Optometry is pushing for scope expansion and a new report details how this might play out
* 1 2 For Sensity Fast performance details visit http://bit.ly/3HYtmeh.
ARRIVAL OF NEXTGENERATION IMAGING
An Alice Springs optometrist is the first independent globally to purchase Cylite's HP-OCT
THE FUTURE OF BULK BILLING
Optometry boasts one of the highest rates among all health professions, but at what cost?
AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975
Paediatric Myopia, Keratoconus, Diabetic Retinopathy and Inflammatory Eye Disease.
These are just some of the topics confirmed for this year’s Specsavers Clinical Conference.
Bringing together optometry and ophthalmology professionals from across ANZ, with up to 20+ hours of CPD available across two days, this event is not to be missed.
Book your tickets now at: specsaversclinicalconference.com.au
September 14-15
Gold Coast + livestreamed across ANZ
OPTOMETRY AUSTRALIA BACKS NATIONAL SKILLS MATRIX FOR SCOPE OF PRACTICE REFORM
In the latest proposals to optimise the health workforce, Optometry Australia (OA) has welcomed a national matrix that clearly sets out the skills and capabilities of health professionals, regardless of whether they are regulated, and the establishment of an independent body to oversee how scope-ofpractice changes are rolled out.
The peak body has responded to Issues Paper 2 of the Scope of Practice Review that is assessing the barriers preventing Australia’s healthcare practitioners from working to the full extent of their skills and training to deliver best practice primary care.
In October 2023, Optometry Australia provided initial feedback, stating the profession faced “various funding, regulatory, technological, cultural, and
inter-professional barriers” preventing them from practising to their fullest scope. It also called for a detailed comparison of health professionals in other countries to identify opportunities for further scope enhancements and highlighted examples of health systems where prescribing of oral medications and intravitreal injections – which Australian optometrists are prohibited from performing – are performed by non-ophthalmologists.
It also wants to see greater use of collaborative care models –already established in parts of the country – but pointed out scalability remains a hurdle.
So far, the Scope of Practice review has been through two rounds of consultations, receiving close to 1,000 submissions and
involving many face-to-face meetings. Issues Paper 2 outlines findings from the second round of consultations and presents eight key recommendations for reform.
After reviewing the document, OA said it welcomed a proposed national skills and capability
RISING COSTS DETER EYECARE PATIENTS
Around a quarter of Australian eyecare patients are avoiding treatment for their condition due to cost reasons, according to new research that points to the impact of declining Medicare rebates and a mismatch between subsidised care and practising patterns.
The study, published in the latest issue of Public Health Research & Practice, a peer-reviewed journal of the Sax Institute, surveyed patients attending collaborative eyecare clinics where optometrists provide diagnostic imaging and services typical of public hospitals or large private ophthalmology practices.
Patients faced significant financial barriers, with 36.8% reporting that they did not
obtain services prescribed by an optometrist due to costs.
One or more direct or indirect cost barriers were experienced by 42.6% of respondents for optometric care, and 40.4% for specialist eyecare.
Patients with poorer self-rated health or lacking private hospital health insurance were the hardest hit.
“Our findings underline the considerable cost barriers people face when accessing eyecare,” said senior author Dr Angelica Ly, a researcher at the School of Optometry and Vision Science at UNSW Sydney.
“We found that on average, one in four patients were opting not to access eyecare services
because of the cost, even after attending a collaborative care clinic that provides services at no cost to patients. And nearly half reported cost as a barrier when seeking eyecare. Our research shows that more support is needed, especially for people with poor self-rated general health or without private hospital health insurance.”
framework and matrix that sets out the skills and capabilities of health professionals, including members of regulated, self-regulated and unregulated professions.
According to the government, this would contribute to better recognition of health professional skills and strengthen the system by informing workforce planning. This reform is considered “foundational for all remaining reform options and integral to facilitating health professionals to work to their full scope-of-practice”.
OA said: “This initiative will greatly assist with implementing and coordinating multidisciplinary care programs. To further assist with its utility, we strongly advocate for the matrix to includes the capabilities
continued page 8
The findings come as the industry continues to highlight the declining real value of Medicare rebates, contributing to a considerable uptick in out-of-pocket costs for eyecare services during the past decade, the authors say.
continued page 8
Jo Murphy has become the first independent optometrist in the world to purchase Cylite's HP-OCT. He discusses how the device is giving a new edge to his clinical work.
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OA says the optometry scope in Australia is more limited than in comparable countries. Image: Inside Creative House.
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Simplifying the complex
IN THIS ISSUE
Remote control
As a magazine editor, artificial intelligence (AI) has seeped into my daily workflow. Otter.ai transcribing software, and alternative headlines and phrases offered by ChatGPT, are small changes I’m leveraging for big gains in productivity and even creativity.
Granted, the responsibility of publishing a trade magazine doesn’t weigh as heavy as caring for someone’s eye health, but there’s huge potential for ophthalmic professionals to harness AI. If anything, there is a greater need for this technology to lighten the load, given the strained workforce driven by an ageing population.
Imagine an eye health utopia where AI fills the appointment book, designs your marketing material, interprets multiple scans for a single diagnosis and delivers a drafted management plan – ready for you to adjust and approve.
27 Numerical advantage
Three ophthalmologists explain how they are distilling data for better outcomes in major disease.
50 New horizons
In some respects, we are already there. It’s fascinating to see eye health at the forefront of what should be one of the most transformative eras for our industry. Already, clinics in Australia are using software that analyses fundus images and can screen for glaucoma, macular disease, diabetic retinopathy and cardiovascular health – all on one platform.
Artificial intelligence is poised to revolutionise eyecare, but is the industry ready for this transformation?
This edition on page 50, we also focus on how large language models (LLMs), like ChatGPT, can aid clinical decision making. Although contentious, some studies are showing LLMs can already match or outperform ophthalmologists in the diagnosis and recommended treatment of glaucoma and retinal disease.
AI is also being used to capture clinical notes, relieving a major administrative burden for eyecare professionals who can place their undivided attention on the patient. A guide on how to integrate this responsibly into your practice can be found on page 62.
While there are many hurdles to clear – such as biases, the validity of input data and accuracy – before AI is used ubiquitously, I like to think of these developments in incremental gains to be figured out along the way.
Like I discovered in my own work, by putting my pride aside and embracing AI, it only augmented my performance. It’s a nice reframe and, if applied to the ophthalmic sector appropriately, could help resolve many of the accessibility issues in Australia.
MYLES HUME Editor
UPFRONT
Just as Insight went to print, PROF GRAHAM BARRETT’S intraocular lens design, developed with Rayner, will be the focus of an Investigational Device Exemption study that could pave the way for use of the RayOne EMV Toric IOL in the US. Recruitment has now closed for the lens deemed a truly non-diffractive optic using positive spherical aberration to offer extended vision. “Closing recruitment on this study is a huge milestone for us,” said Mr Jim Nevelos, Rayner’s head of global clinical. IN OTHER NEWS, the
WEIRD
The University of Jena has developed a small optical lens, only a few millimetres in size, whose refractive behaviour changes in the presence of gas. In Nature Communications, the “intelligent” behaviour of the micro-lens is due to a molecular structure that consists of a three-dimensional lattice with cavities that can accommodate gas molecules, affecting the optical properties of the material.
WONDERFUL
A new retinal imaging technique, called spatio-temporal optical coherence tomography (STOC-T), is being developed. Recently, scientists from the International Centre from Translational Eye Research (ICTER), used multiwavelength laser Doppler holography to assess blood flow in various layers of the human retina in vivo, which they believe could impact the diagnosis of circulatory disorders.
WACKY
A new study has emphasised the importance of the “gut-retina” axis in glaucoma. Chinese researchers discovered an association of certain T cells expressing a “gut homing integrin” with glaucoma disease severity. Experiments showed these T cells detoured to the gut where they undergo genetic reprogramming to gain retinal access.
TGA has approved Eylea 8mg, a higher dose of aflibercept for neovascular aged-related macular degeneration (nAMD) and diabetic macular oedema (DME). The TGA registration – on 14 June 2024 – follows approvals in the US and Europe in late 2023 on the back of the pivotal PULSAR and PHOTON studies, two double-masked, active-controlled pivotal trials evaluating Eylea 8mg compared to Eylea injection 2 mg. By introducing a higher dose of aflibercept, it’s hoped this will address treatment burdens. FINALLY, outcomes from a Melbourne bionic eye trial have demonstrated the device’s long-term
durability and stability. The findings add to interim results showing the second-generation device, developed by B ionic Vision Technologies, provided rapid improvements for four patients with blindness caused by retinitis pigmentosa. The new study tracked the patients from 2018 to 2021, finding the device stayed in place behind the retina without complication, with 97% of electrodes functioning 2.7 years after first implant. Principal investigator A/Prof Penny Allen said patients showed significant improvement in their navigation, mobility and ability to detect objects.
Retinal rescue
WHAT'S ON
24 – 25 August
The conference is a chance to brush up on common subspecialty topics ophthalmologists may be curious, or forgotten, about. ophthalmologyupdates.com
NEXT MONTH SCC 2024
14 – 15 September
Specsavers has secured a high-powered speaker line up including Dr Brendan Cronin, Dr Rushmia Karim and A/Prof Chameen Samarawickrama for its conference on the Gold Coast. specsaversclinicalconference.com.au
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of the top of scope of the professions. Following on from this, the matrix should be regularly updated to keep pace with advancements in technology and practice.”
There’s also a proposal to create a new independent body tasked with identifying and implementing emerging best practice evidence into primary health workforce models.
The entity would be responsible for providing advice to governments and regulators on how the various scopes for health professionals can continue to meet community need. This body would also factor in the role of new technology, new roles and new workforce models, and the impact of combined scopes of practice – both overlapping and distinct –of certain professions. It would exist as an independent advisory committee, either as a newly formed autonomous national body or sitting under the remit of a body like the Australian Health Practitioner Regulation Agency (Ahpra). It would act like the Medical Services Advisory Committee (MSAC) or Pharmaceutical Benefits Advisory Committee (PBAC).
“We support an independent body approach to regulating scope-of-practice,” OA said. “This body could be tasked with providing assistance to registration boards to assist with progressing change thereby focusing on scope-of-practice reforms.”
In addition, OA called for simplified legislation for prescribing rights. “This will enable ongoing refinements to be agile and facilitate the utility of the national skills and capability matrix.”
With respect to enhanced inter-professional collaboration, OA said the S cope of Practice Review provided some excellent initiatives for primary care.
“However, it needs further focus on inter-professional collaboration between primary, secondary, and tertiary care to decrease the load on tertiary care. In particular this should include funding models of collaborative care and asynchronous (store and forward) telehealth.”
Restrictive funding models
The review, led by Australian National University health workforce expert Professor Mark Cormack, outlined the biggest challenges facing the workforce. In Issues Paper 2, it found legislation impedes health professionals working to their full scope. Where the law dictates which professions are authorised to provide a service, other health professions who may have the same skill are unable to do so. At times, legislation does not keep up with accepted changes in practice. There are also differences between state and territory legislation.
“Funding and payment arrangements
“WE SUPPORT AN INDEPENDENT BODY APPROACH TO REGULATING SCOPEOF-PRACTICE. THIS BODY COULD BE TASKED WITH PROVIDING ASSISTANCE TO REGISTRATION BOARDS TO ASSIST WITH PROGRESSING CHANGE THEREBY FOCUSING ON SCOPE-OF-PRACTICE REFORMS.”
OPTOMETRY AUSTRALIA
impede health professionals working to their full scope.
"Existing funding models restrict some professions from working to their full scope-of-practice and fail to adequately support primary care health professionals to work together in teams,” the report said.
With this, it said there was reduced workforce mobility and skills portability, resulting from inconsistent recognition of professional scope and qualifications. Poor workforce retention, due to scope limitations, was identified as a strong influence on health professionals choosing to leave the health workforce.
“[There is] restricted consumer access to optimal care, particularly for consumers living in regional and remote areas. This was highlighted where a health professional is available, but not authorised or enabled to provide care that falls within their scope,” the report said.
“[There is also] reduced opportunity for multidisciplinary care, due to barriers restricting health professionals from working collaboratively as a multidisciplinary team and reinforcing p rofessional siloes.”
The review is being conducted in four phases with a final report and implementation plans expected by October 2024.
MEDICARE'S MISMATCH WITH EYECARE USE
continued from page 3
According to the study, patient expenditure on eyecare has increased significantly over the past 10 years. Fees recommended by Optometry Australia are currently $65–$132, yet the corresponding Medicare rebates are only AU$35.55–$70.55.
The average inflation-adjusted copayment for optometry services increased by more than $30 from 2010 to 2020, they note, and the median out-of-pocket fee for specialist services is currently $96. At the same time, use of optometric services is high, with 82% of Australians having undergone an eyecare test in the previous two years. Another potential reason for increased
out-of-pocket costs, according to the study, is that Medicare coverage of services does not adequately reflect utilisation patterns. For example, at least 55% of optometrists use retinal imaging daily to detect and monitor eye diseases to reduce the risk of vision loss, which is supported by clinical care guidelines. In this application, however, retinal imaging costs as much as $120 out-of-pocket per visit and can support early intervention, yet it does not attract a Medicare rebate.
“Overall, these findings indicate that current collaborative eyecare models may be improved by providing additional support for individuals who are in poorer health or do not have private health insurance. Additionally, public health policies need to use eyecare-specific
strategies to optimise access to eyecare,” the authors said.
This edition of Insight has a focus on the increasing strain on optometry providers to provide bulk billed eyecare (page 31). Currently, the profession boasts one of the highest bulk billing rates (94%), but the rising operational costs – and indexation freezes – are creating tough conditions to continue offering this sustainably.
Optometry Australia has recently stated estimates drawn from comprehensive analysis of practice costs indicate the actual cost of providing a comprehensive consultation in a sustainable business model is over $50 more than the Medicare scheduled fee.
Dr Angelica Ly, UNSW. Image: Angelica Ly.
BUPA BUILDING ON EXISTING OPTICAL AND DENTAL FOOTPRINT
Bupa has unveiled a blueprint to acquire healthcare centres and build on its 49 optical and hearing stores, as well as 178 dental clinics, to create a nationally distributed network offering more integrated services.
On 17 June 2024, the health insurance company revealed a roadmap to create “a more connected and personalised patient journey” across physical and digital channels. It will have an initial focus on mental health, type 2 diabetes, musculoskeletal health, oral and eye health.
Bupa’s current healthcare network is built on dental practices and optical stores, but the Connected Care strategy plans to bring together in-person and virtual care, supported by digital technology and partnerships.
As part of a multi-year investment bolstering its current services, the company said it was initially focused on acquiring healthcare centres that will offer integrated GP, allied health, and pathology services. The centres will be open to anyone, not just Bupa Health Insurance customers.
“We know one of the biggest pain points for customers going through the healthcare
system is how fragmented it is. That’s why we’re working to connect care physically and digitally to remove barriers and increase affordability and convenience,” Bupa APAC CEO Mr Nick Stone said.
“In the long-term, our aim by bringing services together physically and digitally is to deliver simple, person-centred care – the ‘right care’ in the ‘right place’ at the ‘right time’. We want to be a true partner in our customer’s healthcare.”
He said access to clinicians and services would be supported by technology and underpinned by safe, secure, and intelligent data for a more seamless and less confusing health experience.
Stone said Bupa’s long-term Connected Care approach would also help empower customers to manage their own health information enabled by secure digital platforms.
“Giving customers easier access to their own secure health information recognises they are active participants in their own health journeys,” he said.
Independent research, commissioned by Bupa, recently found almost half of
Australians felt accessing healthcare was complicated, and two in three experienced at least one barrier to accessing a healthcare service over the past year with wait times, limited appointments, and costs the main barriers.
The Bupa Pulse Check survey also found there was an increase in the number of people visiting an allied health practitioner compared to last year, and while people preferred in-person appointments due to the need for physical examinations and the ease of building relationships with practitioners, there remained a strong desire for the ongoing use of telehealth.
Bupa has 49 optical and hearing stores across Australia. Image: Bupa.
IN BRIEF
INDEPENDENT EVENT
Optipro, a buying and marketing group for independent optical businesses, is running a 2024 roadshow taking place across three major cities in August. The events will set the stage for an annual tradition of bringing together thought leaders, optometrists, optical dispensers, practice owners, practice managers, suppliers, and other industry professionals. Organisers said attendees could seek to enhance their practice’s success and stay ahead of industry trends. This year’s roadshow will feature exclusive product showcases, including the new Transitions GEN S lens, insightful discussions, and valuable networking opportunities. By establishing this as an annual event, Optipro aims to provide a platform for independent optical practitioners “to access the latest technologies, strategies, and support needed to thrive in a competitive landscape”. The 2024 Optipro Roadshow will start in Perth 9 August, followed by Sydney (14 August) and Brisbane (23 August).
NEW MULTIFOCAL
Melbourne lens manufacturer CR Labs has launched the Australis Grad Multifocal Lens, available from 1 July 2024. The new addition to the Australis Range represents “a groundbreaking entry-level solution”, offering superior visual quality, at an accessible price point, the company said. The Australis Grad lens is designed to provide a seamless visual experience, with a smooth transition from far and near vision. Leveraging CR’s Digital Enhancement technology, the company said the lenses ensured maximal visual comfort and a wider field of view, which is especially beneficial for those who use electronic devices daily. The lens will be available on the CR Labs MyLab ordering platform.
OPSM CAMPAIGN
OPSM has unveiled its 2024 ‘Everyday Excellence’ communications campaign, which spotlights four professionals from various industries who bring “extraordinary to life”. The company said everyday Australians and New Zealanders were selected for the campaign as they “commit to excellence in what they do each and every day”.
Along with a new television spot, the 360-degree omnichannel campaign is being showcased through touch points within OPSM stores, on OPSM.com.au, and across the company’s marketing channels from 17 June 2024. Among the professionals selected for the campaign is Ms Nornie Bero, a Torres Strait Islander and chef from Australia, Mr Angus Vinden is the owner and winemaker of Vinden Wines in the Hunter Valley, Mr Chey Ataria, a designer from New Zealand and the founder of Def Skateboards and New Zealand beekeeper Ms Jess Curtis.
GREATER PROTECTION FOR WA PATIENTS
Optometrists and ophthalmologists practising in Western Australia are now being governed by updated laws that bring the state into line with the rest of Australia.
Among the suite of changes, the Health Practitioner Regulation National Law Application Act protects the title ‘surgeon’ when used by medical practitioners. It also allows the Australian Health Practitioner Regulation Agency (Ahpra) and the National Boards to issue a statement warning the public about individual practitioners “when there is a serious, unmanaged risk to public health and safety”.
Ahpra said the move further strengthened health practitioner regulation and public protection in WA.
Most of these changes have started, with some to start later in 2024 on a date to be agreed by governments.
Changes to the law include increasing penalties for advertising breaches, clarifying when employers must notify Ahpra of practitioner misconduct, allowing National Boards to revoke registrations obtained through false information, and enabling information disclosure to employers about practitioners under investigation.
Additionally, the amendments permit prohibition orders to restrict health service provisions and allow National Boards to withhold information from the public register if it poses a safety risk to the practitioner, their family, or associates.
Ahpra CEO Mr Martin Fletcher said the WA Bill was important to ensure health practitioner regulation was more consistent across Australia in the interests of patient safety.
“Importantly, this legislation recognises the unique needs of the WA community and health sector, while enabling an efficient mechanism to apply any future changes to the National Law.”
Mandatory reporting obligations for all WA registered health practitioners have not changed.
MOST-TRUSTED OPTOMETRY BRANDS REVEALED
For the fifth year running, Specsavers has been named the most trusted optometry brand in Australia and New Zealand by Reader’s Digest Magazine as part of the 25th Annual Most Trusted Brands survey.
Voted by Australians and New Zealanders, Specsavers has been recognised as the brand that consumers trust the most for their eye health between 2020-2024.
The annual survey is based on independent market research bringing together consumer opinions on leading brands across 68 categories in Australia and 67 in New Zealand. A total of 4,300 Australians and 1,800 New Zealanders of a mixed demographic were asked to rate their levels of trust in well-known brands.
With Specsavers topping the optometry category, EssilorLuxottica-owned OPSM and Optical Superstore were the runners up.
Dr Ben Ashby, Specsavers clinical services
director ANZ, was thrilled the company had been acknowledged through the survey.
“Specsavers is committed to providing our customers with a mix of greater choice, high quality, accessible and affordable eye and hearing care,” he said.
“Receiving such great feedback in this prestigious consumer survey is a fantastic reminder that we’re on the right track and something we’re really proud of.
“We know that customers turn to us for expert eyecare, provided by local, highly qualified optometrists. We’re proud to be a brand that can be trusted to consistently deliver the best health outcomes to all our customers.”
Ashby said every Specsavers team member has played an important role in building this trust with customers.
A complete list of Australian winners is available on the Reader’s Digest website.
The change will protect the title ‘surgeon’ when used by medical practitioners. Image: mojo_cp/ stock.adobe.com.
Reader’s Digest
editor-in-chief Louise Waterson (left) and Specsavers NSW/ ACT state director Chris Willis. Image: Specsavers.
Comparable high levels of UCDVA § and CDVA
Similar dysphotopsia profile with lower incidence of optical side effects
High degree of patient satisfaction for daily life activities
Enhanced spectacle independence from far to intermediate distances
TRANSITIONS INTRODUCES ‘ULTRA DYNAMIC’ GEN S LENS
Transitions
Optical has launched its latest lens innovation, Transitions GEN S, available in Australia and New Zealand from August 2024.
