the opportunity cost is too high. “To visit one resident in aged care, you need to book out at least two hours. It’s hard to make a business case on that basis for bricks-andmortarGravesonpractices.”saysOA’s proposal to increase the domiciliary loading to $85 per visit is “still very modest”. “We’re in a bind. The current domiciliary loading fee is a joke. But the fact that it’s there is a double-edged sword. I wrote to the Health Minister a few years ago on this issue, and the Health Minister wrote back that the MBS loading item is there to support us, so that was enough,” Graveson says. By contrast, GPs who treat residents in aged care facilities receive a higher rebate as part of General Practitioner Aged Care Access, a government incentive designed to encourage GPs to provide increased and continuing services in Australian Government funded residential aged care facilities. Under the program, GPs receive $2,000 if they provide between Optometrist Robyn Main in an aged care facility in Perth on Optometry Giving Sight Day 2017.
44 INSIGHT August 2022 REPORT
IN A BIND Graveson, an optometrist and low vision consultant, is the only optometrist who exclusively provides domiciliary care in Hobart. He visits 12 aged care facilities in the Hobart region, seeing four or five patients each visit in a four-week cycle.
Despite Graveson’s altruistic outlook, he is also a realist: “I mostly don’t bulk-bill. That makes me quite different, but it brings its own benefits – and difficulties.” He says that if the Medicare rebate was higher, he’d be able to bulk-bill a larger proportion of his patients, and his privately billed patients would be less Althoughout-of-pocket.heexamines as few as four or five patients each visit (or session), each visit entails a large amount of organisation.
“This is important work, it’s a service that makes a difference to people. Does the government value it? I don’t think so, given the number of cases of untreated glaucoma, dry eye, and diabetes-related vision loss I have seen,” he explains.
“I typically contact the liaison person at the aged care facility a couple of weeks ahead with a list of people to see. There may be patients needing review, or a family may have requested an eye examination for their relative in aged care. I also have to obtain medical and financial consent from an aged care resident’s family.”
Organising a visit doesn’t end there; there is also the logistics of transporting, loading and unloading equipment.
involved in domiciliary care through his work in low vision, where he became aware aged care residents weren’t receiving adequate care.
“You need to pack up the relevant equipment from your practice and carry it to your vehicle, (Graveson has most of his equipment permanently in a car he uses specifically for domiciliary visits), travel to the aged care facility, sign-in, complete a Rapid Antigen Test, wait for the result, then carry your equipment into the exam room, set it up, before you’re then ready to examine your first patient, who might not be ready – for instance, they may be showering or sleeping – despite a liaison person knowing you’re coming to see residents.
“In the context of an aged care facility, having residents with vision impairment because they don’t have glasses is significant – their qualityof-life is hugely affected. Optometrists are immensely important in providing the basics of refracting and dispensing which are important to aged care residents’ quality-of-life – be it for reading, crossword puzzles, jigsaw puzzles, craft, Bingo, anything.”
“It highlights the problem with item 10933 – it is impossible to capture how many consults are done after the third patient but it’s unlikely to be more than another 20 to 30%,” Graveson says. “I support OA’s proposal for a higher loading fee. But I also think optometrists should be able to charge item 10933 on third and subsequent consultations. If every patient who received a domiciliary service received a domiciliary item number, the Medicare data would give us a more accurate indication of how many residents are receiving optometry services in aged care. “Optometry also needs its own incentive program, similar to GPs. I can’t see why optometrists can’t have equivalent incentives to GPs. Do they – the government – support eyecare in aged care facilities or don’t they?”It’sa question that has grass-roots ramifications in Hobart, where Graveson often receives requests to visit residents in aged care facilities in addition to the 12 he currently services.
“I have to say no to requests from other aged care facilities because I’m already at capacity. The same goes for home visits – I have to say no.”
DAILY CHALLENGES MOUNTING
60 to 99 eligible MBS services in residential aged care facilities in a financial year; an additional $2,500 if they provide 100 to 139 services; another $2,500 if they provide 140 to 179; and an additional $3,000 if they provide 180 or more services. Eligible GPs can get four payments totalling $10,000 for the financial year, in addition to the consultation fee. No such incentive exists for optometrists. “The optometry MBS rebate is the patient’s rebate. It is halved if you see two patients, then it drops to a third of the value if you see three patients. If you see four or five patients, they don’t get any domiciliary rebate. If you’re not bulk-billing, the fourth and fifth patients receive less total rebate. It’s an equity problem,” Graveson says. In the decade between January 2010 and December 2019, before COVID, Graveson says the total number of domiciliary consults was 140,790, which loosely translates to 14,000 per year, for a population of over 180,000 aged care facility residents. He says compared to the population living in aged care facilities –which was 184,000 people in 2017 – that’s less than one domiciliary exam per 10 people per year.
Ms Robyn Main has been providing optometry services to most of “WE’RE IN A BIND. THE CURRENT DOMICILIARY LOADING FEE IS A JOKE. BUT THE FACT THAT IT’S THERE IS A DOUBLE-EDGEDSWORD” PAUL GRAVESON TASMANIAN OPTOMETRIST
SKYE CAPPUCCIO OPTOMETRY AUSTRALIA
“Aged care facilities are meant to have designated staff for optometry and dental visits, called Clinical Nurse Managers, but some are not educated to the importance of optometry – residents should still be entitled to good eyesight despite the rest of their health problems – or unaware how to organise a visit.”
Disappointingly for Main, the current domiciliary MBS item numbers lack appropriateness and relevance.
LOADING FEE ‘LESS THAN A THIRD’ OF WHAT IS REQUIRED
She has confronted a long list of issues in that time, which she started documenting in 2015, and hasn’t seen much change. “I started noting down some daily challenges and barriers I have, ranging from administrative problems, incorrect medical records, patient logistics, occupational health and safety, to inadequate consulting room space and patient communication.”
Main also finds organising visits to be wrought with difficulties.
“We believe a fairer fee will help ensure those optometrists who provide domiciliary care can continue to do so, and enable more optometrists to be able to provide domiciliary services in their communities alleviating concerns of being out of pocket. It’s an important step in making sure older and immobile members of our community can have ready access to the primary eye and vision care they need,” Cappuccio concludes.
46 INSIGHT August 2022 advocating for an increase in the optometric domiciliary loading benefit in residential aged care for a number of years, to no avail. In 2014, results from an OA member survey to assess the true cost of providing domiciliary eyecare helped form a revised MBS domiciliary loading benefit, which the organisation says remains relevant today. General manager of advocacy, Ms Skye Cappuccio, explains what motivated OA to nominate this issue as part of its its 2022 federal election platform. “In 2015, the government announced the MBS Review which has effectively, and rather disappointingly, meant the government has been unwilling to consider change to existing MBS items outside of the review,” Cappuccio“However,says.webelieve
“I often travel more than 70 km to aged care facilities in Perth. That means more than 140 km in peak traffic, sometimes three hours a day spent in the car just getting to and from aged care facilities. I don’t think $24.20 is enough for the domiciliary loading. It needs to be more or at least include the addition of a kilometre allowance.”
Recently widowed, Main lost Richard, her husband of 35 years, to Creutzfeldt-Jakob disease, also known as CJD, a rare degenerative disease of the brain, in December 2021.
“I am still grieving and only just returning to work. I’m now a widow and most of those in aged care facilities are widows so I have more compassion to give them as I walk the same journey,” she says. Prior to COVID and her late husband’s illness, Main was visiting 180 aged care facilities a year; now she visits 70. When she spoke with Insight in April, Perth’s aged care facility staff were on strike over a pay increase, which was preventing her from working too.
“WE BELIEVE A FAIRER FEE WILL HELP ENSURE THOSE DOMICILIARYOPTOMETRISTSWHOPROVIDECARECANCONTINUETODOSO”
Apart from the Medicare fee for an eye exam, Main doesn’t get any financial benefit from attending to aged care residents. Like Graveson, she is aware that GPs receive a bonus, rated per number of patients they see in addition to their Medicare exam rebate, and like Graveson, she questions if optometry could be included in this financial arrangement.Mainsaysshe has personally encountered many of the issues and challenges facing optometrists in providing care to older Australians outside of established practice. But before she elaborates, she shares why she started providing optometry services in aged care facilities.
One of the problems Main encounters almost daily when providing optometry services to residents in aged care is lack of consent. “Consent from next-of-kin is needlessly difficult. Often, ageing parents are going blind because their next-of-kin haven’t signed a consent form. Some aged care facilities only have 10% response rate to written consent forms sent out. Consent should not be required – it is an aged care facilities duty of care that should enable all residents to be able to access optometry.”
“In the past, I would chase these up by phone and email. Now, I send a card in December reminding them they missed the annual optometry
change on this issue is well overdue and, as a result, we have elevated this as a priority for Optometry Australia. Further, the Aged Care Royal Commission has served to shine a light on the need to support better healthcare access for aged care residents, which we are hopeful will see the government more attuned to the need to increase the benefit and support more optometrists to provide more domiciliary services to older indicationsCappuccioAustralians.”sayscurrentsuggestthere is insufficient servicing of older, immobile Australians by optometrists. mainly to the low loading fee which continues to be well below the true cost of providing domiciliary care providing a major financial disincentive for optometrist. Some of our more vulnerable community members are unfortunately impacted by this ongoing set of circumstances,” she says. In support of OA’s argument, Cappuccio points to modelling which shows the current scheduled full fee amount grossly underrecognises the cost of providing domiciliary“Optometrycare.Australia worked with members to determine the additional time inputs required on average to provide domiciliary care, and used this as the basis for costing the provision of domiciliary services. This modelling suggests that the loading fee is less than a third of what would be reasonably required to cover the costs of providing such care,” she says. Hence, OA is proposing the domiciliary loading be increased from $24.40 to $85.00.
“My personal experience of working in this area came from three sources. Firstly, I heard Peter Herse speaking at an optometry conference in WA using Medicare stats showing a drop in optometry services in the over-70’s. Secondly, my 74-year-old father needed domiciliary optometry care due to lung cancer medication affecting his eyesight. And thirdly, the corporate optometry group I was working in strongly disapproved of domiciliary care as it took too much time for too little profit to be sustainable,” she says.
Main sends reminder notices to all the aged care facilities she visits, but usually 15-20% fail to organise an optometry visit annually.
REPORT Eyes Mobile Optometry Outreach.
visit and please consider … I haven’t got time to chase them up, yet their residents are missing out on their eye exams and could be in danger of jeopardising their eye health due to staff neglect,” she says.
Main has also frequently encountered flawed medical records, including incorrect date-of-birth, incorrect Medicare numbers, and incorrect Department of Veterans' Affairs numbers.