According to the company, the “ultra dynamic lens” goes beyond simple correction by adapting its tone to changing light conditions, indoors and outdoors, faster than previous technology and is based on five years of research into photochromic technology, where more than 100,000 lenses were tested.
OV/SA PRAISES EXPANSION OF GLASSESSA PROGRAM
Optometry Victoria South Australia (OV/SA) has welcomed the SA Government’s decision to expand the GlassesSA program, as outlined in the SA State Budget 2024-25.
GlassesSA is an initiative that helps South Australians obtain low-cost glasses or – for those with serious eye conditions – no-cost contact lenses.
From 1 January 2025, the SA Government will simplify and extend access to subsidised glasses by offering eligibility to all holders (and their dependents) of the Pensioner Concession Card, Health Care Card and Low Income Health Care Card.
Currently, only those receiving the maximum rate of certain Centrelink or Department of Veterans Affairs payments can benefit from this program.
Transitions GEN S brings together three core elements of performance for wearers. The first is GEN Speed, referring to its ultra-responsiveness to light, with fade back being around two minutes, making it two times faster than Transitions GEN 8, the company reported.
The second key element is GEN Style; Transitions GEN S is available in eight colours, including a new addition, Ruby. Ruby is said to be a trending tone and was recently named ‘colour of the year’ by a leading colour institute.
“All colours have been optimised to be true to tone at all stages of transition, offering vibrant tints. While being fully clear indoors, and beautifully coloured outdoors, the dynamic lenses provide endless possibilities of pairing to complement any look,” the company said.
Finally, GEN Smart relates to “effortless vision”.
Transitions GEN S is reported to offer better visual performance, faster, to ensure a continuous visual experience in varied and changing light environments. The lens provides 39% faster vision recovery from intense bright lights versus clear lenses. During fade back, tests have shown a 39.5% improvement in contrast sensitivity and 40% faster vision recovery versus Transitions GEN 8, a statement said. Moreover, the lens provides light protection, darkens outdoors, blocks 100% UVA and UVB rays and filters up to 32% of blue-violet light in the clear state and up to 85% when activated.
“This is a significant and much-needed development in vision care accessibility for South Australians,” said Mr Timothy Lo, president of OV/SA.
“By broadening the eligibility criteria, a much larger group of people can now be reached. This ensures more South Australians can access the essential eyecare services they need, ultimately improving their quality of life.”
Lo also extends his gratitude to the SA Government for prioritising eye health in the State Budget.
“It’s estimated over 90% of blindness and vision loss is avoidable, and vision loss can have devastating impacts on the health and
overall well-being of affected individuals and their families.
“The SA Government’s decision to expand the GlassesSA program demonstrates their continued commitment to updating the scheme to meet community needs.
"We are grateful they have recognised the importance of vision care and have made it a priority, and we look forward to working together to improve eye health outcomes for all South Australians.”
The SA Government confirmed that GlassesSA will operate in the same way with the changes – optometrists carry out an online check of a customer’s Centrelink details and claim through the portal for EFT reimbursement. Existing additional program subsidies, including free standard glasses for eligible Aboriginal customers and optional out-of-pocket upgrades, will remain.
TOPCON RETINAL CAMERA REACHES AUSTRALIAN SHORES
Device Technologies is now supplying the latest device from Topcon Healthcare, the NW500 non-mydriatic retinal camera, to the Australian ophthalmic market.
“The user-friendly fundus camera is fully automated, meaning a single button touch initiates alignment, focus and capture process. The simplicity of use gives clinicians the option to confidently delegate screening to staff, thereby offering opportunities to enhance the clinical workflow,” Device Technologies stated.
The 12-megapixel image sensor delivers sharp and consistent images, while the slit scan illumination and rolling shutter mechanism further enhance the NW500’s image quality, enabling the camera to overcome the issue of images unsuitable for
grading, thereby streamlining the diagnostic workflow. Even in well-lit conditions, the NW500 can deliver images with less flare and shadow than its predecessor, the TRC-NW400.
“Adding to the image quality offered by the NW500 is its ability to provide clinicians with 50-degree imaging across the three traditional fixation positions (disc, centre, and macula). The peripheral photography mode allows further fixation points in the traditional nine directions of gaze,” Device Technologies said.
“The NW500 represents a significant opportunity for clinical businesses, delivering innovative technology that enhances diagnostic imaging and streamlines the imaging process.”
The lens, available in eight colours, includes a new addition. Image: Transitions Optical.
From 1 January 2025, eligibility of the GlassesSA program will be expanded. Image: Serhii/stock. adobe.com.
NW500 can deliver images with less flare and shadow than its predecessor. Image: Device Technologies.
MDFA LAUNCHES NEW SUPPORT SERVICE FOR MACULAR DISEASE PATIENTS
Macular Disease Foundation Australia (MDFA) has launched Eye Connect –Australia’s first comprehensive support service for people living with macular disease.
Studies have shown that only 56% of patients with macular disease recall receiving a clear diagnosis, including the name of their condition, with 58% unable to recall receiving any lifestyle modification advice from their eyecare professional.
MDFA has responded with Eye Connect that enables people to access free, evidence-based support in between appointments with their eyecare professional.
Eye Connect is currently available to people with any stage of age-related macular degeneration (AMD). It has been developed based on insights from a neovascular AMD pilot program and research involving people living with macular disease, carers, ophthalmologists and optometrists. Soon, the service will be expanded to support other macular conditions.
A new Eye Connect community service video for eyecare professionals produced
by MDFA has been produced. The aim is to provide eyecare professionals with an understanding of how MDFA can support their patients after they leave the clinic. Eye Connect offers a range of tailored support in three key areas:
• Health information: patients are provided with evidence-based information about macular disease, and non-clinical support services to help them confidently manage their condition.
“Supporting eyecare professionals to deliver better health outcomes for patients with macular disease is a key priority for Macular Disease Foundation Australia. We have every confidence that Eye Connect will help drive this forward by complementing the information people receive in a clinical setting,” said Dr Chapman.
• Practical advice: includes tips and guidance on things like nutrition for healthy eyes, immediate care after their appointments, daily living with reduced or low vision, and transport advice.
• Emotional support: the Eye Connect team can help patients manage concerns they may have about their diagnosis and treatment and connect patients to peer support.
MDFA CEO Dr Kathy Chapman said people with macular disease wanted to connect with more practical and emotional support to manage their condition at home.
Meanwhile, diabetic eye disease will be a focus of Eye Connect's expansion as diabetic retinopathy affects one in three Australians aged over 50 with diabetes.
“The Eye Connect service will provide a valuable supplement to the information that clinicians give their patients with macular disease,” said A/Prof Alex Hunyor, MDFA’s Medical Committee chair. “Offering support that is tailored to the individual patient is a really practical addition to the services already provided by the Foundation.”
Health professionals can refer patients to the new service online, via Oculo or by calling MDFA on 1800 111 709. Patients can also self-refer via the foundation’s website or over the phone.
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macular disease patients between appointments with their eyecare professional. Image: MDFA.
WHEN YOU CAN TURN ON THE LIGHT
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The 2040 optometrist
How will the role of the optometrist evolve within the next two decades?
Optometry
Australia offers some well-informed predictions in an updated report factoring in the future of technology, scope-of-practice and funding models.
Artificial intelligence (AI) and real-time access to comprehensive eye health data, flexible working conditions, optometrists working as neurosensory specialists and alternative funding models to Medicare. These are some of the ways Optometry Australia (OA) envisages the profession to be working by 2040.
The organisation has launched its Refreshing Optometry 2040 report. It’s an update to its Optometry 2040 project released in 2018 that identified plausible, and the preferred, futures for optometry, optometrists and community eye health.
OA undertook the work after recognising some assumptions had progressed faster than expected, while others were slower or hadn’t budged at all. To reassess and refresh its scenarios, it enlisted experts Professor Niki Ellis and Ms Jane Palmer, of Niki Ellis and Associates, to lead the project, with futurist Professor Sohail Inayatullah reviewing at key points.
‘A MULTI-TIERED PROFESSION’
According to OA, in 2024, it’s hoped optometrists are an integral part of a multidisciplinary, collaborative health care system that provides patients with seamless access to services.
AI – coupled with real-time access to comprehensive health data – will enable optometrists to predict future patient health issues and work with them as active participants in decisions about their care.
“This scenario sees optometry as a multi-tiered profession with several specialisations, including as neurosensory specialists utilising diagnostic retinal imaging for a range of neurological conditions, and postgraduate professional paths that variously meet the complex eyecare needs of geographically and culturally diverse populations,” OA stated.
“Supported by regulatory reform, optometry expands in scope to include a greater role in disease management and intervention. Optometrists work across a wide range of modalities, and are embedded in a network of primary care, specialist and other support services (including GPs, ophthalmologists and disability services) with support from AI, real-time data, and technologies such as implantable eye health monitors.”
According to OA, the work of optometrists could be conducted virtually, face-to-face, remotely or highly localised, at home, in health kiosks such as pharmacies, in multidisciplinary primary care clinics, or in legacy retail businesses.
“The range of delivery modalities means that optometrists have flexible working hours and a networked capacity to share/distribute service delivery, reducing workforce turnover and increasing work-life balance,” OA stated. With a substantial rise in chronic and complex health conditions, OA expects the community to accept governments cannot fully fund healthcare. This could spur public-private partnerships with community businesses and industry, and a greater financial contribution from consumers and health insurers. Medicare fee-for-service funding may be largely replaced by
ABOVE: In future, Optometry Australia says the work of optometrists could be conducted virtually in health kiosks, multidisciplinary primary care clinics, or in legacy retail businesses.
funding of health services based on “packaging of services for each patient” (capitation) or on patient outcomes. New and improved communications and data transfer systems to increase the effectiveness and efficiency of interprofessional practice would also be established.
Meanwhile, “horizontally integrated health services” could see optometry incorporated into small centres such as pharmacies, through to larger multidisciplinary urban and regional health hubs. It’s believed glasses and contact lenses will easily be obtained online, while consumers continue to refer to optometrists with any concerns, and for ongoing management of eye health conditions.
“[In 2040] public education and awareness programs have raised consumer understanding of the broader role of optometrists in holistic and preventive health care, and provide consumers with guidelines on eyecare, at-home digital ocular services and how to decide when to contact an eyecare professional,” OA said.
For optometry training and education, there will be a new emphasis on teamwork, leadership and collaboration, says OA. Education opportunities would be shared with other health professions, including training placements. Optometrists would also receive ongoing training in culturally safe practice, while a digital health transformation and the use of big data will require ongoing education in advanced technologies such as AI and cybersecurity.
“[In 2040] optometry practice is now fully responsive to social and regulatory demands for sustainability to limit the impacts of climate change, and overall, CPD programs are continuously reviewed to respond to new technologies, government policy changes and evolving community needs,” OA stated.
TAKING CONTROL OF OPTOMETRY’S FUTURE
The work done on the Refreshing Optometry 2040 project has been considered in OA’s strategic plan for 2024.
“Optometry is constantly changing due to demographic, technology, economic, government and societal forces,” OA CEO Ms Skye Cappuccio said.
“Optometry 2040 is about taking control of our future, so it was clear that more work needed to be done to support the ongoing evolution of optometry in Australia, to take advantage of the opportunities of new technology, big data and a growing workforce, and increase access to eyecare for all Australians.”
She said by embracing the updated preferred future for optometry, the sector could collectively shape a future where eye health is accessible and equitable for all Australians, and optometrists are used to their fullest clinical scope.
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Honouring a legacy
A uveitis diagnosis during childhood set SHELLEY KLINE on a challenging life trajectory. Thankfully, she had an ophthalmologist who remained in her corner for almost 40 years. Now, she’s paying it forward with a scholarship.
Behind Ms Shelley Kline’s eye patch is a story of courage, determination and resilience. What started with a devastating uveitis diagnosis as an eight-year-old spiralled into a years-long fight to preserve her vision, debilitating pain and the difficult decision to ultimately remove her eye.
There’s been some dark moments, but throughout her life legendary Australian ophthalmologist Professor Frank Billson AO has – next to her family and husband – been her most trusted advisor, guiding her through the major decisions concerning her right eye and taking a genuine interest in her life.
Although Prof Billson has roots in Victoria, including deep ties with The Royal Children’s Hospital (RCH), by the time Kline came into his care he was practising in NSW. She was at primary school, visiting a local ophthalmologist once a week in Melbourne for monitoring, but flying up to Sydney with her mum to see “Prof”, as she fondly refers to him, for more complicated care. Her dad was often working but would join when he could.
“I remember we’d be sitting for hours waiting to see him, and you understood why as soon as you walked through the door because he spent so much time with each person, treating you like a human being with so much empathy and compassion. He had a beautiful demeanor and that’s why he was so well-regarded,” she recalls.
“He also taught me to not let these conditions stop you from achieving anything you want to. It was the best piece of advice that still sticks with me today.”
Kline was in Prof Billson’s care for almost 40 years. To honour his contributions to ophthalmology, in 2021 she created the Professor Frank Billson Research Scholarship at the RCH. The annual grant gives clinicians at the hospital’s Ophthalmology Department the opportunity to advance research into paediatric eye conditions. This scholarship, solely dedicated towards advancing research generated within the RCH ophthalmology department, is the first of its kind.
Kline was given a $250,000 target that would allow the RCH Foundation to fund the annual scholarship in perpetuity, but through her fundraising efforts she has eclipsed this.
“I’m determined to reach a target of $500,000 raised and I’m almost there. With such a significant amount of money towards the scholarship, the ophthalmology team can plan for research projects in the future and leverage from money raised for further funding,” she says.
It’s beyond anything she expected, and with Prof Billson now retired in his 90s, she’s proud to have set up the scholarship in his lifetime, preserving his legacy indefinitely.
“I’ve done this to honour my professor. Research and educating the next generation meant so much to him, this is my way of saying thank you for everything he’s done for me,” Kline says.
“The RCH is one of the best paediatric hospitals in the world. But the difference between a good hospital and great one is philanthropy. Government funding covers operational costs, so I want to ensure that with this scholarship, we can have a positive impact on as many children as possible with eye conditions.”
A CONSTANT IN HER LIFE
At the age of eight, Kline was living a normal childhood. One day she reported feeling unwell. It seemed innocuous at first, but she was referred to several specialists before an ophthalmologist delivered the diagnosis.
“I remember my mum crying because the eye doctor said that I had an
Above: Shelley Kline was diagnosed with uveitis in childhood, eventually leading to enucleation.
Left: Shelley Kline introducing her family, including husband Adam Joel, to Professor Frank Billson in Sydney.
Images: Shelley Kline.
Wearing so many hats Kline says it is remarkable to consider how much time he had for her.
PROFESSOR FRANK BILLSON RESEARCH SCHOLARSHIP RECIPIENTS
They are designing and implementing online education and collaboration modules to upskill optometrists in paediatric eyecare. It’s hoped the initiative will see some children receive all their eyecare locally, while others will participate in a collaborative model of shared care between the local optometrist and RCH. Both models of care will increase access to eyecare in metro and regional Victoria and reduce the need for families to attend the RCH eye clinic, saving them time and money. It will also improve access to the RCH eye clinic for patients unable to be managed in the community.
Uveitis has been a life-long fight with many downstream effects. The diagnosis meant she couldn’t distinguish pain or feel changes in her eye. Concerned about glaucoma, she saw an ophthalmologist weekly who managed the inflammation and checked the intraocular pressure (IOP). Her pupil needed to be constantly dilated and she remembers being teased for having “different coloured eyes” and wearing spectacles.
“You didn’t see a lot of kids with glasses back then, and the frames were always daggy. I was so embarrassed. My parents did everything they could to help me and made sure that I had the best care. We travelled the world to see the best doctors and I’m always very grateful for that,”
Along the way, Kline learned some interesting facts about her condition: that non-infectious uveitis was more common in girls, and when faced with big changes in her life, it could go into remission.
“I’ve got three children and every time I was pregnant, I had no pain or issues. It’s like almost like my body protected me from it,” she says.
Together with Dr Rod O’Day, ocular oncologist, and Dr Olivia Rolfe, they reported the treatment burden for children with unilateral retinoblastoma and compared the outcomes for Victorian children who received globe-sparing treatment, when safe to do so, versus primary enucleation. This work supports the decision-making process for parents when their child receives a retinoblastoma diagnosis, empowering them to make a fully informed decision including the implications of each treatment option.
autoimmune disease called uveitis, which we didn’t know much about. I was just a child and I never in my life thought that it would impact me for so long.”
Her family were determined to find answers, travelling to San Francisco to visit a designated clinic.
Soon, the legendary Professor Gerard Crock, Australia’s first professor of ophthalmology based at the Royal Victorian Eye and Ear Hospital, introduced her to Prof Billson as one of the only specialists in Australia with uveitis expertise.
Prof Billson has a long and distinguished career in ophthalmology that began in Melbourne. He has long standing ties with the RCH, including as head of ophthalmology for seven years in the 1960s. His research and clinical interests have had a major focus on neonatal and paediatric ophthalmology and during his time at RCH, its expertise in paediatric ophthalmology became internationally recognised.
Later he moved to Sydney to become Foundation Professor of Clinical Ophthalmology at the University of Sydney, setting up the Save Sight Institute. He spent almost 25 years at the Sydney Eye Hospital (SEH) and Royal Prince Alfred Hospital. Plus, he co-founded Foresight Australia in 1978, a not-for-profit, and established Sight for Life Foundation supporting SEH’s registrar training program.
“We also discovered that you often don’t get blessed with one autoimmune disease, but two. When I was 12 years old, I had a skiing accident and came back to Australia for an arthroscope and that’s when we found out I had juvenile rheumatoid arthritis too.”
Regardless, Prof Billson continued to play in a role in her life. Even when Kline moved to Israel for seven years – suffering a major uveitis attack while there – he was only ever a phone call away.
But her affected eye continued to deteriorate. The IOP was extremely low, and the extreme pain and medication burden were hard to manage. She underwent three procedures in quick succession to save it, but there was little functional vision left. She consulted Prof Billson and decided enucleation was the best option.
“It was very hard time because I was in so much pain and my dad was passing with cancer,” she recalls.
“I wore a brilliant prosthesis for a year and it helped to alleviate some issues. But then I developed giant capillary conjunctivitis (GCC), an inflammatory reaction to a foreign body that feels like razor blades when you blink. We couldn’t get it under control with medication, and I decided to take it out and felt much better without it.”
Despite this, Kline still struggles with health issues stemming from uveitis. GCC impacts her occasionally, and she suffers from central sensitisation. There’s also painful peripheral nerve damage around the eye. Fortunately, a mother from her children’s school works in fashion and designed strapless cotton eye patches that stay in place with micropore tape. She’s also found some ultra-light glasses, and worked hard to find a good GP, rheumatologist and a psychologist to help manage the mental load.
“Sometimes I think I should pat myself on the shoulder, but I am hard on myself. This health condition is debilitating, so I’m not in a paid job and I can’t do everything that some other mums can. But I have amazing support from my husband (Adam Joel); he’s always backing me up and cheering me on to be positive. My brother, Gideon, is someone who never complained when the focus was on me growing up and he still is so concerned about my health,” she says.
“My philanthropy work is my passion. I’m excited for the challenge of fundraising and proud of what we have achieved so far. I love meeting and talking to people and telling them about Professor Billson and the impact he has had on my life, and many others.”
NOTE: A mini documentary, funded by Cooper Investors, on the Professor Frank Billson Research Scholarship has been released and can be accessed via www.rchfoundation.org.au/professor-frank-billson-research-scholarship/ To donate, visit www.rchfoundation.org.au/donation/frankbillson/
Above: 2024-2025 – Cathy Lewis, RCH chief orthoptist, and Dr Anu Mathew, RCH director of ophthalmology.
Above: 2022 – Dr Sandra Staffieri AO, senior orthoptist, research lead and retinoblastoma care coordinator at the RCH. Images: Alvin J Aquino, the Royal Children’s Hospital Melbourne.
In February 2024, Alice Springs optometrist JO MURPHY became the first independent optometrist in the world to purchase a Hyperparallel OCT, representing the next generation of imaging technology invented, developed and manufactured in Melbourne by Cylite. He discusses how the device is giving a new edge to his clinical work.
As a full-scope independent optometrist in Alice Springs, Mr Jo Murphy offers the full gamut of services. Specialty contact lens fitting, myopia management and keratoconus examinations make up a major part of his working week. But space is at a premium and it can be difficult to justify investing in a single modality device that, for instance, only measures axial length or scleral topography.
When Murphy’s OCT overheated not long after purchasing Eyecare Plus Alice Springs from longtime owner Mr Bill Robertson in late 2021, initially this was viewed as a setback. He then discovered it couldn’t be repaired, but his fortunes turned when Teacher’s Health in Brisbane offered him a recently retired OCT from one of its practices.
With a stopgap solution in place, in retrospect, the mishap was an opportunity to pay down some debt and bide his time to invest in a system at the cutting edge of OCT technology.
Murphy first saw the Cylite Hyperparallel OCT (HP-OCT) at O-SHOW22 and was immediately impressed by what a true 3D image of the eye could offer and its potential to perform multiple functions. He visited the Cylite head office in Melbourne later in 2022 to trial a prototype and tour the manufacturing facility.
Cylite started taking orders at O=MEGA23 and with the device now commercially available, Eyecare Plus Alice Springs became the first independent practice to purchase the technology. While it has posterior segment capability, it’s the HP-OCT’s anterior segment imaging that’s turning heads across the global ophthalmic industry.