“When I have broached the subject with some Clinical Nurse Managers, they just sound weary and sceptical; ‘We don’t have the time’ or ‘It’s all too hard’.”
A domiciliary visit under item 10931 attracts a fee of $24.20 and a benefit of $20.60 (85%).
“Sometimes patients don’t bring their spectacles to their appointment because they may be lost, locked away or taken home by family. I have often had to rummage through a patient’s personal belongings to find theirVisitingspecs.”upto 180 aged care facilities has also exposed Main to a variety of consulting rooms, not all of which are fit for purpose.
“Medical diagnosis and medication charts are not always accessible, and I may require staff assistance to gain access, but they are often too busy or not available, so it’s a labour issue.” Patient logistics can cause headaches too. “Bringing patients in a timely manner works in theory, but not always in practice. I can have 10 patients waiting for me in a corridor and this can cause frustration for everyone. This is usually due to lack of staff in aged care facilities on duty to help on the optometry day. Again, it’s a labour issue. At other times, I have had to get the resident out of bed and to the consulting room for the exam.
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ARE
to examine patients in an aged care facility. “I
of these available now as GPs walk around with laptops and consult at bedsides and the space is used for something else, such as
the doctors consulting room,
LED Retinal Camera but
Non-Mydriatic there nowhere else usually sometimes, but there less occupational therapy,” Main explains. Communicating with patients is not plain sailing either. For example, some dementia patients can only be screened for basic eye conditions, others require a full exam as they are still able to read and enjoy much of life “Dementiavisually.patients can be impulsive and unpredictable. I have been hit, punched, spat on and head-butted by dementia patients, but not during tonometry, which is my worst fear. Staff normally warn me of this behaviour. Often, I find these patients are blind so it may actually be a cause/effect of their blindness coupled with their dementia,” Main says. “Frail elderly patients cannot be hurried in body or mind. Their family are not usually present at the eye exam, so I have to quiz these patients with failing memory regarding their ocular history and discuss outcomes which they often don’t remember.”
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And the paperwork? “A full report is required by the aged care facility. This report is not covered by Medicare. I do it free-of-charge. If specs are required, I prepare a quote which is meant to go to next-of-kin for perusal and payment. Only 30% of quotes for new specs are filled. I am not sure if this is due to family finances or because the patient is palliative. I can onlyMainspeculate.”alsoprovides referrals for ophthalmology and says most (about 90%) are followed through. “Of the 10% that aren’t, I follow up at the next visit. Often referral is for cataract and reasons given for not attending are due to poor health or long hospital waiting lists. Many of these patients have to be seen at teaching hospitals due to mobility (full hoists) and they have very long waiting lists.”
use the hairdresser’s room or
is
n Optometrist Robyn Main with Harry Abrahams, a retired optometrist who now lives in aged care. (Consent from son and optometrist, Paul Abrahams).
The October 2022 issue will feature the Insight Dry Eye Directory, Australia’s most comprehensive source for dry eye care. Back by popular demand, this all-in-one resource is a valuable purchasing guide for practices, showcasing available Therapies and Diagnostics in Australia. It will also feature a comprehensive list of dedicated Dry Eye Clinics It’s FREE and EASY for you to list your products or services. If you operate a dry eye clinic, or are a supplier of dry eye products, scan the QR code to organise you listing, or visit insightnews.com.au/dry-eye-directory-2022 To amplify your product via advertising, contact Insight Editor Myles Hume: 0402 133 188 myles.hume@primecreative.com.auor Scan HERE to arrange your listing. www.insightnews.com.au Insight Dry Eye Directory returning in 2022 AUSTR A LI A’ S LE A DING OPHTH ALMIC M AGAZINE SINCE 1 975
A CAREER IN OPTOMETRY Lam finds fulfilment in helping others. Optometry is simply the vehicle she uses to give back. Dr Margaret Lam was recently appointed national president of Optometry Australia.
“I was driven by a sense of deep indebtedness that my parents and grandparents risked their lives just so I could have a life. And this inspired me to push myself, be grateful and make the most out of my life. It inspires me to be grateful for my family and the life we’re very fortunate to have.”
“At 16 years of age, my grandfather took a massive risk and left China because of the Chinese civil war, feeling as though he had no choice for survival except to escape to Vietnam. He made the difficult decision to leave his mother behind. Unfortunately, he was never able to return in time to ever see his Mum alive,” she says.
MARGARET LAM:
Lam’s ascendency to the Optometry Australia (OA) national presidency was confirmed at a national board meeting on 28 June, the day after Mr Murray Smith suddenly resigned seven months into the role to focus on his family, health and wellbeing. Today, Lam is an accomplished optometrist in every sense. She’s the head of optometry services with George & Matilda Eyecare, of which she became a partner optometrist five and a half years ago when she sold her three Sydney-based theeyecarecompany practices. In the academic sphere, she’s an Adjunct Senior Lecturer for the School of Optometry and Vision Science at UNSW. And at a governance level, she joined the OA national board in late 2019 after a long history as a director on the board of Optometry NSW/ACT. She is also the national president of the Cornea and Contact Lens Society of Australia, bringing a combined 12 years of governance experience.
after graduating from the UNSW School of Optometry and Vision Sciences in 2001 before establishing her independent Sydney-based optometry practices in 2005. But like many descendants of migrants to Australia, Lam remains humbled and motivated by her origins.
Now only the third female optometrist to be appointed president of OA in the organisation’s 103-year history, she will spearhead a full female leadership team, with Mrs Fiona Moore appointed deputy president and Ms Tori Halsey re-appointed treasurer. Never before has there been three women simultaneously in these roles. It’s an impressive resume for someone who started their career
DR MARGARET LAM has been appointed Optometry Australia’s 40th national president, becoming only the third female optometrist to assume the role in the organisation’s 103-year history. Insight traces her rise from humble beginnings.
“My parents then faced similar fears during the Vietnam war, which led them to risk their lives taking a rickety boat into the unknown for survival, ending up in Sydney, Australia. Growing up in tough conditions, my parents worked incredibly hard running their business to provide for their fourRealisingchildren.”the sacrifice of her family from a young age, Lam never needed to be pushed at school.
What makes her tick? S
50 INSIGHT August 2022 PROFILE
purred by a willingness to serve and a work ethic born out of indebtedness to her family who took a major gamble to provide a better life, the national optometry profession has discovered a well-equipped leader in Dr Margaret Lam.
B.I.G. NORM™
for election in Optometry NSW/ACT seven years ago because I wanted to make a difference in optometry in improving collaborative care with ophthalmology, GPs and allied health care. I also wanted to build strong networks of collegiality among eyecare professionals, and be a voice to government bodies and key stakeholders, and encourage the further development of our profession to broaden our scope of care.”
Ultimately, Lam wants to continue increasing public awareness about the role of optometry as primary eyecare providers.
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A young Margaret Lam with her father who, with her mother, fled war-torn Vietnam in search of a better life.
"It was one of the best strategic decisions I have made, I feel supported in a large independent optometry community that really helps support its practitioners and their businesses to grow."
“That is, when a patient has an eye problem, they think immediately of seeing their optometrist, realising our work supporting ophthalmologists, general practitioners, and allied health care professionals to elevate levels of all patient care,” she explains.
THE FUTURE As president, Lam wants to contribute to Optometry Australia's Strategic Plan for 2021-2024, the blueprint of projects and goals to sustain and evolve optometry in Australia. Particularly, she says Optometry Australia must continue to be the voice to guide the future direction of the profession as it will enable optometrists to have a strong, united and uniform approach to government, healthcare and sector advocacy.
“I feel fortunate that our field of optometry can prevent patients from losing their sight, or we can restore a patient’s vison or quality of life,” she says. “We are primary eyecare practitioners that detect life- or patients.optometristsmycouldagopatients,profession,bothconditions.sight-threateningIenjoyhelpingcolleaguesinmyaswellasmyandsevenyearsIwonderedhowIalsoinvestsomeoftimetohelpmyfellowhelptheir“Iinitiallydecidedtostand
“Our goal is to create an enduring profession, and to create an enduring organisation in Optometry Australia that supports it. I see many incredible challenges ahead in this role and I am incredibly excited to be assisting to build that future.” n
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In terms of her clinical and business success, Lam says Mr Chris Beer has been an influential figure. The founder and CEO of G&M, and former Asia-Pacific CEO for Luxottica, is considered a mentor and close friend.“I joined G&M as I wanted my independent practices to have the security to continue to grow in an everunpredictable optometry environment. I joined pre-COVID, and am certain that my practices would not have been able to weather the financial storm as well as they did if it wasn’t for G&M," she explains.
See more, know more with more InsightSubscribe FREE and receive the latest news Insight is mobile and tablet friendlyFind jobs and advance your career with Insight’s Classifieds Get to know the newest products from suppliers across Australia Insight’s new website keeps you updated on the latest industry news and information. With a world-class responsive design, Insight is now accessible seamlessly on any device, 24/7. Sign-up FREE to our eNewsletters and industry reports delivered weekly straight to your inbox. www.insightnews.com.au
Eagles value when you go the extra mile to find suitable appointments and keep them informed on accurate timeframes. If you win them over with efficiency and skill, they will trust you to offer the best.
ACOD trainer, and proud Owl, Ms Lara Markham’s said selecting a new frame takes time. “I appreciate the input of people’s opinion’s close to me, however, once I’m set on a style it’s hard to talk me out of it. I’ll have most likely investigated a few key styles online and have a shortlist of potentials prior to visiting. I’m that annoying
n
NOTE: References can be found in the online version of this article.
DISPENSING INSIGHT August 2022 53
ACOD trainer Ms Elizabeth Sumner is your typical Dove. It’s important they feel welcome but are given space. She prefers to select frames on her own before obtaining the opinion of others. “I only like to present a couple of choices to others so will only do so once I’ve spent ample time going through what’s available.”
When faced with a vibrant Peacock, engage and assist. They will want your assistance and support. Don’t feel offended if they don’t take your advice – they need to hear five other people tell them the same thing. Offer to take photos, make the experience hands on, and pass options to try on. They thrive on interaction and will enjoy being talked through the dispensing process.
There is a common thread between the birds – people over the product. Even with decisive Eagles who are results-driven, it is the people that draw them back.
ACOD’s resident Peacock, director and senior trainer Mr James Gibbins, has gained input from his family and the optical dispensers when selecting frames and loves to show his latest selection to ACOD students. A happy Peacock will be your biggest advocate. EAGLES LIKE FUNCTION With an Eagle, keep your explanations concise and showcase your efficient systems in store. They may not want your help with frame selection – they will be more efficient on their own. Senior ACOD trainer and Eagle Ms Carly Toms explained: “I rarely ask opinions – they need to do the job and feel comfy.”