“It has the potential to replace so many machines; anterior and posterior corneal topography, a scleral topographer and biometry as well as full volumetric anterior and posterior OCT imaging, make it ideal for my practice,” he says.
“While specialty contact lenses are a significant part of my work, it’s also difficult for me to find the space and build a financial case for a machine
that offers a standalone modality like scleral profiling. Specialty contact lens practices can justify it, but for me the Cylite HP-OCT is a much better proposition.”
The HP-OCT has quickly cemented its place as one of, if not the, key device in Murphy’s equipment suite. Once the normative retinal database is ready and integrated with the system, he expects it to enter a whole new realm.
Scans can be conducted by an optometric assistant and once the image is pulled up in the consulting room, Murphy has a wealth of information he can slice and cut in any direction, X, Y or Z axis – all without any gaps, holes or B-scan stitching artefacts to deal with. It’s something he hasn’t had access to previously.
This is because the HP-OCT offers an industry-leading 302,400 A-scans per second. It can simultaneously image across a wide area of the eye with minimal motion artefacts.
In turn, in one scan, the system captures a full 3D image of the anterior segment. This supports personalised contact lens fitting with highly accurate and repeatable elevation and curvature maps. A full set of biometric measurements, including axial length, supports myopia management. Plus, the same volumetric imaging technique can also be applied to the posterior segment to produce excellent volumetric retinal images.
“What particularly stood out to me is that, with traditional OCTs, they are scanning with one beam of light, so you need to know what you want to capture. If it’s an epiretinal membrane, for example, you need to know beforehand whether a horizontal or vertical scan is going to best document the wrinkle in that particular retina,” he explains.
“Whereas the HP-OCT incorporates a micro-lens array to split the light source into 1,008 individual beamlets – each of which scan a very small area. But these beamlets are scanning at the same time, which makes it less prone to some of the errors that can occur through movement. The HP-OCT then captures and builds a true 3D volumetric model – and you can decide
Image: Eyecare Plus Alice Springs.
Optometrist Jo Murphy (left) with Cylite senior product manager Matthew Wensor on the day of his HP-OCT install.
however you want to view that once the scan has been acquired. This is beneficial from an accuracy and patient flow perspective.”
He’s also been impressed with the coverage of the scan. His HP-OCT anterior lens captures a 16.6 mm X 16.6 mm scan, which he says easily captures all that’s required to assess the anterior segment.
For Murphy, it’s enabled him to visualise diseases unlike before. In fact, it took some adjustment. An example of this is pinguecula or a pterygium, a condition that he previously showed patients with a slit lamp camera.
“I thought slit lamp photos were a good way to demonstrate how sun exposure is affecting the front of their eye. But since bringing it up on the HP-OCT image, it seems to have had a more profound impact. Several patients who have ignored my advice for years are now taking sun protection seriously and buying sunglasses with side protection,” he says.
“I’ve found myself referring to an eye model a lot less. Instead, I’m using a single Cylite scan of their own eye where I can show the apex of their cornea through to the back of their crystalline lens. This has been fantastic for explaining diseases and their treatments.”
AN ELEVATED LEVEL OF SERVICE
Murphy has spent the last decade working as an optometrist in Central Australia. When he is not working in Alice Springs, he’s often visiting far flung communities performing outreach work, flying the plane himself as a licensed pilot.
Often in these settings, he’s making clinical decisions with traditional equipment, some that may have even become redundant for the modern optometrist. The irony isn’t lost on him that, upon returning to Eyecare Plus Alice Springs, he now has access to one of the latest and unique OCTs on the market.
“The best way we can provide an excellent service is to use all of the tools at our disposal. Sometimes that’s an HP-OCT, widefield camera, meibography or your trusty retinoscope,” he says. “At the end of the day, if you’re trying to make a decision on whether someone requires further assessment, and especially if they are travelling long distances, you want to obtain the most information as possible, so investing in technology is a no brainer.”
The HP-OCT captures a full 3D volumetric image of the anterior and posterior segments, allowing the practitioner to slice and cut in any direction, X, Y or Z axis –without any gaps in the image or data.
The data estimates as many as 1:200 (others are as high as 1:2,000) people have keratoconus, and Murphy believes this prevalence rate matches with his practice.
The HP-OCT, and its ability to capture highly accurate measurements of the topography of each optical surface within the anterior segment, especially shines in these cases. For mild to moderate keratoconus, he believes the system will prove valuable in detection but also monitoring for progression and potential referral for collagen cross linking. In advanced keratoconus, the HP-OCT has excelled because it is tear film independent and is not subject to ring jam like the previous placido disc topographer Murphy used.
“Previously with keratoconus, we had to scan the eye with a corneal topographer, and then move them to our standard OCT, but this was only able to image about six millimetres at a time and just in single line scans. Now we can obtain all of this, plus more, in one scan,” he says.
“I’m hoping that it also leads to more accurate contact lens fitting in keratoconus, with less chair time. I’m still using it in more of a traditional sense, where I might be performing a baseline scan and putting a trial lens on the eye and assessing the post-lens tear film to make modifications to the lens. Previously this would require at least five different scans on the OCT per contact lens. Now I can capture the entire post lens-tear film in a single scan. But there is the potential for this type of technology to enable us to build a lens shape that’s more highly individualised, once the work has been done to link with the lens labs.”
The HP-OCT is also set to offer advantages in myopia management. In 2023, Cylite signed an agreement to integrate PreMO myopia app into
its software developed by Professor James Wolffsohn and colleagues at Aston and Ulster universities, helping clinicians to predict myopia onset and progression in their patients, including growth curves.
While Murphy has only used the Cylite to obtain baseline axial length measurements for myopes, he believes the software will inform discussions with parents on the need for treatment and, in future, monitoring its effectiveness.
“Again, it was hard to justify the capital expense or floor space of a machine that measures axial length alone, but to have it incorporated into an existing machine is ideal for our practice,” he says.
USER EXPERIENCE
To support its hardware, Cylite has also developed software called Focus. For the practitioner, this is the user interface, and something the company knows it will be closely judged on.
With the bulk of Cylite’s efforts focused on the hardware, it is now beginning to roll out gradually improved software to improve the user experience and to add new features. Murphy has viewed the newest version – in final stages of certification – that he anticipates having shortly with “greatly increased capability”.
“When you consider this machine is capturing a 3D volumetric scan of the eye using OCT technology, the options for what metrics can be extracted and compared over time are seemingly endless,” he says.
“The software developers are conscious of being able to provide a machine with customisable features so that individual practitioners or researchers can extract certain metrics that are useful to them, while also making the interface user friendly. I think they have done this really well and I am excited to see what future development of the software will bring.”
Image:
Cylite.
OPSM’s remote optometry journey, with the optometrist on screen and the in-person aspect run by a technician.
A new way of practising optometry
Beyond greater accessibility to eyecare for Australia’s under-served regional and remote patients, remote optometry represents a new era with greater flexibility for the workforce. Insight is taken through the OPSM remote optometry journey.
The delivery of optometry in Australia is well-regarded by global standards, but challenges remain. Chief among those is access to eyecare for the country’s regional and remote population, followed by a maldistributed workforce, and somewhat rigid working conditions for optometrists.
Remote optometry has emerged as a new care model that can overcome some of these longstanding barriers. Leveraging new technological developments by EssilorLuxottica, OPSM has been significantly investing time and resources to develop and customise local clinical protocols and “reimagine the patient journey”.
The result is a cohesive and elevated remote comprehensive eye exam where the patient is in a conveniently located practice, accompanied step-by-step by a trained technician, while the optometrist is located remotely – oftentimes in another state.
THE REMOTE OPTOMETRY JOURNEY
As Insight editor, I was invited to go through the OPSM remote optometry journey in May 2024 at the showroom in OPSM Macquarie Centre Sydney.
For the demonstration, the network’s professional services manager
for NSW/ACT, Ms Astha Rai, acted as the remote optometrist.
The appointment started with the technician performing pre-test procedures beginning with the Wave Analyser Medica 800 (WAM800), capturing autorefraction to 0.01 D, low and high order aberration assessment, topography, pupillometry, retro-illumination of the crystalline lens, pachymetry, and tonometry.
Next, I was taken to an ultra-wide digital retinal device that takes a 200-degree view of the retina, as well as OCT with the capability to perform scans of my macula and optic nerves.
It’s immediately clear how pivotal the technician is, in addition to linked and easy-to-operate technology.
The technician then took me into the consulting room that looked like any other in the OPSM network, minus an in-person optometrist. Instead, this is where I’m introduced to the optometrist over a video link. Rai, as the optometrist in this scenario, takes down a detailed history, and notes my high astigmatism and toxoplasmosis scar from the pre-test work up, and is then able to remotely control and perform the subjective refraction on the Essilor VR800. It’s a remarkable piece of technology capable of refining the refraction to 0.01 D, but what’s
Image:
EssilorLuxottica.
Image: EssilorLuxottica.
The pre-test involves an Optos ultra widefield scan operated by a technician on the patient in-store.
precision. There’s no rotation of lenses in this phoropter.
Rai has the option to choose from my existing prescription or autorefraction as a starting point and performs the refraction.
A slit lamp examination is also performed with the Essilor SL650. During the diagnosis and management discussion, the optometrist can present scans and results on screen, demonstrate any changes to prescription at the touch of a button and present visualisations of common eye disorders. It’s also possible to show what my vision would look like with certain lens designs.
Having the information presented this way is simple to understand and I imagine would get the patient invested in their eye health.
In my case, the optometrist hands back to the technician and recommends a new pair of lenses to account for my changed prescription, as well as a discussion around polarised lenses as a second pair for golf and other outdoor activities.
Although an ophthalmology referral wasn’t required in this instance, if one was, it can be done securely using the Oculo platform.
EXPANDING ACCESS TO EYECARE
While remote optometry presents an opportunity to offer more flexibility into the optometry workforce in terms of working hours and location, its primary function is to reduce the wait time for routine eye examinations by increasing the availability of optometrists in under serviced communities.
In turn, this empowers patients to be proactive about their eye health. OPSM’s remote optometry program is being rolled out following a highly successful pilot at its South Hedland, Albany, and Kalgoorlie locations in 2023. The network plans to expand its remote optometry service across a number of locations by the end of 2024.
Early career optometrist Ms Kim Nguyen was one of OPSM’s first remote optometrists. She is located in Doncaster, Melbourne, where she spends two days per week practising remote optometry, seeing patients who visit OPSM stores in South Hedland and Kalgoorlie, both in remote parts of Western Australia. During the other three working days, she is practising in-person optometry.
Despite only graduating from the University of Melbourne in 2022, Nguyen was keen to be part of this new way of providing optometric care. It made sense, given her interest in the topic.
During her university studies she published a paper demonstrating the lack of digital competencies among optometry students amid the increasing prevalence of digital health models. Another formative experience was time spent in the OPSM relief team where she visited regional Victorian areas and provided temporary optometry cover.
That experience alone provided first-hand exposure to some of the challenges regional patients have when accessing eyecare, motivating her to make a difference to communities as a remote optometrist.
“In the locations where we are providing remote optometry, the nearest ophthalmologist is sometimes five hours away and other times they are only getting face-to-face optometry one week every few months, so it’s a long wait time for an eye test,” she says.
“Many of these conditions are treatable, and when we think about the eye health gap experienced by some regional and remote patients in Australia, remote optometry is helping to bridge that.
“The major benefit is that everything’s on one platform, which is great given all the information we receive in the pre-test.”
Nguyen says one of most important factors is the technician.
“They provide in person support for the patient and ensure the remote eye exam runs smoothly, especially if there’s difficulty in communicating with the patient; for example, if they’re hard of hearing or there’s a language barrier,” she says. “The technician is a crucial part of the remote optometry model, and those involved in the program are very
dedicated and proactive individuals.”
To aid communication, the remote optometrist can also access short videos that can be played during the consult to educate the patient on certain eye conditions. Plus, Nguyen says it’s been great to show the patient their own eyes through videos captured on the slit lamp and digital retinal scans.
As part of OPSM’s remote optometry journey, comprehensive triaging ensures that any ocular emergencies are referred appropriately prior to consultation.
Nguyen recalls seeing a variety of non-acute eye conditions as a remote optometrist, including a recent case where she diagnosed geographic atrophy. The patient had infrequent eye health checks due to extended wait times for in-person appointments.
“Through the remote consultation, I was able to educate the patient about their eye health, convey the management plan, and emphasise the importance of regular eye exams,” she says.
Image: EssilorLuxottica.
Insight editor Myles Hume undergoing autorefraction as part of the OPSM remote patient journey.
Kim Nguyen, one of OPSM’s first remote optometrists, practising out of Doncaster, Melbourne.
Image: Prime Creative Media.
Deciphering the data
With a wealth of high-tech hardware at the fingertips of modern-day eyecare professionals, patient information and the way it's managed is a pressing issue. Three ophthalmologists explain how they are distilling data for better outcomes.
The term ‘paralysis by analysis’ was coined some decades ago, but as a practising eyecare professional in 2024, it could not be more relevant if one is not judicious about the information they rely on for chronic disease management and treatment planning.
With the increasing sophistication of ophthalmic instruments, the role of the optometrist and ophthalmologist is to absorb each measurement, image and detail of patient history and synthesise it into insights that can preserve and even restore vision.
Today, effective data management is at the centre of successful eye clinics. Without organised and easily accessible information, how can eyecare professionals be expected to spot vital physiological changes amid the hustle of daily practise?
ZEISS is one company that has realised this challenge and responded with ZEISS Forum that it describes as the leading ophthalmic data management solution. The platform and its clinical workplaces work to provide seamless data integration of various diagnostic devices that ultimately help clinicians make treatment decisions from a single workstation.
Insight speaks to three ophthalmologists about the key data they use to inform their cataract and refractive surgeries, and glaucoma management, and how ZEISS equipment and software creates confidence and convenience in their daily practise.
CATARACT CALCULATIONS
a single display. As much of the data pre-populated, it requires minimal manual data entry and allows him to plan the surgery before the patient in real time.
Importantly, the software can be customised to the surgeon’s preferred settings, including A constants, most-used intraocular lenses, and formulae.
One of the key devices that feeds into EQ Workplace is the ZEISS IOLMaster 700 biometer. Dr Ingham says pre-cataract surgery, the device’s topography maps can clearly show corneal changes to pick up undiagnosed conditions like keratoconus, as well nasal flattening from previous pterygium surgery. Intel like this is vital given that some presbyopia-correcting IOLs are particularly intolerant of residual refractive error.
Dr Peter Ingham, who owns Adelaide Eye & Laser Centre and works alongside Dr Ben LaHood, performs around 900 cataract surgeries a year, with an increasing proportion of those being premium multifocal and extended depth of focus (EDOF) intraocular lenses (IOLs).
With the heightened complexity of planning for these procedures, the clinic has counteracted this by simplifying its cataract surgery workflow and investing in ZEISS Forum and by extension EQ Workplace. The latter is a cutting-edge cataract surgery planning solution that allows him to have biometry, other vital scans and a calculation platform all on
“Even if I do not use TK values for calculation, it gives me an indication of whether the adjustment for posterior corneal astigmatism is likely to be as extreme in certain eyes and I can adjust my toric IOL cylinder power accordingly.”
Dr Ben LaHood Adelaide Eye & Laser Centre
“It also conveniently displays other crucial information like anterior chamber depths, white-to-white measurements, as well as your X and Y offsets, which are quite helpful if you’re considering implanting a more premium-type lens.”
When planning for surgery, Dr Ingham and Dr LaHood routinely use total keratometry (TK). TK is available on the ZEISS IOLMaster 700 and combines telecentric keratometry with swept-source OCT to measure both anterior and posterior corneal surface simultaneously.
A recent study conducted by Australians Associate Professor Michael Lawless, Dr James Jiang, Dr Chris Hodge, Professor Gerard Sutton, Associate Professor Tim Roberts and Professor Graham Barrett found that in post-myopic LASIK eyes, the Barrett True K formula with TK improved the outcome predictions compared to the Barrett True K with Classic Ks within ±0.5 D by more than 12%.
Dr LaHood says although TK values over simple anterior keratometry is unlikely to yield significantly better results in eyes – other than in post-refractive laser surgery – he finds it reassuring having TK values available. He uses TK values to assess toric IOL plans even if the figures are not used in IOL calculation.
He was part of a group that published the first analysis of the ability of the IOLMaster to measure posterior corneal astigmatism and found that eyes with against-the-rule astigmatism had a wide variability in the axis of their posterior corneal astigmatism. When using anterior keratometry
Image:
ZEISS.
Image: Ben LaHood.
alone, he says it is assumed that posterior corneal astigmatism steep axis will be vertical.
“However, looking at TK values, even if I do not use them for calculation, gives me an indication of whether the adjustment for posterior corneal astigmatism is likely to be as extreme in certain eyes and I can adjust my toric IOL cylinder power accordingly. From auditing my surgical results, I can see this technique and being able to readily look at TK values when selecting an IOL has been beneficial for my patients,” he says.
While accurate biometry truly holds the key to optimal outcomes, he says data also plays a vital role post-operatively. In Dr LaHood’s clinic, all lens-based surgery patients return for repeat biometry, subjective refraction and examination. Even though it’s time consuming, it allows for analysis, auditing, and ultimately improving future outcomes.
Recently, he reviewed 150 eyes he implanted with a single type of toric IOL and used the anterior keratometric axis to align each one.
“This is different to the plan received for each eye when using the Barrett formula which recommends an adjusted axis of implantation. I had the outcome data analysed by Prof Graham Barrett and we looked at what would have been the best axis of implantation,” he says.
“It showed there would have been a small improvement following his plan rather than what I had been doing. This is the type of question that you can only answer by collecting data. It has changed my practice and I hope to see even better results for my patients going forward.”
REFINING REFRACTIVE SURGERY
Dr Ingham and Dr LaHood also offer refractive laser surgery, and while this means they can readily enhance IOL outcomes when necessary –and giving them more confidence to try new IOL designs – it also provides
an important clinical service for those not ready for IOLs.
With access to the ZEISS Visumax 800 laser and the Alcon Wavelight laser, ICL surgery and keratorefractive laser procedures including PRK, LASIK, and SMILE, are all available.
Dr LaHood reinforces that accurate biometry is the lynchpin to excellent outcomes. Essentially, once the surgeon and patient enter the laser operating suite, the hard work has been done.
“To achieve accurate biometry, we need to optimise the surface we are measuring. We are trying to be precise working with a changing, dynamic, fluid surface. One problem we have is that all too often, we get the ocular surface as good as possible for biometry but fail to continue this optimisation post-op. All eye surgery temporarily worsens tear film quality as it is inflammatory,” he says.
“Post operatively an unhappy patient, who had an optimised tear film for pre-op measurements, may not be happy with their outcome due to a lapse in tear film treatment in combination with their new optical set up. It is unlikely the lens is at fault, but more likely that their ocular surface is suboptimal once again. So I think we have to move away from just getting an ocular surface primed for biometry and better educate patients that this is going to be an ongoing maintenance even after surgery.”
To refine his results, Dr LaHood has each refractive laser patient return for post-op imaging of their cornea, subjective refraction and examination. This is vital because post-operative accuracy after laser procedures can be more difficult to define as the targets are different (often mild hyperopia in young eyes) and outcomes can change with time and corneal remodelling, especially after PRK.
He adds it is easy to have the outcome of one or two cases alter one’s thinking so consider the big picture and rely on analysis of multiple cases.
Image:
ZEISS Forum provides seamless data integration, pictured here in glaucoma management, of various diagnostic devices that ultimately help clinicians make treatment decisions from a single workstation.
“The ZEISS Refractive Workplace allows in depth analysis of refractive procedure outcomes and that has been helpful to be able to easily enter and review outcome data,” he says.
“I have previously done this in an Excel spreadsheet. The Refractive Workplace graphical displays are easy to interpret and use to refine treatment planning nomograms. Each laser is different and so for me, moving from Auckland to Adelaide and between lasers, it has been very important to be able to easily analyse a large number of outcomes and refine my treatment plans.”
FINDING THE GOLD IN GLAUCOMA MANAGEMENT
To make a glaucoma diagnosis – and to especially spot the rapid progressors and refer for treatment – the clinician needs to make a call by combining structural and functional data, often over an extended period.
So when Dr Geoffrey Chan began his public work at Fremantle and Fiona Stanley Hospital in Western Australia, one can imagine the frustration when faced with a clunky electronic medical record (EMR) system consisting of handwritten notes and visual field results scanned into the system and printed on each patient visit. Often these were unlabelled and not filed in chronological order.
“It was very hard to make sense of that data, and incredibly inefficient if you’re having to click on each scan date to try and pull up the relevant data.”
However, this all changed when the hospital invested in ZEISS Forum software a couple of years ago, something Dr Chan was already experienced with from his private work at the Lions Eye Institute. It’s given him access to ZEISS Glaucoma Workplace – a platform that brings together all the data crucial for glaucoma from devices like the Humphrey Field Analyser 3 (HFA3), Clarus ultra widefield retinal camera, and Cirrus OCT.
The platform makes it easy for Dr Chan to access patient data, with Forum existing as the place to store and access all ophthalmology data while sitting parallel with the hospital’s existing EMR. In the clinic, he usually has the patient’s medical notes accessed via the EMR on one screen while the other screen runs Forum where he can cycle through the scans and investigations.