DOVE – A LIFELONG CUSTOMER
VIRGILIA READETT
ACOD’S VIRGILIA READETT PROVIDES DETAILED EXAMPLES OF D.O.P.E. PERSONALITY TRAITS AND HOW THE OPTICAL DISPENSER CAN ADAPT TO PROVIDE A MEMORABLE CUSTOMER EXPERIENCE.
THE FASTIDIOUS OWL Owls may seem time consuming – because they are. Offer detailed quotes and information. Use multiple methods to explain the product features and benefits. This may be physical samples, digital displays or perhaps your technical explanation. Some jargon, if used correctly, will impress.
HANDS ON WITH A PEACOCK
n Part 1, we covered the D.O.P.E model – Dove, Owl, Peacock, Eagle – to help optical dispensers profile their customers to tailor their service. Here, I apply this model to Australasian College of Optical Dispensing (ACOD) trainers and provide tips for how each case could be handled.
Peacock-type customers often need validation from their peers before making a decision.
This was seconded by ACOD director and senior trainer Mr Chedy Kalach: “I like to be approached by the staff initially, and to check back occasionally, as needed.” Be warned – Doves are a high-risk group because they talk with their feet. They may never return if there’s adaptation issues, don’t like their frames, or feel unwelcomed. Elizabeth explains, “If the staff wouldn’t leave me alone and kept trying to assist after I inform them that I want to browse independently I would most likely leave and not return.”
If faced with troubleshooting for an Owl, let them see the step-by-step procedure. Go as far as keeping a checklist or filling in an adaptation or a troubleshooting report. Impress with your technical explanations and they will return for your expertise.
It’s important to let this group come to their own decisions, as well as being preemptive with adaptation to new lens designs or prescriptions. It’s best to open the door for them to feel safe and welcome should they need to return. A satisfied Dove will be a customer for life.
“THERE IS A COMMON PRODUCT”OVERBIRDSBETWEENTHREADTHE–PEOPLETHE
ABOUT THE AUTHOR: VIRGILIA READETT teaches with ACOD and has been in optics since 2012. She holds a Certificate IV in Optical Dispensing, Certificate IV in Training & Assessing, and a Bachelor of Arts majoring in Communications. person who will try on several frames of similar styles multiple times and still need to think about it. I’ll also compare similar styles from different stores. I often end up choosing more than one pair to be sure I’ve made the 'right' decision. “However, I value good quality assistance from staff. I love when they genuinely show interest and passion about what they’re saying/doing. I appreciate when they understand my needs and offer extra product advice. I value when they can also clearly explain the how’s and why’s and the pros and cons so I can make my decision.”
KNOWING THE BIRD-TYPES – PART 2
1. “Within 10 degrees above and below the horizontal meridian 90 degrees of clear vision is required” and; 2. “Within a radius of 20 degrees from central fixation up to four contiguous points can be missing”, can help them to accept their position. Patients also often don’t understand that the purpose of a restricted licence is to ensure they are traveling in familiar territory and know the markings, dangerous traffic spots and can concentrate on other drivers and their behaviours. Often once this is explained they accept that perhaps a licence to travel 20km from home to do essential tasks is appropriate and the interstate visit to see the beloved cousin twice removed canBeingwait.able to drive means independence, freedom and greater quality of life. To have a practitioner such as an orthoptist explain the NERYLA JOLLY “WHEN PATIENTS ARE UNDERSTOOD”THESIGNIFICANCERESULT,TOARERESULTSTHEIRSHOWNDEFECTIVEANDCOMPAREDANORMALTHENTHEOFREDUCTIONIS
vision standard does not solve the problem but often the patient understands why they cannot drive and surprisingly often says: “Thank you – I now know why!” To read the updated fitness to drive criteria, visit followedclickaustroads:com.au/drivers-and-vehicles,‘AssessingFitnesstoDriveAustroads’,by‘Vision&EyeDisorders’.
54 INSIGHT August 2022
AUSTRALIA’S FITNESS TO DRIVE CRITERIA HAS BEEN UPDATED WITH INPUT FROM THE OPHTHALMIC SECTOR. NERYLA JOLLY
n
The entire chapter needs to be read to gain more details of the assessment guidelines and specific requirements. This is important because, for example, in regard to visual fields, the revision now defines a significant loss when there are more than four contiguous spots missed in the central 20 degrees. It also states “a person is not fit to hold an unconditional licence if the binocular field does not have a horizontal extent of 110 degrees within 10 degrees above and below the horizontal midline”. There is reference to a conditional licence but no specific details. As an orthoptist working with patients who require vision assessment for fitness to drive, my role has been to conduct many of the tests detailed in the report required by the Driver Licencing Authority. Orthoptists may be involved in this testing either as part of the overall assessment of a patient in a general consultation, in public hospitals or as an independent orthoptic practitioner providing an overview report. The latter may occur because some patients value their license so highly that they seek another opinion, don’t understand the issue or reject that they have a problem. They may also need to understand the significance of a restrictedAlthoughlicence.providing patients with a negative outcome when it comes to their driver licence can be difficult, I have found that when they are shown their defective 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
KEY CHANGES AND HOW TO DELIVER A NEGATIVE OUTCOME TO PATIENTS.