He says a major advantages of ZEISS Glaucoma Workplace, especially when linked with a ZEISS native retinal camera such as the Clarus, is its ability to automatically segment out an image of the optic nerve at each relevant visit. Bringing together the OCT, visual field and retinal scans, at his fingertips he has all the structural and functional information he needed to make efficient and informed clinical decisions.
“The beauty of the ZEISS Glaucoma Workplace is the summary pages it generates. My favourite is the Structure-Function Guided Progression Analysis (GPA) which integrates longitudinal data to show areas where change has been detected. The Structure-Function Maps available present the key parameters with RNFL (retinal nerve fibre layer), ganglion cell analysis, and the concurrent visual field all on the one page,” he says.
“My favourite is the Structure-Function Guided Progression Analysis (GPA) which integrates longitudinal data to show areas where change has been detected.”
Dr Geoffrey Chan Fremantle and Fiona Stanley Hospital
The ZEISS Refractive Workplace removes the need to entre data manually, helping streamline the planning stage.
“It’s a very efficient way of managing and monitoring glaucoma, displaying all the relevant information for clinical decision making. It also helps you keep track of when the patient last had X and Y test. Also, its role in patient education is probably the most powerful aspect, removing the need to switch between tabs, and using a single screen to demonstrate optic nerve damage and how this corresponds to the patch of vision missing in the visual field result.
“It brings to life the structure and function implications for the patient.”
On Forum in Glaucoma Workplace, Dr Chan can access Trend and Event Analysis on a single page, allowing him to plot visual field progression over time and making it clear where exactly the patient might be headed.
“With that, the system can highlight with yellow and red colour coding which part of the discs might be changing over time. It is augmenting our clinical decision making by flagging areas that we should pay attention to.”
Another key metric, intraocular pressure (IOP), is captured through Goldmann applanation, but this can be manually inputted into the patient’s record at each event. The same can also be done for a medication change and surgery, plus more.
“It allows you to flag events over time to see how the visual field and how the patient is changing in a graphical representation,” he says.
Dr Chan says the Glaucoma Workplace shines in all types of glaucoma patients. In suspects, it clearly highlights any changes to the optic disc while in rapid progressors, it can quickly flag the need for intervention.
“In these cases, the technology makes it easier to see linear trends, looking at how fast the RNFL and the mean deviation are progressing over time; the people whose linear trend shows a significant downhill decline. The goal is to pick the rapid progressors in 10% to 15% of our patients.”
In terms of co-management, Dr Chan works closely with an employed optometrist within the hospital who performs screening and monitoring of glaucoma suspects, and mild and moderate glaucoma cases. They work alongside one another one day a week where the optometrist can escalate concerning cases in real time, or she can store and forward cases that Dr Chan can access virtually.
“ZEISS Forum and the Glaucoma Workplace represents the era of seamless integration where everything’s filed, dated, labelled and easily accessed,” he says. “These are vital elements of data storage and for a condition like glaucoma that’s all about longitudinal data.”
Image: Geoffrey Chan.
Image:
ZEISS.
ONCE-DAILY IKERVIS® IN THE PERSPECTIVE STUDY: REAL-WORLD EVIDENCE OF IMPROVEMENT OF SEVERE KERATITIS IN DED * 1
*Significant improvements from baseline to Month 12 in mean CFS score (Oxford Grading Scale, P<0.0001).1
out more about the PERSPECTIVE study and how Ikervis® can help your patients at eyehealth.com.au PBS Information: Authority Required. Refer to PBS Schedule for full information.
Before prescribing IKERVIS ®, please review the Approved Product Information available from Seqirus Medical Information (1800 642 865) or www.seqirus.com.au/products
This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of the new safety information. Healthcare professionals are asked to report any suspected adverse events www.tga.gov.au/reporting-problems.
IKERVIS® (ciclosporin 0.1% ophthalmic emulsion). Indication: Treatment of severe keratitis in adult patients with dry eye disease which has not improved despite treatment with tear substitutes. Contraindications: Hypersensitivity to the active substance or any of the excipients; Ocular or peri-ocular malignancies or premalignant conditions; Active or suspected ocular or peri-ocular infection. Precautions: Any reversible underlying conditions, not associated with dry eye disease, should be treated prior to initiating IKERVIS ®; History of ocular herpes; Contact lenses should be removed before instillation of eye drops and re-inserted at wake-up time and careful monitoring of severe keratitis is recommended; Glaucoma – limited experience with IKERVIS®. Exercise caution especially with concomitant betablockers; Co-administration with eye drops containing corticosteroids may potentiate effects of IKERVIS® on the immune system; May affect host defences against local infection and malignancies. Use in Pregnancy (Category C): No data available; Not recommended in pregnancy unless the potential benefit to mother outweighs the potential risk to fetus. Use in Lactation: Insufficient information on breastfed infants; it is unlikely that sufficient amounts are present in breast milk. A decision must be made to discontinue either IKERVIS ® or breastfeeding during treatment. Use in Children: No data available. Interactions with other medicines: No data available. Adverse Effects: Common: erythema of eyelid; lacrimation increased; ocular hyperaemia; vision blurred; eyelid oedema; conjunctival hyperaemia; eye pruritus. Very common: eye pain, eye irritation. Dosage and administration: The recommended dose is one drop of IKERVIS ® once daily to be applied to the affected eye(s) at bedtime.
An increasing number of GPs are abandoning bulk billing due to the rising costs of doing business. Could optometry – as one of the highest bulk billing professions – face a similar fate? The answer is nuanced, as Insight discovers.
Knowing
your worth
Optometry faces an interesting conundrum when it comes to Medicare. On the one hand the gap between what an optometrist receives for providing bulk billed services and the actual cost of providing clinical care sustainably is vast. Yet, the profession boasts one of the highest bulk billing rates among all health disciplines (around 94%).
So, when the sector tries to convince the government that Medicare rebates need to rise to better match the cost of providing contemporary optometric care, policymakers struggle to see a system under strain. Adding to the situation is the ingenuity of optometrists to cross-subsidise the retail and imaging components of their business to cover the rising cost of clinical care.
It’s a situation Optometry Australia CEO Ms Skye Cappuccio is familiar with. She’s long rallied against the erosion of optometric Medicare including through various indexation freezes and a 5% cut in the infamous ‘Hockey Budget'. Thankfully indexation has resumed from 2019, following extensive advocacy from Optometry Australia.
“Medicare rebates are insufficient to cover clinical care,” she says. “A lot of optometry practices are making their money in the retail space, so glasses and lenses, and a lot of them are loss leading in the clinical care space.
“It’s extremely difficult to get better fees under Medicare. Even larger, and hence politically powerful, professions like GPs continue to struggle with this. The particular challenge for optometry is that whilst we have incredibly high Medicare bulk billing rates, it is close-to-impossible to convince the government that the fees are insufficient and that they need to invest further.”
As alluded to, bulk billing rates have declined significantly among Australian GPs. A survey from the Royal Australian College of General Practitioners’ (RACGP) annual health of the nation report, published late 2023, found only 12% of GPs bulk billed all of their patients in 2023, compared with the 24% who reported doing so in 2022. Among the 2,048 GPs surveyed, this represented a halving of the bulk billing rate.
The Australian Medical Association said the Medicare rebate for a usual consult used to cover costs of providing that care, but this now covers less than half of the cost of running a consultation. Now, about
“We’re likely to see gradual reduction in bulk-billing rates in coming years, particularly as we see more practices performing chronic disease management and more complex care that isn’t easily cross-subsidised.”
two thirds of patients are bulk billed all of the time, the organisation’s figures showed.
Optometry Australia has recently stated estimates drawn from comprehensive analysis of practice costs indicate the actual cost of providing a comprehensive consultation in a sustainable business model is over $50 more than the Medicare scheduled fee.
Cappuccio expects fewer optometrists to provide bulk billed care over the next decade, but she says there are several factors underpinning the relatively high bulk billing rate.
Around 94% of optometry services have been bulk billed back to around 2015. Prior to this, there was a condition on optometry that capped the service fee they could charge on Medicare-subsidised care. Because this was only slightly higher than the bulk billing rate , most didn’t charge a service fee.
“For a very long time, almost 100% of optometry services were bulk billed because of the fee cap. But after 2015, thanks to lobbying from Optometry Australia the fee cap was removed, which changed the conditions that should have been driving bulk billing,” Cappuccio says.
“We did see a drop in bulk billing rates to about 94%. We were expecting many more practices to reduce bulk billing. Undoubtedly, a lot of it comes down to the competition and the perception of competition in the industry. There’s often a perception from practices that they can’t
Skye Cappuccio Optometry Australia
Image:
Optometry Australia.
THREE WAYS PATIENTS CAN BE BILLED FOR SERVICES
1. Bulk billing – the health practitioner accepts the Medicare benefit as full payment for the consultation and there are no out-of-pocket expenses for the patient. The patient agrees for Medicare to directly pay the rebate to the doctor for the service provided.
2. Private billing – the patient is billed an out-of-pocket fee determined by the practice. If the patient is a Medicare card holder, they may be eligible to claim a rebate from Medicare. Those not eligible for Medicare may be billed privately.
3. Mixed billing – both bulk billing and private billing is used in the practice.
Source: Victorian Government.
compete if they aren’t predominantly bulk billing.
“I think we’re likely to see gradual reduction in bulk billing rates in coming years, particularly as we see more practices performing chronic disease management and more complex care that isn’t easily cross-subsidised with retail sales and often requires longer appointments.”
Aside from retail, Cappuccio says optometrists are finding other ways to offset the losses from their clinical care, such as charging for OCT, retinal imaging and other services outside Medicare.
A small number of practices have ceased bulk billing altogether by adopting a private billing model where the patient is charged upfront the actual cost of their care, and will receive a Medicare rebate if eligible for the service.
“Sometimes there’s more fear about moving to this type of model than reality might suggest is necessary. We regularly hear from optometry members who were worried about making this billing change, but when they did it turned out to be extremely positive. It’s also important for optometrists to remember it doesn’t have to be all or nothing, many practices charge private fees but will bulk bill concession card holders to ensure they can still access healthcare,” she says.
“You need a considered change management process to introduce billing changes, taking your patients on the journey with you and being clear about who you’re billing and when, so all of your staff, as well as all patients, have an understanding of who’s going to be billed and in what contexts.”
She says Optometry Australia has developed comprehensive resources to assist members making the transition away from bulk billing, including videos and webinar, a glaucoma billing and fee calculator tool, recommended private fee list and staff training resources.
So, what does the future hold for bulk billed optometry?
Cappuccio expects to see change, albeit slow. A reduction in bulk billing might result in alternate funding methods, including optometrists positioning themselves to work at a broader scope.
“To be able to provide full-scope care for patients, we need to be able to fund it. We either need to see a change in the way optometrists are billing to fund enhanced levels of chronic condition management or a change in the funding systems ,” she says.
“With the MBS review now finalised for optometry we have commenced planning for our next round of advocacy in this space including new optometry MBS items to try and obtain fairer renumeration for many of the key services members provide.
“It’s clear the government has some appetite for changing primary healthcare funding models, but these changes have been talked about for the last 15 years and are only now being incrementally implemented in general practice. There’s hope that we might see some change in the optometry space in years to come.”
A fundamental problem is that Medicare items don’t provide enough coverage to support that kind of care. For example, the scheme hasn’t covered as many visual fields services as an optometrist would like for high-quality care for a newly diagnosed glaucoma patient in the first year. Interestingly, shortly after this interview, the Federal Budget announced in May 2024 allowed for a new item from March 2025 for a third visual field test in a 12-month period for patients with a high risk of glaucoma progression. It’s progress, but indicative of how long change takes.
INDEPENDENT WEIGHS UP PRIVATE BILLING SWITCH
As an independent optometrist, Dr Jonathan Ucinek sees few ways he or his colleagues can run a successful business based purely on bulk billed clinical services.
“To me, it appears the only way to make bulk billing viable is by having two or three optometrists fully booked and you’re seeing one patient every 15 to 20 minutes,” he says.
“In the private, independent setting we’re often spending more time with patients, it’s difficult to provide the level of optometry I provide
within that timeframe.”
Dr Ucinek took over a defunct practice in Adelaide in December 2021, inheriting the patient base and store fit out and renaming it Northgate Eye Care. One of the biggest things he has been grappling with is his billing structure.
Currently, the practice adopts a mixed billing approach, where the patient is bulk billed, then charged a service fee. For example, for a comprehensive initial consultation patients are charged $20-30 above the 85% Medicare rebate of $62.45 (10910).
“But this is still putting us behind the eight ball,” he says.
“We charge for our imaging to also help fund the practice. Individually, it could be $84 for an OCT, $60 for a retinal image, $60 for a corneal topography but we bundle these up for pensioners to be $84 and for non-pensioners $104. Everybody at our practice, also receives a Rodenstock DNEye scan at no charge, which is one of Adelaide’s most advanced pre-tests because it includes a scan for cataract, corneal topography, anterior chamber OCT and checks the thickness of the cornea in addition to the standard autorefraction and non-contact tonometry.”
Dr Ucinek wants to move to a private billing model, where the patient is charged for the clinical services in full, upfront and on the day, before receiving a rebate in their account shortly after. For a small enterprise like Northgate Eye Care, this will help generate better cashflow, rather than having to wait two weeks for the bulk billed income to reach the business account.
“The main hurdle to implementing private billing is the administrative aspect of overhauling my systems. It might start by the beginning of the upcoming financial year. We are just trying to get training and notifications up and running first,” he says.
Dr Ucinek has accessed Optometry Australia resources that advise he should be charging $130 for comprehensive initial consults, but he’s worried that patients used to receiving the perceived “free” bulk billed care won’t understand the rationale for this.
After such a heavy investment in imaging technology, he wants to avoid the need to cross-subsidise his care, and charge a rate that places value on the equipment suite and the professional service delivered.
“We are concerned we will lose patients in this move to private billing, but even at a loss of 10%, we still stand to be better off with such a move.
OUR COMMUNITY SUPPORTING YOUR INDEPENDENT LOCAL SUCCESS
Since starting Northgate Eye Care, practice owner-optometrist Dr Jonathan Ucinek has wanted to move to a private billing model.
Eyecare Plus Mermaid Beach
Eyecare Plus Moss Vale
Eyecare Plus Orange
Eyecare Plus Wagga Wagga
“It is equally important that as a sector we demonstrate continuous improvement in the value we provide for all Australians through Medicare services.”
Dr Ben Ashby Specsavers
The benefits of the move will improve patient outcomes by enabling us to practise sustainable optometry and continue to provide the rare but amazing eyecare services to the community at our practice.”
For the future of Medicare, Dr Ucinek says he would love to see extra codes that reward optometrists for specific tests they perform, that aren’t outsourced to ancillary staff.
“For example, a code for the corneal pachymetry, corneal topography, contact tonometry and gonioscopy as well as OCT and retinal photography. We would also benefit for an assessment code for meibomian gland dysfunction, so that we get rewarded for the extra services and care we are providing our patients,” he says.
INDUSTRY’S LARGEST BULK BILLER
As Australia’s largest provider of optometry services, Specsavers has struck the balance of offering affordable, quality patient care while ensuring its clinical services are bulk billed at no out-of-pocket cost to the patient.
Director of clinical services, Dr Ben Ashby, says bulk billing is a cornerstone of the business – and would remain so.
“We see more than four million Australians a year for their eyecare, and it is a great honour and responsibility that so many people trust us with their vision, which is why we believe in offering accessible and affordable bulk billed eyecare to all Australians,” he says.
“The contribution that optometry provides in early diagnosis and treatment of avoidable causes of blindness could be placed at risk if there is a move away from bulk billing. It is equally important that as a sector we demonstrate continuous improvement in the value we provide for all Australians through Medicare services and also that government funding for eyecare keeps pace with the growing costs of providing these services.”
Dr Ashby says Specsavers is focused on accessibility and affordability. Anything that made it financially harder for patients would restrict access to regular eyecare. By offering bulk billed eye tests, the network provides a place for Australians to access professional clinicians providing comprehensive eye examinations and a range of affordable eyewear.
“We know that with an ageing population and an increasing prevalence in eye conditions, anything that creates a barrier for Australians to access regular eyecare will result in poorer health outcomes for patients. Particularly with economic conditions putting a strain on everyone’s spending choices, introducing any financial barriers to attending a regular eye test will only result in more undetected eye conditions and an increasing cost to the public health system. Investing in preventative care now ensures equitable access to quality eyecare for all Australians,” he says.
“By removing barriers, we’re able to focus on helping to detect sight-threatening eye conditions that left undiagnosed can cost the Australian economy billions of dollars every year.”
As for the future of Medicare, Dr Ashby believes there could be potential to cover remote optometry consultations – where rural and remote patients can connect with an optometrist virtually for a comprehensive eye exam.
The model also pioneers a potential new way of working for optometrists, Dr Ashby notes, providing flexibility into a workforce that traditionally has never been available, providing models of care that help make the profession sustainable and well distributed across the country.
“While we’re currently piloting this model, we’ve been collaborating with the industry on how a model like this can provide safe and sensible eyecare to Australians, and with funding support
Image: Specsavers.
Optometrists in Australia bulk bill around 94% of the time.
Image: Rose Marinelli/Shutterstock.com.
could be sustainably rolled out across the country,” he says.
“As reported in the Deloitte Access Economics insights into the optometry workforce report released this year, there is an urgency for the industry to look at ways to enhance the delivery of eyecare in the face of a workforce shortage and increasing demand. We know the health landscape shifted owing to the impact of COVID-19, highlighting the opportunity of the value and potential of new and alternative health models to meet local needs.”
SYSTEM IMPERFECT, BUT AUSTRALIA IS FORTUNATE
Bulk billing is also fundamental to much of the work the Australian College of Optometry (ACO) performs, at its Carlton headquarters in
Melbourne and seven satellite clinics. Traditionally, bulk billed eyecare has been offered to those with a concession card, those who identify as an Aboriginal or Torres Strait Islander person, or are a refugee or asylum seeker.
Many of these patients are also eligible to receive subsidised glasses, contact lenses and visual aids under the Victorian Eyecare Service, a Victorian Government program administered by the ACO.
In October 2023, ACO expanded its bulk billing eligibility to cover all children under the age of 18 regardless of their socio-economic status, in a major move to combat rising myopia rates.
Dr Nellie Deen, general manager of city clinics, says as a not-for-profit that receives government funding, the ACO had different objectives to private optometry businesses, but still needed to be prudent when it came to covering its operational costs and bulk billing of patients.
For those who fall outside the eligibility listed above, a modest $38 out-of-pocket fee is charged, which covers all imaging and any other diagnostic work-ups.
After moving to Australia from the US, Dr Deen says Australia is fortunate to have a system where bulk billing is still available, even though it’s imperfect.
“In the US insurance companies play a significant role, and many people avoid regular check-ups with their GP or getting their eyes examined simply because they lack insurance coverage for those specific services,” she says.
“It’s important to realise how fortunate we are in Australia. When we decided to bulk bill all children under 18, we recognised it as a crucial step since they need frequent check-ups, and preventable eye diseases can easily be missed. It’s vital for bulk billing to continue, especially for more vulnerable patient groups.”
Bulk billing is fundamental to the ACO's work at its headquarters and seven satellite clinics.
Image: Australian College of Optometry.
Specsavers Clinical Conference (SCC) is one of the largest events on the Australian and New Zealand optometry calendar.
Bringing together optometry and ophthalmology professionals from across ANZ, this year’s SCC will help you gain valuable CPD hours, by delivering a program designed to improve your clinical practice and extend your skillset.
With up to 20+ hours of CPD available across two days and a line-up of incredible industry speakers SCC is an event not to be missed.
Book your tickets now at: specsaversclinicalconference.com.au
September 14-15 Gold Coast + livestreamed across ANZ
Glaucoma: Integrating OSD management with peri-operative optometric care
DR ALEX IOANNIDIS explores the intersection of two critical aspects of glaucoma care: the peri-operative contributions of skilled optometrists and the impact of ocular surface disease in glaucomatous patients. He also discusses how, when necessary, surgical solutions can alter the patient’s trajectory – often succeeding under the auspices of collaborative care.
OABOUT THE AUTHOR:
LEARNING OBJECTIVES:
At the completion of this article, the reader should…
• Understand the impact of ocular surface disease (OSD) on glaucoma management
• Improve skills in educating patients about the iStent implantation procedure, discussing the risks and benefits and addressing patient concerns
• Understand the importance of individualised peri-operative care plans that address both glaucoma management and OSD treatment
cular surface disease (OSD) presents a multifaceted challenge in the management of glaucoma, often complicating treatment strategies and affecting patient comfort and adherence. At the same time, the peri-operative care of patients undergoing interventions like iStent implantation requires meticulous attention to detail to ensure optimal outcomes. Integrating the management of OSD with peri-operative optometric care is crucial for enhancing treatment efficacy and patient satisfaction in glaucoma management.
THE IMPACT OF OSD
OSD is a multifactorial disorder of the conjunctival epithelium, cornea, lacrimal, and meibomian glands that results in either deficient or inappropriate tear production. OSD can lead to decreased visual acuity and result in significant ocular discomfort.¹
OSD can occur in conjunction with many other ocular conditions and often co-exists with glaucoma due to the current use of medications used to treat the condition. At present, 11% of the five million Americans over 50 who have dry eye disease also have glaucoma.2
Topical medical therapy is the most common initial treatment for glaucoma, and 49-59% of glaucoma patients on topical anti-glaucomatous medications have some form of OSD.3 OSD in these patients can be a pre-existing condition that is exacerbated by topical therapy or a novel disease that manifests after initiation of topical glaucoma therapy.
Topical glaucoma medications can cause significant morbidity with patients complaining of a burning sensation, irritation, itching, tearing, skin pigmentation and decreases in visual acuity often within three months of medication initiation.4
Furthermore, untreated primary open angle glaucoma (POAG) patients have a higher risk of OSD in part due to a 22% lower basal tear turnover rate in comparison to patients without glaucoma.5
The resulting OSD in patients with glaucoma can lead to poor medication compliance from the associated symptoms. This can lead to cessation of therapy by the patient without informing the physician resulting in elevation of IOP and disease progression.
In addition, OSD is also linked to a higher rate of failure in filtration glaucoma surgery.
Thus, management of OSD in glaucomatous
patients is important when trying to reduce further ocular morbidity and to improve the success of glaucoma therapy.
CASE 1
A 69-year-old female patient with unilateral POAG presented complaining of chronic conjunctival injection and irritation. Her condition was stable based on serial VF testing and OCT analysis of the optic nerves.
Her IOP was measured at 18 mmHg on GAT. Her glaucoma was being treated with latanoprost nocte in the left eye. On this last review, she was found to have developed a cataract and was keen to explore her options on reducing the drop burden on her ocular surface – and to become drop free if possible.
Clinical examination revealed significant skin pigmentation and conjunctival injection of the left eye (Figures 1 and 2).
Cataract surgery was performed in combination with implantation of the iStent inject system in the trabecular meshwork. Her postoperative IOP was 14 mmHg and the latanoprost drops were ceased in the left eye. Within a month there was a marked improvement in the appearance of her conjunctiva with resolution of the symptoms of irritation.
Alex Ioannidis
Figure 1. Patient showing significant skin pigmentation due to chronic prostaglandin analogue use in the left eye. There is mild enophthalmos with deepening of the sulcus superiorly.
Images: Alex Ioannidis.
Figure 2. Significant conjunctival injection due to chronic prostaglandin use in the inferior fornix in the left eye.
Her forniceal conjunctiva ceased to be injected (Figure 3).
CASE 2
The chronic use of medications to lower IOP can have other unintended consequences when it comes to the management of the ocular surface.
The use of prostaglandin analogues has also been associated with local tissue atrophy in the orbit – a type of orbitopathy – reported to occur with a number of prostaglandin analogues in current circulation.6 This can result in deepening of the orbital sulcus due to the loss of adipose and connective tissue in that area (Figures 4 and 5).
CASE 3
Corneal toxicity secondary to chronic medication use is another area where the iStent inject system can make a significant difference eliminating the gritty and stinging sensation that is associated with drop installation.
The main culprit in these cases with benzalkonium chloride (BAK) which acts as a preservative in glaucoma medications. BAK has been shown to strongly induce the expression of inflammatory mediators in the lens epithelial cells compared with latanoprost or timolol.
The Blue Mountains Eye Study and Ocular Hypertension Treatment Study both suggested higher rates of cataract formation in those with antiglaucoma therapy. Miyake conducted studies that suggested that BAK preserved drops prior to cataract surgery increased the risk of cystoid macular oedema.
Chronic BAK exposure has been associated with significant ocular surface toxicity, often manifesting as a diffuse punctate keratopathy (Figure 6).
Once iStent inject surgery has been performed – as in this case – and BAK is eliminated from the ocular surface, significant improvement of the overall corneal health is seen with resolution of the signs (Figure 7).
The use of microtrabecular shunts such as the iStent inject system from Glaukos has been revolutionary in the management of mild-to-moderate stable glaucoma.
We see that the chronic use of drops has a detrimental effect on the ocular surface of these patients resulting in secondary morbidity which can be quite significant but also can result in poor adherence to management protocols.
It’s advantageous to offer this cohort of patients access to the iStent inject system reducing or eliminating the drop burden and thus achieving better outcomes and disease management.
PERI-OPERATIVE CONSIDERATIONS FOR OPTOMETRISTS
The involvement of an optometrist in the peri-operative care of patients undergoing iStent implantation is crucial for enhancing patient outcomes through comprehensive care and education of the patient and collaboration with the referring ophthalmologist.
Optometrists play a significant role in both the pre-operative and post-operative phases, ensuring patients are well-informed, prepared and supported
throughout the process. Below are key peri-operative considerations for optometrists to keep in mind:
PRE-OPERATIVE PHASE
1. Initial assessment and referral
• Screening for glaucoma: conduct thorough eye examinations to diagnose glaucoma and evaluate its severity.
• Patient education: informing the patient about glaucoma and discussing the range of treatment options, including the potential benefits of iStent implantation.
• Referral to ophthalmologist: optometrists play a key role in identifying suitable candidates for iStent and referring them to an ophthalmologist for further evaluation and surgical planning.
2. Management of Ocular Surface Disease (OSD)
• Treat dry eye and OSD: address the ocular surface issues that may arise due to glaucoma medication.
• Patient education on OSD: educate patients on how to manage dry eye symptoms and how iStent implantation can help to maintain ocular surface health.
3. Pre-surgical counselling
• Explain the procedure: optometrists should educate their patients about what to expect during iStent implantation, including the steps of the surgery and its benefits.
• Discuss risks and benefits: provide balanced information on the potential outcomes, such as reduced intraocular pressure and potential decrease in medication use.
Figure 3. Image of the left conjunctival fornix indication marked improvement in the appearance of the conjunctiva with resolution of the erythema.
Figure 6. Toxic epitheliopathy in a patient prior to iStent inject surgery. The patient was on a preserved prostaglandin analogue (PGA). Fine punctate erosions of the cornea seen centrally.
Figure 7. Two months after surgery there is a marked improvement in the appearance of the corneal epithelium as exposure to BAK has been ceased.
Figure 5. Lateral view of the same patient indicating the resultant tissue atrophy from chronic PGA use. In some cases the degree of enophthalmos can impair Goldmann applanation tonometry as the eyes sink into the orbit.
Figure 4. Prostaglandin related orbitopathy. Note the sunken appearance of both eyes with deepening of the superior sulcus. This patient was receiving bimatoprost (Lumigan) for her glaucoma prior to iStent surgery.
• Address patient concerns: answer any questions and alleviate fears or misconceptions about the surgery.
4. Medication management
• Medication review: adjust existing glaucoma medications if necessary, coordinating with the attending ophthalmologist regarding any changes.
POST-OPERATIVE PHASE
1. Immediate post-operative care
• Monitor healing: assess the surgical site for signs of infection, inflammation or other complications during initial follow-up visits.
• Intraocular pressure monitoring: regularly check intraocular pressure to ensure the iStent is functioning effectively.
2. Long-term follow-up
• Ongoing IOP monitoring: the optometrist will continuously monitor intraocular pressure to detect any changes or need for further intervention.
• Visual field testing: visual field tests are recommended to track the patient’s visual health and detect any progression of glaucoma.
• Optic nerve evaluation: after iStent implantation, OCT evaluation of the retinal nerve fibre layer (RNFL) can provide valuable information about the structural changes in the optic nerve head and RNFL.
3. Medication Adjustments
• Glaucoma medication review: adjust glaucoma medications as needed
• Coordinate with ophthalmologist: maintain open communication with the ophthalmologist to ensure a cohesive treatment plan and make necessary adjustments.
4. Patient Education and Support
• Post-operative instructions: provide clear instructions on post-operative care, including activity restrictions, medication adherence and signs of complications.
• Lifestyle advice: offer guidance on lifestyle modifications that can support overall eye health and glaucoma management.
By considering these peri-operative aspects of care for patients undergoing iStent implantation, optometrists can ensure coordinated care that enhances patient outcomes and satisfaction.
CONCLUSION
The iStent inject offers a procedural option that can streamline patient care in glaucoma management. Optometrists, as primary eyecare providers, play a crucial role in identifying suitable candidates for this procedure and educating them about its potential benefits.
The safety profile of the iStent inject makes it a viable option for early surgical intervention in
patients with mild-to-moderate glaucoma, often in conjunction with cataract surgery. Optometrists can engage in collaborative care by assessing patients for iStent inject candidacy, conducting pre-operative assessments and providing patient education.
A collaborative approach ensures that patients are well-informed and have realistic expectations about the procedure. Post-operatively, optometrists monitor patients’ intraocular pressure and manage medications, working closely with ophthalmologists to optimise outcomes.
Ultimately, the optometrist’s involvement in the peri-operative care of iStent inject patients contributes to comprehensive and coordinated management, which can improve patient outcomes.
NOTE: References available upon request and in the online version of this article.
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Posterior vitreous detachment: Minimising complications through collaboration
All optometrists understand that posterior vitreous detachment often presents with symptoms like floaters and flashes of light, and how to assess for associated retinal tears or detachment. DR TUAN TRAN highlights the latest research on potential complications and emphasises the need for effective co-management between optometrists and ophthalmologists to minimise them.
AABOUT THE AUTHOR:
Medical Retinal & Vitreoretinal Surgeon KindSIGHT Eye Specialists, Brisbane Maroochy Eye Specialists, Sunshine Coast Images: Dr Tuan Tran
LEARNING OBJECTIVES:
At the completion of this article, the reader should…
• Recognise the clinical signs and symptoms of posterior vitreous detachment (PVD), including indications for immediate versus delayed management
• Identify risk factors associated with increased likelihood of retinal tears following PVD
• Understand the types of retinal breaks, including horse-shoe tears, operculated tears and round (atrophic) holes, and their risks for progression to retinal detachment
• Consider developing a comanagement strategy between optometrists and ophthalmologists for patients presenting with acute PVD
cute symptomatic posterior vitreous detachment (PVD) is a common presentation to both optometrists and ophthalmologists. The main concern is the potential development of retinal tears (RT) or retinal detachment (RD).
The general course entails a dilated examination to assess for signs of RT or RD. In the absence of these signs, patients are often reviewed in four to six weeks’ time, or earlier, if there are any worsening or changes to their symptoms.
However, this simple generic approach may not be best for all patients, in particular those with risk factors. This article delves into PVDs and the potential complications of RTs and RDs, and how the co-management between optometrists and ophthalmologists can minimise them.
CAUSATIVE FACTORS OF PVD
The prevalence of PVD increases with age. Ageing of the vitreous occurs by liquefaction of the gel (vitreous syneresis). As the hyaluronic acid content decreases, vitreous collagen fibres release water. Over time, this results in enlarged pools of fluid within the gel.
PVD occurs when there is a spontaneous separation of the cortical vitreous from the posterior pole that advances toward the anterior periphery. A complete PVD is indicated by the presence of a Weiss ring, a partially or completely grayish-brown, mobile ring, which can be observed during a fundus examination.
Complete PVD occurs when the cortical vitreous detaches without leaving a hyaloid remnant layer. In contrast, in ‘incomplete PVDs’ (vitreoschisis), some portions of the vitreous remain attached (incomplete PVDs make up approximately 50% of PVDs).1
Importantly, when a Weiss ring denotes vitreous separation at the posterior pole, it is still possible for vitreous to still be attached to the retina elsewhere.2
A PVD often precedes rhegmatogenous retinal detachment (RRDs) as traction from the process of PVD are applied on areas where there is strong retinal and vitreous adhesion causing a retinal break, often anterior to the equator.
Where there is adherent vitreous to the flap of the break, a horseshoe tear results and tractional forces may hold open the retinal break allowing subretinal accumulation of liquified vitreous.3 Operculated tears result if the vitreous traction is strong enough to cause avulsion of the retinal flap at the base generally
Figure 1. A case of a 55-year old male who presented with an acute left posterior vitreous detachment (PVD) and was referred for an operculated inferotemporal tear (white arrow). Slit lamp examination found a further two superotemporal operculated tears outside the area of the ultrawide field image (pink arrows). SD-BIO examination found a large horse-shoe tear (red arrow) which had a high risk of developing. The horse-shoe tear was undetected by slit lamp examination and ultrawide field imaging.
resolving the tractional forces that may hold open the break.3
As expected, the incidence of PVD increases with age. They are prevalent in only 10% of those aged between 50-59 years old, compared to 60-70% of those over 70 years old and 80-90% of those over 80 years old.4,5
Early PVDs may be seen in myopes, patients with ocular inflammation, vitreous haemorrhage, trauma and cataract surgery. Most PVDs are symptomatic, however 20% may be asymptomatic.1 In those presenting with a symptomatic PVD, the fellow eye may have an asymptomatic PVD (approximately 15%) or an asymptomatic retinal tear (in approximately 5%).6 Thus, when patients present with an acute PVD, it is always advised to perform dilated fundus examination in both eyes.
PVD and the risk of retinal tears
Most studies have found the incidence of retinal tears in patients presenting with an acute symptomatic PVD between 2% and 8%.7,8 However, some have demonstrated rates as high as 18%.9 Retinal tears are most often seen in the superotemporal quadrant (60%), then inferotemporal quadrant (30%), then superonasal quadrant (6%) and finally inferonasal quadrant (4%).
In approximately 50% of cases with retinal tears, more than one tear will be found – on average, 1.4 tears.4,8 If a tear is found in the inferonasal
Figure 2. A 75-year-old male former higher myope with previous bilateral LASIK and cataract surgery presented with an acute PVD in the right eye with UCVA 6/7.5. The retina was attached. He was reviewed after four weeks without any worsening or changes to his symptoms and was found to have an inferior macular on RRD with a causative, very small operculated hole (blue arrows) along superior edge of the RD.
quadrant, it’s four times as likely that there is another tear elsewhere.
Risk factors for retinal tears
Risk factors10 for retinal tears include:
• the presence of pigmented retinal pigment epithelial (RPE) cells in the vitreous humor (Schaffer sign)
Eyes with Atrophic Holes or Lattice Degeneration where the Fellow Eye has had an RD
Prophylaxis of Asymptomatic Retinal Breaks for Patients
Undergoing Cataract Surgery
In addition, peripheral punctate haemorrhages warrant close monitoring because they indicate areas of transient vitreous traction and could potentially become sites of future retinal tears.11
Clinical examination in assessment of retinal tears is best performed with scleral depressed binocular indirect ophthalmic (SD-BIO) examination. Studies have demonstrated higher rates of identified RTs (8% to 10%) compared to slip lamp biomicroscopy (4.4%).12 A recent large prospective study based on more than 1,000 community referrals found that slit lamp examination identified 85% of RTs, where 15% were identified by SD-BIO examination but not on slit lamp examination.6 SD-BIO found all cases of RD, 97% of RTs (both symptomatic and asymptomatic) and only 0.5% of patients could not tolerate SD-BIO.
Acute PVD and vitreous haemorrhage
Vitreous haemorrhage (VH) is defined as the presence of blood in the vitreous cavity. The presence of a VH, particularly a dense VH in the setting an acute PVD denotes a more concerning circumstance. The risks of having a RT increases up to 30-90%.13-16 There are more often multiple and larger tears increasing or hastening the time to progression to RD.
The median time to develop a delayed RT is 14 days, much earlier than without VH.17 In patients with dense VH, early vitrectomy is often performed as a retinal tear can be found in 50-90% of cases. In contrast, delaying vitrectomy risks unidentified untreated tears progressing into RD in 40-79% of cases with 50% of these RDs being complicated by proliferative vitreoretinopathy (PVR).13,14
PVD and delayed RT
After the initial examination of an acute PVD without any RTs found, a repeat examination is often performed at four to six weeks due to the risk of delayed (late-onset) RTs. The rate of delayed RTs varies significantly between studies (2.4% to 12%), however, in most studies the rate under 5%.6,9,17-19
It’s important to identify delayed RTs early.
TREATMENT
Treat promptly
Treatment may not be necessary
Treat promptly
Usually treated
Consider treatment unless there are signs of chronicity such as pigmentation
Treatment is rarely recommended
Not treated unless PVD causes a horseshoe tear
Usually does not require treatment
No consensus on treatment and insufficient evidence to guide management
No consensus on treatment and insufficient evidence to guide management
No consensus on treatment and insufficient evidence to guide management
Twenty-five per cent to 41% may develop into RD,18,19 and 28% of RDs that develop following laser treatment of an initial RT are due to the development of a new delayed RT.19 So it’s also important to follow up with patients after their laser prophylaxis to not only assess the adequacy of laser, but to assess for new delayed retinal tears. Risk factors for delayed RTs are similar to the risk factors mentioned above for RTs, however, studies have consistently found additional risk factors including males and those less than 60 years old.17
The timeframe of repeat examination at four to six weeks is based on a historical notion that breaks may occur with vitreous contraction soon after an acute PVD.9 However, up to 45-50% of delayed RTs and 68% of delayed RDs may occur after six weeks,9,17 and only 40% of these delayed RTs or RDs were symptomatic.19 Furthermore, 29% of those that develop delayed RT may develop further RTs.6 This confirms the requirement for further reviews after six weeks, particularly in higher-risk patients, even despite the absence of new symptoms.
HORSE-SHOE TEARS, OPERCULATED TEARS AND ATROPHIC HOLES
There are three types of retinal breaks: horse-shoe tears (HST), operculated tears and round (atrophic) holes.
Horse-shoe tears
HSTs are the highest risk: over 50% lead to RRD if left untreated.9, 20,21
It’s also important to be aware that asymptomatic HSTs may also cause RD in five per cent of patients,22 and old HSTs may still cause RRDs in 2.8% of patients.23 While it has been documented that prophylactic laser reduces the risk of RD to less than 5%,6,22 these studies did not differentiate the cause of RD from other untreated retinal breaks that developed after laser treatment – up to 7.3-14% of patients with retinal tears who are treated may develop subsequent new breaks.6
Operculated tears
Operculated tears make up 6-13% of all RTs. They may lead to RRD but the rate is unclear. Three studies with a small number of patients found that no patients developed RD after long-term follow up.20,24,25 However, another study found that one in six may lead to RD.26 Presumably, there may be vitreous traction at adjacent areas around the tear explaining the appearance of some operculated tears surrounded by a cuff of subretinal fluid or associated with a subclinical RD. In patients having RD repair by either scleral buckling or vitrectomy, the causative break is not uncommonly seen to be caused from an operculated break. This suggests a potential role of prophylactic laser in operculated tears (both symptomatic and asymptomatic) as the low risks of these tears developing into RD may outweigh the minimal risks of laser retinopexy. It is worth getting an ophthalmic assessment for consideration of retinal laser prophylaxis in these patients.
Table 1. Management recommendations for peripheral retinal lesions
Round (atrophic) holes
Round (atrophic) holes have a low (approximately 1.5%) potential in leading to RD.20 If they do, they are often slowly evolving, chronic RDs. It’s estimated that only 2.5-5% of all RRDs are due to these round-hole RDs.27 These lesions may be safely monitored on an bi-annually or annual basis.
The American Academy of Ophthalmology (AAO) preferred practice patterns were based on the available evidence and have provided management recommendations for laser prophylaxis of peripheral retinal lesions (see table 1).22
While the table provides useful guidance on referring to ophthalmologists, it’s important to bear in mind that although many of the lesions have a low risk of developing into RD, they may still be higher than the minimal risks of laser retinopexy.
CONCLUSION
Both optometrists and ophthalmologists play an important role in the setting of acute PVDs and RTs. Successful collaborative care allows improved management of patients and minimises the risks of missed RTs and the development of RD.
REFERENCES
1. Richardson PS, Benson MT, Kirkby GR. The posterior vitreous detachment clinic: do new retinal breaks develop in the six weeks following an isolated symptomatic posterior vitreous detachment? Eye (Lond). 1999;13 ( Pt 2):237-40.
2. Kuhn F, Aylward B. Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res. 2014;51(1):15-31.
3. Ghazi NG, Green WR. Pathology and pathogenesis of retinal detachment. Eye (Lond). 2002;16(4):411-21.
4. Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-onset floaters and flashes: is this patient at risk for retinal detachment? JAMA. 2009;302(20):2243-9.
6. Nixon TRW, Davie RL, Snead MP. Posterior vitreous detachment and retinal tear - a prospective study of community referrals. Eye (Lond). 2024;38(4):786-91.
7. Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology. 1994;101(9):1503-13; discussion 13-4.
9. Uhr JH, Obeid A Wibbelsman TD, Wu CM, Levin HJ, Garrigan H, Spirn MJ, Chiang A, Sivalingam A, Hsu J. Delayed Retinal Breaks and Detachments after Acute Posterior Vitreous Detachment. Ophthalmology. 2020;127(4):516-22.
10. Coffee RE, Westfall AC, Davis GH, Mieler WF, Holz ER. Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol. 2007;144(3):409-13.
11. Takahashi M, Trempe CL, Schepens CL. Biomicroscopic evaluation and photography of posterior vitreous detachment. Arch Ophthalmol. 1980;98(4):665-8.
12. van Overdam KA, Bettink-Remeijer MW, Klaver CC, Mulder PG, Moll AC, van Meurs JC. Symptoms and findings predictive for the development of new retinal breaks. Arch Ophthalmol. 2005;123(4):479-84.
13. Sarrafizadeh R, Hassan TS, Ruby AJ, Williams GA, Garretson BR, Capone A, Jr., Trese MT, Margherio RR. Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. Ophthalmology. 2001;108(12):2273-8.
14. Katsumi O, Hirose T, Kruger-Leite E, Kozlowski I, Tanino T. Diagnosis and management of massive vitreous hemorrhage caused by retinal tear. Jpn J Ophthalmol. 1989;33(2):177-84.
15. DiBernardo C, Blodi B, Byrne SF. Echographic evaluation of retinal tears in patients with spontaneous vitreous hemorrhage. Arch Ophthalmol. 1992;110(4):511-4.