THE ORTHOPTIST’S ROLE IN VISION AND DRIVING
DETAILS
Image of diplopia in right and left gaze.
Peripheral loss is a significant vision problem that prevents people from holding a driver licence. results and are compared to a normal result, then, the significance of the reduction is understood and they can better accept the reason.Forexample, having double vision when looking right makes it difficult to correctly judge the position of a car on your right or a pedestrian on a crossing. Yes, you can turn your head but that takes extra time and you have to also look for the left side, then back with head correction. It takes extra time which often isn’t available in busy traffic conditions.Inthepresence of peripheral field loss, showing the patient the two measurements of:
ABOUT THE AUTHOR: NERYLA JOLLY MA (Macq) DOBA (T) is a registered orthoptist working in independent private practice. She has had over 20 years of research and experience in the field of vision and driving.
V ision is essential for driving. In the government document ‘Assessing Fitness to Drive’, under ‘Medical Standards for Licensing’, a chapter is devoted to vision and eye disorders. In 2021 the document was reviewed with input from RANZCO, Optometry Australia and Orthoptics Australia. The revised 2022 document was recently released, with many of the standards remaining the same and some points being clarified. Revisions made to the criteria related to vision disorders and driving include a clarification to the visual field criteria for scotomas, monocular vision standards for commercial drivers, the inclusion of orthokeratology as a means to meet visual acuity standards, further guidance related to diplopia and the inclusion of additional evidence and rationale for the use of telescopic lenses.
It is important that patient care is not the victim in all of this, and corners are not cut.
Diagnostic and software vendors will also need to support their customers with technology that saves them time, while simultaneously improving outcomes.
Finding staff that have the skills and the drive to work. It’s become difficult to find people that want to work in healthcare at any level –cleaners, administration, health support workers and nurses. The recruitment pool does not seem to have the depth required.
RETENTION It is harder than ever to find staff that have loyalty, and this is driven by a series of factors. Due to recruitment being difficult, staff that remain are often working harder than previously and possibly more than theyManagingwant.
HOW WILL THIS BE MANAGED?
COVID protocols have added to the challenges of running an ophthalmology clinic.
MANAGEMENT
ABOUT THE AUTHOR: DONNA GLENN has been the business manager at Gordon Eye Surgery in Sydney for over 15 years. She is also a member of the RANZCO Practice Managers Committee. INSIGHT August 2022 55 their financial commitments noting the increasing rise in the cost of living.
Practices will need to look for efficiencies; they need to see more patients in the same time frame. Systems need to be streamlined – time and motion studies may help to identify areas with the capacity to increase productivity. Integrated software or other technological tools which save time should be researched.
The healthcare sector will need to be supported by government in the way of Medicare rebates or concessions in other financial components of the business.
To stay competitive and recruit and retain staff, wages will increase and, generally, so will all other costs. This will need to be passed on to health consumers. For those patients that cannot afford it, they will move to the public sector –placing even more pressures on public hospital outpatient clinics.
appointment books is an ongoing challenge, exacerbated by chronic conditions that were not adequately managed during lockdown phases due to severe limitations on the nature of eye health consultations. Further, doctors and staff have needed to cancel clinics at short notice due to influenza or COVID. This is a juggle that does not seem to be easing. Staff are tired, and perhaps less engaged than previously. Economic forces are also wearing away the otherwise loyal staff member who may move roles based on renumeration rather than job satisfaction, convenience or pure loyalty. It’s understandable that staff need to make wise economic decisions to meet AS COVID FATIGUE TRULY SETS IN, DAILY CHALLENGES FOR PRACTICE MANAGERS HAVE BEEN AMPLIFIED.
STAFF STRESS & ANXIETY
And healthcare managers are going to have to dust off their wand and perform the magic they are known for. Practice managers are a profession of strong, multi-skilled people. They are HR managers, financial controllers, health advocates, visionaries and leaders. This may be their chance to shine as a profession and wipe the misconception of glorified receptionists by demonstrating the important role they hold in Australia’s healthcare system. n
DONNA GLENN EXPLAINS HOW OPHTHALMIC PRACTICES CAN ADAPT. TIME FOR PRACTICE MANAGERS TO WORK MAGIC THAT PATIENT CARE IS NOT THE VICTIM IN ALL OF THIS, NOTCORNERSANDARECUT"
Practice managers need to be aware of the state of staff mental health. Recent media reports have shown that healthcare support workers, be it administration or managers, are walking away from the healthcare industry. Patients are being reported as more demanding, and practice support workers are being subjected to abuse at levels never seen before.
T hank goodness COVID has passed and we can all move on. Is that how you feel as a person managing a health service or practice? Or do you feel the fall out is just starting to become apparent?Forthepast two years, information overload, changing protocols and concern for the welfare of staff, colleagues and patients – along with the novelty of Zoom meetings – kept the adrenaline levels high and ophthalmology practices humming. But now it seems the economy and COVID fatigue is truly setting in and health service managers are being challenged to find the magic to hold it together and move forward. This issue seems prevalent across the board in healthcare, with some common challenges: RECRUITMENT
Regionally this is going to hurt the system that has no capacity and is already struggling.
OPTOMETRISTS Alison Middleton has joined independent optometry network ProVision as its South Australia Business Coach, bringing a strong retail optical background that includes experience at Sunglass Hut, OPSM and Luxottica. She also has experience as an optical dispenser and is qualified with Cert IV. Middleton has created and delivered state training programs and was the state One Sight Clinic leader for Indigenous and local school clinics.
– Special Projects in Australia and New Zealand. With 18 years' experience in communications roles, nine of those with Specsavers, she returns to Australia from her years spent with Specsavers covering the Nordic markets as Public Relations Director. Before heading to Europe, she signed Australian designers including Carla Zampatti and Ellery to work with the Specsavers Style division. Do you have career news to share? Email editor Myles Hume at myles.hume@primecreative.com.au to be featured.
ProVision has announced Sabina McDonald is returning as a Business Development Executive. With more than 30 years of experience in the optical industry, she has worked with major companies such as Bausch + Lomb, Marchon, and Hoya. McDonald previously worked with ProVision as a Business Coach, and for 6.5 years recruited over 45 optometry practices while coaching and mentoring over 40 practices across Victoria.
Belinda Mah has been appointed Trade Marketing Manager for Safilo in Australia. Mah brings extensive trade marketing experience, working with premium and luxury brands across various industries in Australia, the UK and the US. Her areas of expertise include strategic planning, brand management, promotions, communications, pricing, visual merchandising, research and analysis, point-of-sale, data analysis and team leadership. Goran Majstorovic appointed as its Head of Brand Creative. He brings more than 20 years of brand strategy, marketing and advertising experience in both in-house and agency roles. His career has seen him work across a broad range of industries and categories, including financial services, consumer technology, sport, gaming and retail.
Insight's monthly bulletin to keep the Australian ophthalmic sector updated on new appointments and personnel changes, nationally and globally.
EXPERIENCED ZEISS MEDTEC PRODUCT SPECIALIST MOVES INTERSTATE
MARKETING EXPERT
Avril Miranda has recently joined the Victorian Zeiss Medical Technology team as a Product Specialist in Surgical Ophthalmology. An optometrist by trade, Miranda has several years of international experience managing a refractive based clinic in Dubai for almost seven years. She was previously in a similar role in Zeiss Queensland’s Medical Technology business and, after relocating to Melbourne with her family, is now excited to make use of her clinical experience in Victoria.
People ON THE MOVE CAREER 56 INSIGHT August 2022
RETURNS TO INDEPENDENT SCENE
SPECSAVERS
New Zealand employment enquiries: Chris Rickard – Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499 Graduate employment apac.graduateteam@specsavers.comenquiries:
2022 CALENDAR
Locum employment enquiries: Cindy Marshall cindy.marshall@specsavers.com or 0450 609 872
Graduate Recruitment Team are currently looking for new graduates to join our teams in Regional NSW & QLD. Whether it be for a new challenge or relocating for different lifestyle – this could be your first step in opening doors for your professional career. Providing a generous bonus along with a competitive regional salary and relocation package, this is an opportunity to good to be missed. Specsavers is the largest employer of graduate optometrists across Australia and New Zealand and we have continued to develop our comprehensive two-year Graduate Program which provides newly qualified optometrists with a dedicated mentor, support network and structured program to assist you in your development. Interested in relocating to NZ? Specsavers has a range of opportunities for NZ optometrists looking to return home. From North to South, we have fantastic opportunities 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. There’s no place like home – so if you’re ready to return, let us help you. Optometrists can expect to earn in excess of $200k in Devonport, TAS! Looking for an opportunity in Devonport? This is for you. On offer is a 50 per cent shareholding and an experienced retail team in a 3-test room store with state-of-the-art equipment including OCT. Fantastic opportunity to specialise in a clinical area of interest as the store is Myopia control Misight accredited. Specsavers Devonport is situated on the north coast of Tasmania and surrounded by beaches, mountains and walking/cycling tracks. Relocation support available. Two great Optometrist opportunities – Specsavers Townsville, QLD Work with market leading equipment – including OCT, be supported by experienced retail teams and have access to excellent opportunities for further career development. Flexible rosters to support work/life balance – including three consecutive days off every fortnight. If you relocate with a friend RDOs and leave can be rostered to align so you can enjoy the lifestyle together. Extremely attractive salary including $10k sign on bonus and $5k relocation support. Highest package ever! $180,000 for the growing Mobile Optometrist Role Specsavers is growing our community-based Mobile Optometry Team across Australia. With an amazing $180,000 package on offer including five weeks annual leave, professional registrations, and travel/accommodation are covered. You will experience a wide variety of cases, whilst being able to explore different regions of Australia. We are looking for someone who has the desire and flexibility to travel. –
6 August apgcongress.org/ NSW RANZCO OPHTHALMOLOGY& UPDATES! Sydney, Australia 27 – 28 August ranzco.edu SEPTEMBER 2022 BARCELONA SPECS Barcelona, Spain 3 – 4 September barcelonaspecs.com SPECSAVERS CONFERENCECLINICAL 10Australia–11September scc2022.com.au/ EUROPEAN SOCIETY OF CATARACT & REFRACTIVE SURGEONS Milan, Italy 16 – 20 September congress.escrs.org SILMO PARIS Paris, France 23 – 26 September silmoparis.com OCTOBER 2022 CCLSA ICCLC 2022 Sydney, Australia 15 – 17 October icclc2022.com.au PROVISION CONFERENCENATIONAL Melbourne, Australia 21 – 23 October eventbrite.com.au EYECARE PLUS NATIONAL CONFERENCE 2022 Broadbeach, Australia 28 – 30 October web.cvent.com RANZCO 53RD SCIENTIFIC CONGRESS Brisbane, Australia 28 October – 1 November ranzco2022.com/ ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE Brisbane, Australia 28 – 31 October orthoptics.org.au NOVEMBER 2022 HONG KONG INTERNATIONAL OPTIC FAIR Hong Kong 9 – 11 November event.hktdc.com ASIA OPTOMETRIC CONGRESS & AEGEAN CONFERENCEOPTOMETRIC Kuala Lumpar, Malaysia 15 – 16 November asiaoptometriccongress.com/3rdasia-optometric-congress/