Eye (Lond). 1995;9 ( Pt 4):502-6.
17. Vangipuram G, Li C, Li S, Liu L, Harrison LD, Lum F, Shah GK. Timing of Delayed Retinal Pathology in Patients Presenting with Acute Posterior Vitreous Detachment in the IRIS(R) Registry (Intelligent Research in Sight). Ophthalmol Retina. 2023;7(8):713-20.
18. Sharma MC Regillo CD, Shuler MF, Borrillo JL, Benson WE. Determination of the incidence and clinical characteristics of subsequent retinal tears following treatment of the acute posterior vitreous detachment-related initial retinal tears. Am J Ophthalmol. 2004;138(2):280-4.
19. Goldberg RE, Boyer DS. Sequential retinal breaks following a spontaneous initial retinal break. Ophthalmology. 1981;88(1):10-2.
20. Davis MD. Natural history of retinal breaks without detachment. Arch Ophthalmol. 1974;92(3):183-94.
22. Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern(R). Ophthalmology. 2020;127(1):P146-P81.
23. Neumann E, Hyams S. Conservative management of retinal breaks. A follow-up study of subsequent retinal detachment. Br J Ophthalmol. 1972;56(6):482-6.
24. Byer NE. Prognosis of asymptomatic retinal breaks. Arch Ophthalmol. 1974;92(3):208-10.
25. Colyear BH, Jr., Pischel DK. Clinical tears in the retina without detachment. Am J Ophthalmol. 1956;41(5):773-92.
26. Robertson DM, Norton EW. Long-term follow-up of treated retinal breaks. Am J Ophthalmol. 1973;75(3):395-404.
27. Tillery WV, Lucier AC. Round atrophic holes in lattice degeneration--an important cause of phakic retinal detachment. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1976;81(3 Pt 1):509-18.
Ultimately, the importance lies in recognising risk factors and understanding that RTs may develop earlier in these patients, as well as the potential for delayed RTs beyond the generic four to six week review. NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.
16. Nischal KK, James JN, McAllister J. The use of dynamic ultrasound B-scan to detect retinal tears in spontaneous vitreous haemorrhage.
A strong business case
Many optometrists today say they couldn’t practise without their OCT, and it seems ultra-widefield retinal imaging is heading down the same path. Two independents discuss how Optos technology has influenced the way they practise.
To operate a high-performing two-practice optometry business –one on each side of the NSW-Queensland border – Mr Andrew Bowden is cognisant that when he invests in high-end equipment, it needs to at least pay its own way, plus more.
It goes without saying that installing two new Optos Daytona ultra widefield imaging devices came at a substantial cost, but within a month of using the devices at Envision Optical Tweed Heads and Burleigh Waters, he could already see it was paying dividends in terms of commercial and clinical outcomes.
When the Daytona system was installed two years ago, it replaced a retinal camera that captured a 45-degree area. He charged a separate fee for this, but since acquiring Optos technology and its 200-degree imaging capability, the practice could justify increasing this by 50% with no resistance form patients. After recently switching to a three-tiered private billing model, an optomap image is now included in his standard and premium eye exam package (with flexibility for pensioners and similar patients).
“We’ve tracked our retinal photography over the years and could see that it was a nice little profit centre for us. It was the same when we introduced the Optos devices; we could definitely see it was cash positive within the first month just off scan fees alone,” he says.
“It’s always a challenge of trying to find that sweet spot, balancing the practice’s profitability and sustainability alongside the affordability for the patient.”
As a result, ultra widefield retinal scans on the Daytona – called optomap images – has become a virtuous cycle for Envision Optical. The business has seen its retinal scan volumes increase because staff see the value in it, and patients are impressed with the technology, especially after receiving a brochure demonstrating how much more of the retina it can scan compared to traditional retinal photography.
For the optometrist, Bowden says optomap imaging plays a key role
in primary eyecare, with an ability to detect retinal tears or lesions in the periphery – often so far out they may have been missed otherwise. He can also easily monitor them over time and provide clear and efficient co-management with ophthalmologists.
It’s because Daytona and Optos’ other devices, Monaco and Silverstone, can capture approximately 82% of the retina, something the company says no other device can do in a single shot. Optos has expanded its technology now with nine imaging modalities available across all its platforms, including the recent addition of optomap
Andrew Bowden has increased his retinal scanning fee by 50% with no resistance from patients after installing an Optos Daytona at both his Envision Optical practices.
Image: Envision Optical.
Retinal detachments picked up by Queensland optometrist Helene Holmes on her Optos Daytona Plus system.
“I get a lot of benefit out of its multi-functionality. Autofluorescence has become invaluable because you can often glance at the colour photo and think it looks good, and then you switch to autofluorescence and you can see pathology hidden there, which helps you make an informed decision around monitoring or referral.”
In cases like the above, Bowden says Optos ultra-widefield imaging has offered a seamless patient experience and is simple to use for his optical dispensing staff. The high resolution optomap scan is exported into the cloud and can be accessed in any of his four consulting rooms.
“The beauty of it is that you’re opening the image as soon as the patient’s walking into the room, and it’s very easy to flick through and perform a serial comparison to check for any changes year-to-year. It’s super easy to use, quick, and you can zoom nicely on areas of interest,” he says.
“In the patient with the choroidal nevus, she could look at the screen as I move around the image and explain what I’m looking for. I was able to clear her for melanoma in her eye.”
Since acquiring the Optos Daytona, Bowden has picked up more cases of Coats disease, an idiopathic ocular condition characterised by retinal telangiectasia, aneurysms, and exudation.
“I’ve had three or four of those in the last 18 months that I’d hardly seen
previously because it occurs way out on the edge. But we’re picking up things daily, and when you go back and look with the fundus lens you realise you’re only often seeing the edge of a disease, but it is so comprehensively imaged on the Optos device.”
When a disease is evident on the optomap requiring potential referral, the scope and quality of the images make it simple for Bowden to send a quick de-identified image to the local retinal subspecialist.
With a full appointment book, he says ophthalmologists don’t want to be unnecessarily seeing patients that can be cared for at the primary eyecare level.
“It’s a slightly clunkier version of telehealth and modern healthcare but using the tech to ease that communication has proven a great co-management tool,” he says.
“Overall, the Optos technology ticks all the boxes that I always look for in equipment: is it good for the patient, are we able to extract important clinical information, does it suit us workflow wise? My philosophy has always been, if you just do what’s best for the patient, then invariably, the business side of it takes care of itself, and I feel like we are achieving this with this technology.”
A BIG ASSET TO THE PRACTICE
As an independent optometrist in the rural town of Ayr, Queensland, the closest ophthalmologist is about an hour’s drive north in Townsville. That means Ms Helene Holmes, who has operated Helene Holmes Optique Eyes for 27 years, has a heightened need for precise referrals to ensure no one’s time is wasted.
Alongside her OCT, the Optos Daytona Plus is a piece of equipment she could not practise without today, making co-management with ophthalmology straight forward.
A classic example occurred just recently when a patient visited complaining of an arc at the edge of her vision. An initial assessment with a volk lens and slit-lamp confirmed a retinal detachment, but with the Optos scan it was possible to see the entire scope of detachment, including where the tears occurred.
“It was great to be able to send those images to the eye specialist; the images eliminate any doubt and any back-and-forth discussion over the phone,” she says.
“And I think it helps the ophthalmologist to plan their treatment because they can see whether it’s a little horseshoe tear requiring laser, or as in this case, a quarter of the retina was hanging off and they can prepare for surgery.”
Holmes still remembers the moment she first encountered Optos ultra-widefield imaging. It was about 10 years ago at an optometry conference. During a presentation, the speaker showed an optomap image and she was blown away by the 200-degree scope it could capture. It was streaks ahead of anything she had used before, so she quickly purchased a device. This was upgraded to a newer model six years ago that was easier to position the patient on.
“I think our community underestimates the technology at our disposal and the amazing images we can capture today,” she says.
While she’s able to practise with more confidence, the technology also has a convenience factor, being simple for ancillary staff to conduct the image acquisition.
“It’s very operator friendly. But probably the greatest asset is the ability to capture such great images undilated. In the retinal detachment case mentioned before, I could see it in its entirety without having to dilate the patient. It saves so much time and the patient can immediately go to the ophthalmologist for treatment, and I can continue with my day of appointments,” she adds.
“Overall, it gives me much more confidence, saves time and is hugely beneficial with co-management.”
Helene Holmes says optomap imaging adds more precision to her referrals with the nearest ophthalmologist more than an hour away.
Images: Helene Holmes Optique Eyes.
Where tradition meets innovation
Tokai Optical president HIROKAZU FURUZAWA continues to uphold the values that his grandfather set in stone at the company’s origins in 1939. He discusses exemplifying this legacy through cutting-edge lens design and how the Australian market fits into the company’s global plans.
Mr Hirokazu Furuzawa, president of Tokai Optical, carries forward the legacy established by his grandfather, Mr Shizu Furuzawa, who was there at the company’s inception 85 years ago when he founded the Furuzawa lens factory in Nagoya, Japan.
Joining Tokai in 1994, Furuzawa’s journey from growing up as a descendant of a Tokai founding father before working on the production line, being promoted to oversee international divisions and then ultimately his presidency in 2009 is a story that embodies everything Tokai stands for. It’s a company built on decades-old family values that filter down to its customers – many who are small business owners of independent optical practices in Australia.
Over the course of its 85-year history, Tokai’s name has been synonymous to the evolution of spectacle lens technology, and perhaps there is no one better placed than Furuzawa to guide the company into its next era.
The family-owned Japanese lens manufacturer has been present at each major development in this space since Furuzawa’s grandfather laid the foundation in March 1939.
As a pioneer on many fronts, today Tokai’s mission is centred on QOL: ‘quality of life’, ‘quality of light’ and ‘quality of lenses’. Moreover, uniqueness is a cornerstone of the company that Furuzawa says is reflected in its products, services and human resources.
“Firstly, in terms of ‘quality of life’, Tokai provides high-quality lenses worldwide,” Furuzawa says. “Secondly, regarding ‘quality of light’, Tokai transforms light into high-value products and services.”
He adds that since the company’s foundation, ‘quality of lenses’ has been the driving force towards excellence, with a strong focus on creating unique eyeglass lenses and services under the ‘Made in Japan’ banner.
Furthermore, Furuzawa says Tokai’s commitment to research and development (R&D) contributes to the company’s success.
Each year, Tokai develops unique lenses and advanced designs in-house. The company also independently innovates multicoating technologies
and collaborates on lens materials with partners, including its unique 1.76 high-index lens materials, which is said to be the world’s thinnest.
“These efforts contribute to the high-quality, high-performance image of the Tokai brand. We are dedicated to continually delivering these standards globally, alongside our partners and customers,” Furuzawa says.
Underlying Tokai’s values is its cooperative philosophy, which has been carried over generations. As the company expands, its customers, partners, staff and engineers grow in lockstep.
“At Tokai, our staff, engineers, and customers are all growing together, embodying a philosophy of collective growth. We operate as one team – akin to a Tokai family – driven by a shared mission and vision,” Furuzawa says.
This cooperative philosophy is reflected in Furuzawa’s journey from the production line to presidency.
“Understanding production processes and working closely with our staff is especially significant at Tokai, being a family-owned company. Our philosophy revolves around unity as one team which emphasises collaboration across all departments,” Furuzawa says.
“These principles – growth together, unity as one team, and a commitment to uniqueness – have been upheld across generations at Tokai.”
WRITING HISTORY
Over the course of its history, the company has embedded itself within the global lens manufacturing through several key milestones. One of the more significant pivots of lens production was the transition from glass to plastic materials.
“Since its conception, Tokai has evolved significantly. Initially, eyeglass materials were primarily mineral, but with the advent of plastic, the market landscape changed dramatically,” Furuzawa says.
To adapt to market demands, Tokai acquired Sunlux in 1981 – a company in Fukui Prefecture renowned for its plastic lens technology. This acquisition
Images: Tokai Optical.
Shizu Furuzawa founded Tokai Optical in 1939. His grandson Hirokazu Furuzawa (left) now leads the company.
marked a new era for the company as it began to compete in the plastic lens space.
After setting its roots in Japan, Tokai’s international presence began in 1994, as it established full-scale export activities and introduced its 1.60 index lens to Europe.
“Tokai’s exhibitions at MIDO in Milan and Optica in Germany marked a major turning point,” Furuzawa says.
In the same year, Tokai established a joint venture with Tokai Optecs – a Belgian company with a long-standing partnership across Europe, the Middle East, and Africa. This served as the base of its global network.
“Since then, Tokai has expanded globally, now with a presence in Shanghai, Australia, Italy, the UK, Spain and United Arab Emirates,” Furuzawa says.
“Today, Tokai exports to over 70 countries and continues to forge strong partnerships worldwide.”
As the company grew, so did its innovations. It introduced its famous 1.76 index lens in 2006 as well as pioneering neuroscience technology into its lenses in 2008.
More recently, Tokai established commercial operations in Australia in 2019, operated by Mr Justin Chiang. Furuzawa has made a concerted effort to show Tokai’s support for the independent optical market in Australia, flying in for recent events such as O-SHOW 24 and O=MEGA in 2023.
He says while the market is relatively small compared to others it stands out for a few reasons: it is defined by a concentration of top-tier eyecare professionals with a strong demand for quality and uniqueness – traits Tokai embodies.
“Our aim is for Australian professionals to rely on Tokai’s unique lenses, ensuring they can deliver exceptional care to their patients with utmost confidence,” Furuzawa says.
“Tokai’s goal is to introduce high-quality options and choices to Australian consumers who seek superior eyewear. By increasing awareness and availability, we empower individuals with the freedom to choose based on their preferences and needs.”
ENVISIONING THE FUTURE
After placing itself firmly in the history of lens manufacturing, Tokai envisions a future in which it shapes and sets industry standards.
“Eyeglasses offer numerous possibilities despite existing barriers. At Tokai, we strive to create new and enhanced values for eyeglass wearers. Firstly, we recognise the intrinsic value of prescription lenses, ensuring clarity of vision for those who require corrective eyewear,” Furuzawa says.
He says this is realised through fashion innovations such tinted and coloured lenses, which serve as stylish accessories.
“Foremost, we prioritise eye healthcare by developing lenses that protect against UV light and other hazards.”
Through its R&D, Tokai is exploring new avenues of innovation with the aim to introduce new functionalities to eyewear. This includes advancements in digital eyewear, such as electronically adjustable dioptres and myopia control technology.
“By leveraging our R&D capabilities, we aim to pioneer new added values in the eyewear industry. We also value market insights to understand consumer needs and behaviours in real-world settings and retail environments,” Furuzawa says.
One of the biggest challenges the global industry faces today is a shift towards carbon-neutrality and waste reduction.
“A major goal for us is to develop more environmentally friendly production systems to sustain our capabilities. As a manufacturer, Tokai produces 10,000 units of optical lenses daily. However, a significant portion of the materials used – more than half – are not fully utilised which results in waste,” Furuzawa says.
“We are focused on optimising our production processes to minimise material wastage and enhance environmental friendliness. This entails re-evaluating how we utilise materials to reduce waste and improve efficiency in our optical range production.”
Currently, the company is working towards minimising waste by producing smaller diameter optical lenses whenever feasible. Looking ahead, Tokai aims to align lens production with specific frame shapes to optimise material usage.
“While this is an ideal scenario for the future, our current focus is on reducing waste not only in lens manufacturing but also throughout our technical operations to enhance sustainability,” Furuzawa says.
Tokai implements several initiatives under the principles of reduce, reuse, and refuse. For example, waste materials that cannot be used are ground into a fine powder. Rather than discarding these, the company collaborates with third-party companies to convert them into industrial charcoal for energy generation.
“With a strong global presence and a focus on continual growth, Tokai is poised to keep leading the eyewear industry for generations to come,” Furuzawa says.
Tokai’s unique 1.76 high-index lens materials is said to be the world’s thinnest.
L to R: Takanori Tanaka; Tokai Optical president Hirokazu Furuzawa; customer support specialist Mikaela Bartlam; Kylie Sargent; Tokai Optical Australia general manager Justin Chiang at O=MEGA23.
AI on the prize
Research exploring the applications of large language models like ChatGPT in ophthalmology has exploded onto the scene in the last two years. Experts discuss how far the technology has come, and how far it still must go if it’s to help carry the workload of eyecare professionals.
Areality where autonomous artificial intelligence (AI) systems are integrated in everyday practise and used for the diagnosis and management of disease, seemed implausible not too long ago.
S ome part of the Australian optometry landscape saw a shift in its approach to disease management with the emergence of technology like Eyetelligence (since rebranded to Optain) – an AI software tool, developed by Australian experts that helps clinicians screen, grade and make decisions for the management of glaucoma, neovascular age-related macular degeneration (nAMD), and diabetic retinopathy (DR).
Developed by Professor Mingguang He from the Centre for Eye Research Australia (CERA), the platform has been rolled out in optometry practices across Australia and New Zealand, and international markets such as Japan, Europe and the United States. And in 2023, the Food and Drug Administration (FDA) approved EyeArt – the first and only AI technology to be cleared by the FDA to detect both mild and vision-threatening DR – without human oversight. Now, a body of research is emerging demonstrating that AI – and large language models (LLMs) in particular – are on track to matching the knowledge of eyecare professionals in practise. Alongside the ability to analyse ophthalmic images, AI now offers the potential to aid more complicated diagnosis and treatment plans.
LLMs only recently came on to the scene in a big way with the debut of ChatGPT in November 2023. As computing power has increased, the emergence of deep learning about a decade ago brought about numerous developments in AI, including LLMs. Now, within the past two years, LLMs in ophthalmology have appeared in medical literature.
Currently, it has applications in medical transcription, electronic health record enhancement, clinical decision support, and automated patient communication, among others. Beyond the practice, AI in physician education and research is being explored – incorporating into lectures to familiarise the new generation of physicians with
the emerging technology.
In one recent study published in Eye, the Google Gemini AI chatbot, formerly known as Bard, was shown to pass ophthalmology board exams.
Meanwhile, another study published in February 2024 in JAMA Ophthalmology, showed that LLMs can match or outperform ophthalmologists in the diagnosis and recommended treatment of patients with glaucoma and retinal disease.
This research from New York and Ear Infirmary of Mount Sinai (NYEE) and conducted by ophthalmology resident Dr Andy Huang and his team, explored the potential of LLMs – specifically GPT-4 – to assess the diagnostic accuracy and comprehensiveness of LLM-generated responses compared to those of fellowship-trained glaucoma and retina specialists.
It intended to validate the potential utility of LLMs as an adjunct in practising evidence-based medicine, particularly in ophthalmic subspecialties that may be limited.
For Dr Huang, it was his own application of LLMs in his day-to-day tasks that inspired him to explore the concept further.
“Personally, I found the application of GPT-4 extremely useful and enjoyable, as it significantly increased efficiency and broadened my diagnostic capabilities for day-to-day tasks in both the hospital and clinic,” Dr Huang tells Insight. “This experience inspired me to explore its utility on an evidence-based level and ultimately led to the initiation of this project.”
The team recruited 12 attending specialists and three senior trainees from the Department of Ophthalmology at the Icahn School of Medicine at Mount Sinai.
A basic set of 20 questions (10 each for glaucoma and retina) from the American Academy of Ophthalmology’s list of commonly asked questions by patients was randomly selected, along with 20 de-identified patient cases from Mount Sinai-affiliated eye clinics. Responses from both the GPT-4 system and human specialists were
then statistically analysed and rated for accuracy.
The results showed that AI matched or outperformed human specialists in both accuracy and completeness of its medical advice and assessments. More specifically, AI demonstrated superior performance in response to glaucoma questions and case-management advice, while reflecting a more balanced outcome in retina questions, where AI matched humans in accuracy but exceeded them in completeness.
The results, for Dr Huang and the research team, were both surprising and anticipated.
“While we expected the LLM to perform well due to its advanced training on vast amounts of big data and medical data, the extent to which it matched or outperformed human specialists, especially generating assessments and plans for glaucoma cases, was remarkable,” he says.
He adds that the results highlighted the model’s potential to support and enhance clinical decision-making in ways the team had not fully anticipated.
“This research and its findings also inspired us to look into more specific utility within each subspecialty.”
In terms of its applications, the findings have significant implications for the future of eyecare. Dr Huang says he envisions a future where AI tools are routinely used to augment clinical practice.
“This could lead to more accurate and comprehensive patient care, and reduced workload for ophthalmologists, which may ultimately improve patient outcomes,” he says.
AI could also provide valuable support in under-resourced settings, helping to bridge gaps in access to specialised care.
For the future, Dr Huang says studies should focus on validating these research findings across larger and more diverse patient populations, as well as in different clinical settings and sites, and to also explore the utility and integration of AI tools into existing clinical workflows and electronic health record systems.
However, he notes that the unprecedented capability of this technology comes with new challenges – which should be the focus of subsequent research.
“Future research must address the ethical, legal, and regulatory challenges associated with the use of AI in healthcare, ensuring that these technologies are used safely and equitably,” Dr Huang says.
“There are countless factors at play, and we do not currently have a grasp of the implications that usage of AI may have if fully integrated into healthcare.”
However, to reach integration into healthcare, AI must still be improved in terms of accuracy, reliability, and comprehensiveness.
“Technologically, these systems must be able to integrate seamlessly with clinical workflows and handle a wide range of ophthalmic conditions and medical conditions/physical limitations – which I predict will be a massive hurdle,” Dr Huang says.
“While
we expected the LLM to perform well due to its advanced training on vast amounts of big data and medical data, the extent to which it matched or outperformed human specialists ... was remarkable."
Dr Andy Huang NYEE
Comparison of LLM chatbot vs ophthalmology specialists on accuracy and completeness in glaucoma and retina questions and cases. Source: (Huang et al., 2024).
UTILITY IN PRACTISE
Dr Jorge Cuadros from the School of Optometry at the University of California, Berkeley in the US, says although LLMs are just beginning to emerge in everyday ophthalmology practise, many patients have been using chatbots such as ChatGPT, LLaMa, or Bard to describe symptoms and receive a diagnosis from conjunctivitis to retinal detachment.
Meanwhile, in eyecare clinics he says they have been used as support tools for differential diagnosis – sometimes detecting rare diseases from free text inputs.
The models have also been used to expedite tedious and repetitive tasks, such as generating progress notes and providing personalised summaries for patients.
“LLMs applied to electronic medical records have been used with success to identify patients who could be enrolled in clinical trials or could benefit from uncommon treatments,” Dr Cuadros says.
“Google’s MedLM and several other models have adopted foundation models to refine their use to healthcare from simple decision tasks to complex workflows.”
He says that experts within the field have noted practitioners are experiencing burnout caused by the demands and complexity of information systems in healthcare.
“LLMs can relieve and potentially prevent this burnout by performing many repetitive and tedious tasks and allow practitioners to focus more on their patients,” Dr Cuadros says.
AI promises opportunities for patients to participate in their medical management, particularly related to chronic diseases. According to Dr Cuadros, patients will be able to compile and organise more data –much of it captured at home – to improve existing conditions and predict future conditions.
“Testing has already become less invasive as LLMs and other forms of AI allow us to more accurately determine, for example, whose glaucoma will progress faster, or who will develop myopia and other conditions,” he says.
HUMANS ARE IRREPLACEABLE
Meanwhile, in optometry, LLM applications haven’t been widely explored and the extent of its current use in the field is unknown. However, clinician-scientist Dr Angelica Ly from the University of New South Wales ( UNSW) sees its utility and potential in some contexts but warns that it is not a replacement to critical thinking.
“LLMs can relieve and potentially prevent this burnout by performing many repetitive and tedious tasks and allow practitioners to focus more on their patients.”
Dr Jorge Cuadros University of California, Berkeley
According to Dr Ly, a common reason for using LLMs is to save time and improve efficiency as they are useful for automating tedious tasks.
“Some possible applications of LLMs in optometry include as an aid to write clinical notes, referrals and patient education materials. They might also be used for patient education, or clinical decision support,” she says.
“Unlike a healthcare practitioner, who has been trained to critically evaluate and apply their information sources, LLMs were not designed to do so. They simply generate ‘one word at a time’ based on probability. They cannot fact check. They regularly make things up and even generate references that do not exist.”
She adds that it is reasonable and common to think of LLMs as search engines for information retrieval, especially because some LLM services have in-built web-browsing capabilities. However, LLMs should not be used as a source of information.
Because of the potential for LLMs to provide factually inaccurate or missing information, there is the risk that they may misinform patients and perpetuate existing biases – potentially causing harm.
“While LLMs show great promise in being able to support and enhance the efficiency of healthcare, they should augment, rather than replace clinician-led care,” Dr Ly says.
Although the responses look and sound convincing, Dr Ly says current LLMs are unable to reason and therefore are vulnerable to factual inaccuracies.
“As when chatting with humans, it is useful to consider how a person’s experiences or knowledge influence their speech. Likewise, the data sources used to train LLMs heavily influence its responses,” she says.
With LLMs, the more data that is available, the better the tool performs. Therefore, scarcity and specificity of optometric data on the internet limits the performance of most general LLMs when attempting to address optometry-related queries.
Dr Ly says LLMs are not designed to reason and thus cannot assess the quality of its input data making it susceptible to bias and favours data that appear frequently on the internet – regardless of accuracy.
“A fun way to remember this is using the expression, ‘Garbage in, garbage out’ – GIGO for short – which describes when flawed input data produces nonsense output. Input data includes unvalidated sources from the world wide web, where anyone, including non-experts, can publish content,” she says.
In patient settings, one important attribute to bear is empathy –something unique to humans. And although LLMs can be taught ‘artificial empathy’, this is not interchangeable with both verbal and non-verbal cues that humans are sensitive to.
Dr Cuadros agrees, saying although recent studies have shown that generative AI models were judged as more empathetic than human clinicians, there is still much value in creating a human connection between patients and their providers.
“Patients and practitioners create a bond that can sometimes last
generations and adds to general wellbeing,” he says.
Dr Ly adds that LLMs can be trained to use empathetic language, providing responses comparable to experts in terms of empathy. However, in a healthcare context, empathy includes more than just words – including both verbal and non-verbal cues such as gestures, which often encourages patients to divulge more about their experience, including data required for a correct diagnosis.
For Dr Ly, best practise utilising LLMs, is using it as an adjunct because, for now, humans are irreplaceable.
“A good rule of thumb for eyecare professionals using LLMs is to always de-identify and double check, meaning be aware of the potential for privacy breaches using these technologies, and always double check for missing, biased or factual inaccurate content,” she says.
Similarly, Dr Cuadros says that while the models may act autonomously, the legal and moral liability is still born by the practitioner.
“Just as with clinical trials that guide our treatment of diseases, we must ensure that the ground truth that is used to develop algorithms are free from bias. This is more difficult to do when the ground truth is from millions of subjects,” he says.
ADOPTING IN PRACTISE
As with many innovations in healthcare, it takes time to adapt them into daily practice. While clinical trials and regulatory oversight ensure safety, there is a growing interest in real-world validation before widespread adoption of new methods and technologies.
“This validation is more important due to the 'black box' nature of the models,” Dr Cuadros says. “Recent innovations allow us to view the features and aspects of the data that are used by the AI to make a decision, however, most of the time we still don’t know how they arrive at their conclusions.”
An even greater barrier to adoption, he says, is the need to change deeply entrenched habits and workflows that have developed over years based on traditional eyecare practise.
“Just as electronic health records initially disrupted care, eyecare providers may initially feel disrupted as they incorporate AI into their day-to-day operations.”
Dr Cuadros says regulations to ensure access to new LLM tools by under-served communities is important – especially because it is often the data from these communities that is used to create the models.
“We need to ensure that new technology reduces disparities among different populations,” he says.
“Dr Naama Hammel said, ‘AI won’t replace clinicians, but clinicians who use AI may replace those who don’t’.”
He adds that the adoption of tools to enhance, rather than replace, clinicians is the best short-term approach to LLMs.
“Healthcare is changing in many ways, including breakthrough drug discovery, genomics, robotics, and collaboration. AI and LLMs are just one of several transformative changes to healthcare.”
“As when chatting with humans, it is useful to consider how a person’s experiences or knowledge influence their speech. Likewise, the data sources used to train LLMs heavily influence its responses.”
Angelica Ly UNSW
Dr
Image: Jorge Cuadros.
Image: Angelica Ly.
On the menu at
SCC 2024:
For eyecare professionals thinking of attending the 2024 Specsavers Clinical Conference, Insight has compiled a sneak peek into the juiciest topics to be delivered by some of the nation’s top ophthalmologists.
One of Australia’s largest conferences on the eyecare calendar, the Specsavers Clinical Conference (SCC), will return for the 13th time this September 2024. This much-anticipated professional development event will be delivered in a hybrid format over two agenda-packed days. This year’s event on the Gold Coast is set to welcome an estimated 800 optometrists, ophthalmologists and industry professionals, both in-person and online from across Australia and New Zealand.
Dr Cronin will also address the common but often overlooked issue of Demodex infestations, providing effective eyelid hygiene techniques to manage this obligate human ectoparasite.
Specsavers has invited an impressive line-up of industry leaders who – alongside its clinical services team – is aiming to deliver a compilation of interactive and therapeutic CPD content that expands attendees’ clinical toolkit, enhances their clinical knowledge and helps to develop best practice skills in eyecare.
Professor Celia Chen, Dr Brendan Cronin, Dr Rushmia Karim, Dr Kate Reid, and Associate Professor Chameen Samarawickrama are among the speakers. Insight spoke with three of them to get a taste of the content on offer at SCC 2024.
DR BRENDAN CRONIN: ‘DRY EYE IS AWFUL, BUT YOUR TREATMENT DOESN’T HAVE TO BE’
Dr Cronin is a renowned corneal and anterior segment surgeon and the director of education at the Queensland Eye Institute. A specialist in complex cataract surgical procedures, he has a special interest in keratoconus, providing topography-guided collagen cross-linking, advanced micro transplantation techniques and excimer laser regularisation procedures.
At SCC, Dr Cronin will demystify the often-misunderstood world of dry eyes and offer a look into the future of dry eye research and treatment options, from novel medications to cutting-edge therapies.
“Are you ready to dive into the murky and much-maligned world of dry eyes and come out with a treasure trove of knowledge that will make you a dry eye magician? Then you won’t want to miss my upcoming talk,” he says.
Specifically, his session will explore the intricate role of ciclosporin eye drops in reducing ocular inflammation, providing attendees with an in-depth understanding of this pharmacological intervention.
“If you think you know everything there is to know about this little wonder drug, think again. We’ll delve into the nitty-gritty of dosing and uncover how ciclosporin can lead to happier, more comfortable patients,” he says.
“Ever had a patient complain about itchy, irritated eyelids and wondered if it was more than just dry eyes? Enter demodex – those pesky little mites that love to call our eyelashes home,” he says. “In my session, we’ll go over everything you need to know about identifying and managing demodex. Imagine the satisfaction of basking in a wave of glory after clearing up a case of blepharitis that’s been plaguing your patient for months – it’s a win-win for you and your patient.”
Additionally, the session will explore the benefits of intense pulsed light (IPL) therapy for meibomian gland dysfunction, highlighting its transformative potential for dry eye sufferers.
“Now, here’s where it gets really interesting, because shedding a little bit of very bright light on the lids can make a world of difference to dry eyes. IPL can work wonders. Albert Einstein and Stephen Hawking were no fools when they became fascinated with the properties of light – but even they didn’t appreciate the awesome power of the photon in treating the tear film. Now, who does IPL help and how many sessions do they need? I’ll answer those questions and more at the conference,” Dr Cronin says.
Promising a blend of humour, real-world anecdotes, expert tips and interactive elements, the 40-minute session is set to be anything but dry, he quips.
“Yes, dry eyes can be fun and exciting – especially when you’re learning how to transform your patients’ lives. Expect to laugh, learn, and leave with actionable insights that will enhance your practice and make your patients sing your praises,” he says.
“Whether you’re dialling into the conference virtually or joining us on the Gold Coast, I guarantee this will be a talk you’ll actually enjoy on what has traditionally been thought of as the most boring topic of all.”
Dr Cronin’s interactive clinical therapeutics session, within the Cornea and Dry Eye component of SCC, will take place on Day 1.
DR RUSHMIA KARIM: ‘VISUAL ASSESSMENT, STRABISMUS AND WHAT FRIGHTENS US THE MOST’
Dr Karim understands the challenges and rewards of treating young patients. An eminent paediatric ophthalmologist with extensive training and research experience, she is the former head of the Paediatric Eye Service at Prince Charles Eye Unit at the Royal Berkshire Hospital
Image: FRANCESCO VICENZI, Organic Photo.
Dr Brendan Cronin will discuss the future of dry eye research and treatment options.
SPECSAVERS CLINICAL CONFERENCE
14-15 September
Up to 20 hours of CPD is available across the live and on-demand program.
The in-person component of the conference will be held at the JW Marrio tt on the Gold Coast, Queensland. A strictly limited number of in-person tickets are available on a first-come, first-served basis until sold out.
The full conference will be broadcast online for those who want to join virtually
assessment strategies, how to approach these systematically, and the key takeaways from a paediatric eye exam. Careful counselling with both children and their parents is important, and she will go through some of the fundamental understanding points that can confuse families.
The presentation aims to provide optometry professionals with an understanding of the wide range of paediatric eye diseases, from early misalignment in babies and eye injuries in toddlers to environmental ocular surface diseases, functional visual loss, and unusual optic nerves in older children. These topics will be discussed using case examples and take-home charts.
“We will try and break down both examinations and key paediatric eye conditions so that every Monday morning is filled with excitement, not dread,” she adds. “You will never be bored if you embrace paediatric eye healthcare. The future is in early intervention. Additionally, myopia management is also one of the fastest-growing demand areas so it’s hard to avoid paediatrics in our clinics. It’s time to embrace the fun.”
Trust, UK. She specialises in cataract surgery and ocular motility and alignment in both adults and children. At SCC, she’ll be tackling a topic she knows many people struggle with: paediatric ophthalmology.
“Imagine, you peek into the waiting room on a gloomy Monday morning, and your heart sinks. There are fidgety fingers tapping along the pamphlet aisles and you lock eyes with exhausted parents rocking their prams. This is me every week,” she confesses.
“The fear of examining kids is common and something I know many of my colleagues can relate to. Let me assure you, this is completely natural, as the unpredictability can be daunting. However, treating kids can also be a source of great enjoyment and accomplishment.”
Dr Karim explains there are a few fundamental tricks all eye health professionals need to know when providing safe and robust eyecare for kids. With the right tools and strategies, she believes paediatric eyecare can be immensely rewarding.
“We all have the knowledge, but it’s time to have a toolbelt of tricks, and that’s exactly what we’ll be covering in my session,” she says. “Get ready to learn the essential techniques you’ll need when providing early eyecare in children, including refractive error correction, amblyopia management, myopia control, and strabismus. This can be life-changing for a child and can prevent long-term vision impairment.”
Dr Karim’s presentation will cover the basic elements of vision assessments for children, common paediatric eye conditions, and important red flag conditions. She will discuss complex eye
Dr Karim will speak during the Paediatrics and Myopia Management
A/PROF CHAMEEN SAMARAWICKRAMA: ‘THE WATERY RED EYE: WHAT TO LOOK OUT FOR’
A/Prof Samarawickrama is a leading consultant eye surgeon and clinician-scientist. He is a cornea sub-specialist with a public appointment t Westmead Hospital and is heavily involved with RANZCO, chairing the Younger Fellows Committee. He is also a director of Australian Vision Research, the leading not-for-profit supporting ocular research. His presentation will delve into the complexities of diagnosing and treating watery red eye. The session promises to enhance attendees’ diagnostic skills by helping them develop an eye for differentiating
“While watery eyes frequently point to dry eye syndrome, there are crucial conditions that, if overlooked, can have significant consequences on a patient’s vision,” explains A/Prof
“Together, we’ll explore the intricacies of diagnosing and treating red eye conditions and how to distinguish the telltale signs from those present when the patient is experiencing an allergic eye disease. These often present with similar conjunctival and corneal symptoms yet require a distinctly different approach.”
A/Prof Samarawickrama’s session will also provide critical insights into conditions like herpes simplex virus (HSV) infections, and differentiating between epithelial, stromal, and endothelial disease forms. The session will draw on the findings from the pivotal Herpetic Eye Disease Study (HEDS), which revolutionised treatment paradigms.
“My aim is to give professionals the knowledge and confidence to characterise HSV and other viral causes of watery red eye, such as cytomegalovirus (CMV) and Varicella-Zoster virus (VZV) and arm them with the diagnostic tools to distinguish these conditions accurately,” he says.
“This is not just an educational opportunity; it’s a chance to transform your practice. So, whether you’re a seasoned optometrist or ophthalmologist or are new to the field, this session will provide valuable insights and practical knowledge you can apply immediately.”
A/Prof Samarawickrama says clinicians will leave his session with actionable insights, an understanding of effective treatments that can dramatically improve patients’ quality-of-life and knowledge that will allow them to stay ahead in their field with the latest research and clinical practices.
A/Prof Chameen Samarawickrama will speak on Day 1 as part of the Anterior Eye Therapeutics session.
Above, L to R: Dr Rushmia Karim will cover paediatric eyecare and A/Prof Chameen Samarawickrama will discuss watery red eye.
Insight Dry Eye Directory is back in 2024
The October 2024 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 www.surveymonkey.com/r/INSIGHTDryEyeShowcase2024
To amplify your product via advertising, contact
Insight Brand Manager Luke Ronca: 0402 718 081 or luke.ronca@primecreative.com.au
Scan HERE to arrange your listing.
A CAREER BUILT ON HIGHLIGHTS
DISPENSER DETAILS
Name: Jordan Dyce
Position: In-store trainer and trainee optical dispenser
Location: Specsavers
Launceston
Years in industry: 10
1. What initially attracted you to a career
I initially applied for a role as an optical assistant when I was in year 11, seeking a job to accompany my studies that I found more engaging than working in a fast-food restaurant or supermarket. I joined Specsavers at the age of 16 and fell in love with optics. Over the past 10 years, I have worked in both independent practice and in larger optical retailers. Following my wife and I’s recent move to Tasmania, I have joined the team at Specsavers Launceston as an in-store trainer.
2. What are your main career highlights?
Every time a patient leaves the practice feeling like I have made their life a little better, it feels like a mini highlight to me. Knowing that we meaningfully contribute to the lives of those we interact with has driven me to seek opportunities to use my skills to help others. I had the privilege of participating in Brisbane City Council’s Homeless Connect event as an optical assistant on two occasions. Both times, I found the ability to make a difference in the lives of vulnerable members of the community incredibly rewarding.
In July, I will be joining ODA on their inaugural aid trip to Fiji. I look forward to contributing to improved outcomes and engaging with those in need of care in under served communities.
3. What are your strengths as an optical dispenser, and what excites you?
Building a relationship with the patient, having the confidence and knowledge to field any questions they might have, and ensuring the patient understands I am just as committed as they are to finding the perfect solution. My passion for optics has fed an unending curiosity, and I am driven by the opportunity to develop my skills and expand my knowledge to become a more complete optical dispenser and better
4. Have you received any advice that’s stuck with you on the journey so far? Use your mistakes as an opportunity to improve. The best teachers and leaders I have learnt from have helped me transform my missteps into an opportunity for reflection and growth. I would recommend anyone that is early in their journey to seek leaders who encourage them to do the same.
5. What do you see as the key opportunities and challenges facing the future of optical dispensing in Australia?
Our lives have become more digitalised, and technology continues to creep into our everyday lives. We also have an ageing population. An increasing awareness of digital eyestrain and the variety of different activities that make up everyday life has seen lens technology improve in leaps and bounds over the past decade. Optical dispensers now have the opportunity to use the wide range of digitally surfaced lenses at their disposal to help meet the occupational and lifestyle needs of their customers better than ever before. Of course, improved technology does not come without its challenges. Despite the prevalence of online shopping, I believe there is a level of personalisation and expertise that comes from having a dispenser by your side during the process that simply can’t be matched by online retailers. By continuing to
invest in training and development for optical assistants and dispensers and drawing new people to the industry who are willing to go on this journey, we can continue creating value for customers through our knowledge and expertise.
6. How do you ensure your skills and knowledge stay up to date and current in such a fast-moving industry?
I never get tired of learning. Optics is such a fascinating industry, following publications like Insight helps me stay up to date on relative news within the profession, and ODA as an organisation continually provides dispensers with opportunities to upskill. Specsavers also have great training programs that promote both professional and personal development.
7. Why did you become a member of ODA? Because I believe that optical dispensers play a critical role in the success of optometry practices, and ODA takes a big step towards uniting and advocating for the profession and driving the growth of the industry.
8. What would you say to others thinking of joining ODA?
Do it – building a strong dispensing community is a key step towards advancing our profession and ensuring all dispensers are connected, knowledgeable, and well-resourced.
Images:
Jordan Dyce.
Jordan Dyce says every time a patient leaves the practice happy, it feels like “a mini highlight”.
CELEBRATING LIGHT
It’s easy to forget about the incredible physics at play when dispensing a pair of spectacles. DANUTA SAMPSON dissects how the eye and lens interact with light.
“THERE HAS CONTINUED TO BE A STRONG CONNECTION BETWEEN THE SCIENCE OF LIGHT AND THE EYE HEALTHCARE PROFESSION."
Light is everywhere and it is beautiful. Light and light-based technologies impact almost every aspect of our lives, from entertainment and medicine through to communications, energy and culture.
Recognising this significance, UNESCO established the International Day of Light celebrated annually on 16 May, commemorating the ground-breaking achievement of physicist Theodore Maiman’s successful operation of the first laser in 1960. Since 2018, this day has served as a global platform for individuals, universities, and industries to organise public events fostering awareness of light’s remarkable societal impact.
But what does this celebration have to do with optical dispensing? Well, quite a lot. Optical dispensing is all about improving how we use light to see and is underpinned by light technology and the underlying physics – the field of optics. In this short article, let me reflect on optics and its connection with optical dispensing.
refraction, and absorption. When it encounters a surface, such as the air-cornea interface, it can remain in the original medium (air; through reflection) or travel into the second medium (cornea; changing both its speed and direction through refraction). The difference between the refractive indices (n) of media determines how much light is refracted/bent when it enters the second medium. The process can be mathematically described by Snell’s law.
cornea is responsible for approximately two thirds of the optical power of the eye (+40.00D) and the crystalline lens one third (+20.00D).
BELOW:
Fundamentally, light interacts with matter through reflection, scattering, refraction, and absorption.
Optics is the branch of physics that studies the behaviour and properties of light, with the term originating from the ancient Greek word, optikē, meaning appearance or look. In antiquity, optics focused on explaining how vision worked. Since then, there has continued to be a strong connection between the science of light and the eye healthcare profession.