To list an event in our calendar myles.hume@primecreative.com.auemail: – YOUR CAREER, NO LIMITS SPECTRUM-ANZ.COMVISIT 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 opportunities enquiries: Kimberley Forbes on kimberley.forbes@specsavers.com or 0429 566 846 Australia Optometrist employment enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134
storesSpecsaversAllnowwithOCT AUGUST 2022 AUSCRS Noosa, Australia 3 – 6 August auscrs.org.au 6TH ASIA-PACIFIC GLAUCOMA CONGRESS Kuala Lumpur, Malaysia 3
58 INSIGHT August 2022
I’m fortunate to work in a public hospital
department (The Queen Elizabeth Hospital, Adelaide) where we can implant toric IOLs without a threshold. In fact, we can implant trifocal toric IOLs without limit. This has developed through the immense work of our head of department, A/Prof Michael Goggin, and collaboration from IOL manufacturers, with special thanks to Zeiss. This is a great model for examining what happens when cost is no longer an issue and artificial thresholds have been removed. Interestingly, there are still cases where an appropriate toric IOL version isn’t implanted. I know my colleagues well enough to understand this isn’t to create an artificial difference in quality to promote private surgery, nor to keep referring optometrists happy with patients still needing glasses. Instead, my theory is there is still some hesitancy to implant low power toric IOLs due to uncertainty about dealing with potential problems. There’s also an apathy to do the best possible job, as for so long, leaving residual astigmatism has been acceptable. Anyone who implants low power toric IOLs realises this is a robust technology that works well and the need for further intervention is rare. The other side of this argument is that low power toric IOLs still haven’t been approved by the US FDA , as a clear visual benefit has not been proven in trials. Unfamiliarity and uncertainty with toric IOLs would seem to be a driving factor of poor uptake in public hospitals. Further education, both from industry and colleagues, will be important in further improving uptake in departments like mine. Elsewhere, in departments with a threshold for toric IOLs, I simply ask surgeons to consider whether they would be happy for themselves or their family to be left with residual refractive error when the same operation could provide perfect unaided vision. n
The first common issue is cost. It’s true a toric version of an IOL costs significantly more than non-toric. On the scale of surgical prostheses, IOLs are cheap compared to artificial joints, and heart valves yet provide great improvement in quality of life. There have been plenty of cost-benefit analyses on toric IOLs which I won’t detail here, but basically the decreased need for glasses, lower falls risk and improved quality of life and productivity with toric IOL use, renders the added cost insignificant. A major problem is the people who pay this extra cost for public hospital budgets don’t see the added benefit. Ophthalmology department budgets are limited yet can somehow cope with the escalating millions of dollars needed for intravitreal injections for macular degeneration, diabetes and vascular occlusions annually. Comparatively, lowering the arbitrarily set threshold for toric IOLs is a minor cost.
SOAPBOXWHYISRESIDUAL
BY DR BEN LAHOOD T hrough my training and career, I’ve worked in 10 public hospital eye departments across Australia and New Zealand where an arbitrary threshold decides which patients are given toric IOLs for their astigmatism. This threshold has usually required above two dioptres of corneal astigmatism. We know from large population studies that it’s rare to have this degree of astigmatism – and that residual, untreated astigmatism is detrimental to vision quality. These thresholds meant, as a registrar, I never implanted a toric IOL. Use among trainees does appear to have improved since then. While teaching final year ophthalmology trainees from across Australasia, surveys indicated they had implanted toric IOLs in 1-2% of cataract surgeries before the end of their training. However, in my private clinic where I have freedom to use appropriate toric IOLs for astigmatism, I use 85% toric versions of the various IOLs I implant. My toric IOL usage is not at all excessive. I’m not implanting toric IOLs in case of future development of astigmatism; I’m simply providing a refractive correction right now with as little residual refractive astigmatism as possible. Why is there such a difference in refractive goals between the public and private systems? The best analogy for public hospitals is to imagine seeking
Name: Dr Ben LaHood Qualifications: MBChB PGDipOph PhD Organisations:FRANZCO Ashford Advanced Eye Care and The Queen Elizabeth Hospital Position: Cataract and refractive surgeon Location: Adelaide, South Australia Years in profession: 6 THERE’S AN APATHY TO DO THE BEST POSSIBLE JOB, AS FOR SO LONG, ACCEPTABLE.HASASTIGMATISMRESIDUALLEAVINGBEEN glasses from your optometrist and being given a pair that only corrects spherical error for long or short sightedness but no cylinder correction of your astigmatism. Patients would immediately complain and return their glasses. You can think of other similarly ridiculous scenarios such as an orthodontist only straightening your upper teeth, or a plumber unclogging only the straight sections of plumbing. A combination of factors have led to us only implanting toric IOLs in high astigmatism and this being acceptable.
REFRACTIVE ERROR ACCEPTABLE IN PUBLIC HOSPITALS?