Fundamentally, light interacts with matter through reflection, scattering,
Although the credit for the discovery of the law of refraction is given to Willebrord Snel van Royen (Snellius) in the 16th century, studies have shown that the law was discovered more than 600 years earlier by Abu Sad Al Alla Ibn Sahl, a brilliant physicist who significantly contributed to optics. Scattering and absorption describe light interactions with matter that result in changes in light’s direction of travel and/or energy. In scattering from rough surfaces or from small fluctuations in a medium, light fragments into lots of smaller waves travelling in multiple random directions. This differs from reflection, which causes light to be redirected as a single wave in only one direction. In absorption, light energy is converted to another form of energy, commonly heat.
To see an object, light must interact with it. Let’s consider a green apple. All colours from the visible spectrum (that combine to make up ‘white light’) apart from the green are absorbed (extinguished/removed) by the apple. The green colour is reflected and travels to the eyes. When light passes through the cornea and crystalline lens, if it enters at an angle, the change in speed causes it to refract by an amount that varies with angle and refractive index difference according to Snell’s Law. If this bending is just the right amount for all angles of entry, all rays will converge on the retina to enable clear vision. This is known as emmetropia. There are two contributors to this bending – the curved cornea and the lens. A healthy
A mismatch between eyeball length and eye optics can lead to myopia (convergence in front of the retina) or hyperopia (convergence behind the retina), which causes blurry vision. Here again, optics plays an important role. For example, autorefractors quantify the eye’s optical imperfections. The personalised optical design of spectacles enables the correction of refractive errors, shifting all focusing points to the retina.
An important aspect of lens design is the choice of material, which involves trade-offs between factors such as refractive index (available range 1.49-1.89), Abbe number (that describes chromatic aberration; higher number–less aberration), impact resistance, weight, and cost. CR-39 (n=1.49) is a cost-effective material with a high Abbe number (59), often used to make lenses for low refractive error correction but is the thickest and heaviest. High-index glass (n=1.7; Abbe index=42) offers thinner profiles and clarity, enabling correction of high refractive errors, but is costlier due to complexity in manufacturing. More on lens design is coming in the next article.
In conclusion, optical dispensing, rooted in optics, spans the spectrum of patient care, from diagnosis to treatment. Advances in optical technology continuously reshape this field, demanding a deep understanding of optical principles that have not changed for millennia to deliver contemporary personalised solutions.
ABOUT THE AUTHOR: Dr Danuta Sampson is a translational researcher and senior lecturer jointly appointed between the Lions Eye Institute and the School of Optometry at the University of Western Australia. She is also involved in the global optics and photonics community through engagement with Optica and SPIE – the largest optics and photonics societies globally. She serves as light science ambassador (Optica), supports various committees (Optica) and designs STEM children’s books and educational games/materials (SPIE).
Image: Danuta Sampson.
Compatible with contact lenses
LEADING STEPS: ADVANCING PAEDIATRIC EYE HEALTH
LINDEN CHEN discusses the critical role of early intervention and collaboration for improved paediatric eye health outcomes, and how the StEPs service achieves this.
"MOVING FORWARD, IT IS ESSENTIAL TO CONTINUE SUPPORTING AND ACKNOWLEDGING THE CRITICAL CONTRIBUTIONS OF ORTHOPTISTS WITHIN THE HEALTHCARE SYSTEM."
In my current role as the StEPS coordinator for the Sydney Children’s Hospital Network (SCHN), I have the privilege of overseeing this highly successful program across the South Eastern Sydney Local Health District (SESLHD) and the Illawarra-Shoalhaven Local Health District (ISLHD). As an orthoptist by trade, I bring niche, clinical perspectives to this vital community health initiative. My previous experience as a clinical orthoptist at a private ophthalmology clinic has provided me with a sound understanding of the complexities of paediatric eye health and the critical role of early intervention.
Orthoptists play a pivotal role in the StEPS program, working to the top of our scope to improve efficiency, access, and overall quality of paediatric eye care. In addition to being an orthoptist myself, I manage two dedicated orthoptists – Angela in SESLHD and Suzy in ISLHD. Their roles include triaging referrals for further assessment and facilitating and maintaining the program’s successful referral pathway and model of care. Angela and Suzy also provide comprehensive secondary vision screening for children requiring further assessment. They conduct additional vision tests tailored to a child’s developmental level and comprehensively investigate binocularity. Furthermore, they assist in transitioning families to timely diagnostic assessment services and contribute to the training of vision screening staff. The accuracy of orthoptic referrals is also well-documented in Orthoptics Australia president Dr Amanda French’s academic paper, which highlights the success of the program and reliability of our referral processes.1
The program’s success also hinges on collaboration with various stakeholders, including parents, carers, and staff of schools, preschools, and childcare centres. Additionally, collaboration across the state is essential, as I am honoured to work alongside StEPS coordinators from different NSW local health districts. The community health framework also allows us to interoperate with other disciplines within community care. One recent example involved a child who presented to a community dental service and was referred to StEPS for potential strabismus. The child in question did not attend any preschool or childcare facility and was found through StEPS to have reduced vision as well as an accommodative
professionals, we extend the program’s reach and effectiveness, ensuring more children are screened, even those who do not regularly attend childcare or schooling facilities. A key strength of the StEPS program is its focus on reaching vulnerable communities, including Aboriginal and Torres Strait Islander populations. As a free and highly mobile service, StEPS significantly reduces barriers to accessing eyecare. My team travels extensively, bringing vision screening directly to preschools, childcare centres, and remote communities. This mobility ensures that all children, regardless of their socio-economic background or geographical location, can receive essential vision screening. By providing accessible and equitable eye care, the StEPS program embodies the principles of universal access to health services as advocated by the World Health Organization’s Universal Eye Health Action Plan.2
Each year, over 10,000 children across the state are screened, identifying those with vision problems who might have otherwise remained undetected. Early detection allows for timely treatment, which can dramatically improve a child’s vision and quality of life. It is no secret that early intervention in eyecare, especially detecting and treating refractive error and amblyopia, significantly improves visual outcomes. The StEPS program has demonstrated high effectiveness, with consistent overachievement of the 80% target screening rate (key performance index) in several years.1 The program
Working to the top of our scope allows orthoptists to play a vital role in enhancing the efficiency and accessibility of eyecare, ensuring that more children benefit from early vision screening and intervention. By focusing on early detection, fostering collaboration, and maximising our professional capabilities, we significantly impact the lives of children, their families, and the broader community. Moving forward, it is essential to continue supporting and acknowledging the critical contributions of orthoptists within the healthcare system. By highlighting our achievements and advocating for our profession, we can ensure that orthoptists remain integral to providing high-quality and equitable eye health care. It is therefore a privilege to be part of such an influential program.
References
1. French, A. N., Murphy, E., Martin, F., de Mello, N., & Rose, K. A. (2022). Vision screening in children: The New South Wales Statewide Eyesight Preschooler Screening (StEPS) program. Asia-Pacific Journal of Ophthalmology, 11(5), 425-433.
2. World Health Organization. (2014). Universal Eye Health: A Global Action Plan 2014-2019. Geneva, Switzerland: World Health Organization.
ABOUT THE AUTHOR: Linden Chen obtained his Masters of Orthoptics in 2014 at the University of Sydney. He worked as a clinical orthoptist at Marsden Eye Specialists before becoming the StEPS Coordinator at Sydney Children’s Hospitals Network.
ORTHOPTICS AUSTRALIA is the national peak body representing orthoptists in Australia. OA’s Vision is to support orthoptists to provide excellence and equity in eye health care. Visit: orthoptics.org.au
TAKE NOTE: USING AI FOR CLINICAL RECORDS
Medico-legal advisers often receive questions from practitioners who are considering implementing artificial intelligence note-taking tools in their practice. Avant’s TRACY PICKETT outlines some issues to consider.
“IF YOUR TOOL USES AN AUDIO RECORDING, MAKE SURE YOU HAVE PATIENT PERMISSION BEFORE RECORDING THE CONSULTATION. WE RECOMMEND GETTING EXPLICIT PERMISSION AND MAKING A NOTE OF THIS.”
One suggested role for artificial intelligence (AI) in healthcare is helping practitioners to meet growing administrative burdens, including capturing accurate records for patients with increasingly complex health interactions.
AI tools can transcribe or record a patient consultation and compile structured clinical notes. As well as forming the basis of the patient’s record, these notes can be re-formatted into other documents such as treatment plans, reports or referral letters.
AI tools can also incorporate prompts to help capture key information and assist with prevention or early intervention.
Provided the original record is reviewed carefully by the practitioner, creating multiple documents from the same source data may also reduce the risk of transcription errors.
By removing the need to take comprehensive notes during the consultation, the tools may help practitioners to focus on patients and improve communication.
However, remember the practitioner remains responsible for ensuring notes are accurate and complete.
KEY CONSIDERATIONS
If you are considering adopting an AI tool to assist with clinical notetaking, consider the following issues.
1. Protecting privacy and confidentiality
You must be confident your patient’s privacy and confidentiality is protected before you upload any of their information to an AI tool. That means checking where the data is processed, where and how it is stored, and how it will be used. Publicly available AI tools may not offer sufficient protection for sensitive data.
If your tool uses an audio recording, make sure you have patient permission before recording the consultation. We recommend getting explicit permission and making a note of this.
If you also use the tool to generate other documents such as reports or referrals, always check these do not breach patient confidentiality and ensure you only copy across clinically relevant information.
2. Is your AI ‘medical grade’?
Not all AI tools are the same. Research is progressing on AI designed specifically for medical applications. However, not all current models incorporate sufficient scientific rigour or have been trained on appropriate clinical data to be able to process medical information in a modern Australian context. AI scribing tools currently fall outside the Therapeutic Good Administration’s medical device regulatory processes.
The tool may have been ‘trained’ on historical datasets and there are indications they may perpetuate historical biases, for example based on race, gender or sexuality. It is important that introducing AI support in healthcare does not reverse progress on addressing healthcare inequities.
Tools may have difficulty understanding accents or language other than standard English.
3. Working with the tool’s limitations Transcriptions will not capture non-verbal cues or signs. In some cases it may also be inappropriate to verbalise all your observations, for example, if you have concerns about the cause of a patient’s injuries. You will need to ensure these are incorporated into the record.
AI tools may be unable to interpret inconsistent information, for example a patient who says they have no allergies but later mentions an adverse reaction to a medication.
AI tools may also have a tendency to fill
in gaps or extrapolate findings, which could lead to a misleading record.
4. Checking the record
Errors in the record will lead to concerns about patient safety and may impact the quality of care.
Always exercise your own professional clinical judgement when using AI tools. Treat any AI-generated outputs as drafts and ensure you review and check them to ensure:
• the record is correct
• the AI has captured and correctly interpreted relevant details
• it has not raised a diagnostic issue you had not considered
• the record captures sufficient detail to justify any Medicare item numbers you have billed for the consultation.
CONCLUSION
Before selecting AI for clinical notetaking, do your own due diligence in order to be confident that the tool you choose:
• is appropriate for your practice,
• can help you deliver safe patient care, and
• can comply with your legal and professional obligations – including ensuring patient privacy.
Tools are evolving so you must review any tool which you use in your practice to ensure that it remains fit for the clinical purpose and continues to produce the intended outcomes.
ABOVE: More practitioners are using AI to capture their clinical notes, allowing them to put more attention on the patient.
TRACY PICKETT
ABOUT THE AUTHOR: Tracy Pickett BA, LLB, is a legal and policy advisor for Avant.
SOAPBOX
AN ANSWER TO VISUAL SNOW SYNDROME?
treatment modalities, primarily due to the complex and poorly understood nature of the syndrome.
However, our groundbreaking pilot study, conducted by the clinics of Dr Terry Tsang Optometry, Inc. and Neuro-Vision Associates of North Texas, offers new hope. This research explores the potential of Neuro-Optometric Rehabilitation Therapy (NORT) to reduce symptoms and enhance life quality for those afflicted. Our work was published in the medical journal Frontiers in Neurology, and we presented our therapy to members of the Australasian College of Behavioural Optometrists.
sessions tailored to their specific needs, conducted by a qualified vision therapist or neuro-optometrist. The NEI-VFQ-25, a comprehensive tool for assessing vision-related quality-of-life, was administered at three key intervals: baseline, six weeks, and twelve weeks. This allowed for dynamic observation of any changes or trends that could be directly attributed to the therapy provided.
3. Better social functioning and mental health: There were notable enhancements in social and mental domains, suggesting that NORT could help alleviate some of the psychological burdens associated with VSS.
4. Reduced dependency: As vision improved, patients reported a decreased reliance on others, fostering greater independence.
5. Statistically significant results: The improvements noted were statistically significant, lending weight to the therapy’s effectiveness.
6. Sustainable improvement: Gains in quality-of-life were not only achieved but sustained over the study period.
7. Tailored therapeutic approach: Each patient received customised treatment, enhancing the effectiveness of the intervention.
8. Innovative techniques: The use of advanced neuro-optometric tools and techniques provided a cutting-edge treatment framework.
9. Safe and non-invasive: Unlike pharmacological treatments, NORT is non-invasive, presenting a lower risk profile.
10. Pioneering research: This study contributes significantly to the existing literature by filling in gaps in the understanding and management of VSS. With the potential to significantly improve patient outcomes through a relatively unexplored therapeutic path, NORT offers a new approach to managing VSS.
After experiencing success with our patients, both with the reduction in visual symptoms of dots, after images, etc., and also their ability to resume function with daily living, we teamed up to design this study to help increase awareness of the possibility that neurovisual rehabilitation is a viable method to help this community.
At the time of the study design, there was no statistically trackable method for quantifying the visual symptoms that VSS patients experience. Since many experienced significant quality-of-life changes in addition to the reduction of visual snow symptoms, we chose
At the time of the study, NORT was not widely implemented in the clinical field for VSS, making this study among the first to delve into its potential benefits systematically. The therapy includes a variety of exercises designed to improve oculomotor function, visual processing speed, and accuracy, which are often compromised in VSS patients. The study illuminates several key benefits of NORT:
1. Improved general vision: Patients showed significant improvements in general vision scores from baseline to 12 weeks.
2. Enhanced distance and near vision activities: Marked progress was noted in tasks involving distance and near vision, crucial for daily functioning.
The detailed data analysis provides a foundation for further research, potentially influencing treatment protocols across neuro-optometry.
The holistic improvement in patients’ lives observed in this study underscores the profound impact that such therapeutic methods can have.
Names: Dr Terry Tsang; Dr Charles Shidlofsky
Qualifications: FCOVD, FAAO; OD FOVDR FNAP
Affiliations: Optometric Vision Development & Rehabilitation Association, Neuro-Optometric Rehabilitation (NORA); NORA president, International Sports Vision Association past president
Location: Irvine, California; Plano, Texas
Years in industry: 29; 35
THE THERAPY INCLUDES A VARIETY OF EXERCISES DESIGNED TO IMPROVE OCULOMOTOR FUNCTION, VISUAL PROCESSING SPEED, AND ACCURACY, WHICH ARE OFTEN COMPROMISED IN VSS PATIENTS.
Image: Terry Tsang.
Image: Charles Shidlofsky.
EVENTS CALENDAR
To list an event in our calendar email: myles.hume@primecreative.com.au
NOVEMBER 2024
RANZCO CONGRESS 2024
Adelaide, Australia 1 – 4 November ranzco2024.com
AUGUST 2024
EUROSCOLE AUSTRALIA
Melbourne, Australia 3 – 4 August euroscole.com
TASMANIA’S LIFESTYLE CONGRESS
Tasmania, Australia 17 – 18 August taslifestylecongress.com.au/
OPHTHALMOLOGY UPDATES!
Sydney, Australia 24 – 25 August ophthalmologyupdates.com
PROVISION NATIONAL CONFERENCE
Perth, Australia
30 August – 1 September icmsmeetings.eventsair.com/provision-2024
SEPTEMBER 2024
ESCRS 2024
Barcelona, Spain 6 – 10 September escrs.org
BLUE SKY
Adelaide, Australia 13 – 14 September bluesky.optometry.org.au
SPECSAVERS CLINICAL CONFERENCE (SCC) 2024
Gold Coast, Australia 14 – 15 September specsaversclinicalconference.com.au
OCTOBER 2024
EYECARE PLUS NATIONAL CONFERENCE & AGM
Sydney, Australia 18 – 19 October eyecareplus.com.au/conference/
MARCH 2025
ODA INTERNATIONAL CONFERENCE
Sydney, Australia 7 – 8 March odamembers.com.au
JUNE 2025
ODMA FAIR
Sydney, Australia 27 – 29 June odma.com.au
The Adelaide Convention Centre will host the Blue Sky optometry conference in September and then the RANZCO Congress in November.
Optical Dispensers Australia CEO April Petrusma has revealed plans for an international conference in Sydney with the International Opticians Association in March 2025.
The Optical Distributors and Manufacturers Association is bringing back ODMA Fair in June 2025, which is set to alternate with O-SHOW (pictured).
SPECSAVERS STORIES: BRIANA TSANG
HOW DID YOU COME TO WORK AT SPECSAVERS?
CHANGING LIVES THROUGH
In 2019 I was searching for a second job while studying at university. I chose to apply for Specsavers because I hadn’t worked for a large network before (I was working as an optical assistant at an independent) and wanted exposure before choosing my place of work after graduation. Specsavers has such a large presence in ANZ and I liked how affordable the business makes eyecare for patients, from free OCT to $39 glasses and two for one. I also liked the idea of working in a larger team and three-way handovers connecting clinical and retail sides of the business. I figured it would be a great opportunity while still at university to get a foot in the door if I applied to work there as an optometrist.
WHAT WAS YOUR FIRST ROLE WITHIN THE BUSINESS, AND WHAT DID IT ENTAIL?
I started as an optical assistant at Specsavers Brisbane City, where I learnt about pricing, products, store processes and work culture. This entailed greeting patients, collections, repairs, contact lens teaching, handovers, frame styling, dispensing and pretesting.
WHAT GROWTH OPPORTUNITIES HAVE PRESENTED THEMSELVES?
I was also able to do some of my placement hours at the Brisbane City store and enjoyed sitting in with the familiar faces of optometrists who I worked with on a day-to-day. I believe this, along with the fact that being vice president of the Queensland Optometry Student Society, allowed me to network with the Specsavers graduate team and offered an advantage when I applied for my first optometry position at Specsavers Maroochydore. While waiting for my registration, I worked as a dispenser at Maroochydore, building connections with the retail team while becoming
familiar with how the store operated. My mentor gave me opportunities as an optometrist, from seeing and managing many case presentations, to having students sit in with me and to presenting case studies. He often sat me down to explain key business performance indicators and involved me in many store decisions and processes. Furthermore, I ended up working between Specsavers stores, gaining experience in Buderim, Nambour, Kawana and Noosa, enriching my experience. If I had stayed, my mentor was willing to support my career progression in the direction of becoming a partner. Life had other plans and I’m now happily working at Specsavers Indooroopilly closer to family and my partner who I have bought a house with.
CAN YOU OUTLINE YOUR TOP CAREER HIGHLIGHTS SINCE JOINING SPECSAVERS?
The first day I ran tests as an optometrist was a big highlight because it was the culmination of all of my study and experience and a reminder that I was now capable of providing eyecare independently. Every time a patient thanks me for my service is a win. Most recently, conducting eye tests at the Altru Festival in West End felt incredibly rewarding. Being able to pay forward my knowledge and skills to students sitting in on my consults and to a class at the Pacific Eye Institute in Fiji on a virtual outreach with The Fred Hollows Foundation has created some full circle moments.
WHAT EXCITES YOU MOST ABOUT TURNING UP FOR WORK?
It excites me there is room to grow as an optometrist and person every day. I also get truly excited to work with my talented co-workers, both clinical and retail, in an environment where I know I will be supported, very much like a family.
LET’S TALK!
In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today:
Joint Venture Partnership opportunities enquiries: Carly Parkinson on +61 (0) 478 201 057 or carly.parkinson@specsavers.com
Australia Optometrist employment enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134
Locum employment enquiries: ANZ.locumteam@specsavers.com
New Zealand employment enquiries: Chris Rickard – Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499
$25k sign-on bonus - Optometrist Joint Venture Partnership Opportunity in Whitford, WA Specsavers has an exciting opportunity for a passionate and experienced Optometrist to join our established store in Whitford, Western Australia, as a Joint Venture Partner. Specsavers Whitford boasts 4 test rooms, a varied patient demographic, and an extremely welcoming, supportive team. If you’re looking for a relaxed beachside lifestyle just a short drive from Perth’s bustling CBD, look no further than Whitford!
Optometry opportunities at Specsavers!
Are you seeking a job that offers more? Don’t miss the chance to join our team, where we provide competitive salary packages, cutting-edge technology - including OCT in every store – at no extra charge to your patients, supportive and collaborative teams and fantastic access to career development, including the opportunity to own your own business through our industry-leading pathway program. Whether you are looking for full-time, part-time, or fixed-term opportunities to complement your locum commitments or seamlessly integrate work with your family life, Specsavers has the perfect role for you.
Seeking a talented optometrist to join our extraordinary team at Specsavers Queenstown. We offer cutting-edge technology, a friendly environment, and a commitment to professional growth. Work in one of NZ’s most picturesque locations. Explore stunning mountain views and enjoy a fantastic outdoor lifestyle. Don’t miss this incredible opportunity to be part of Specsavers Queenstown.
The Specsavers ‘Early Bird Package’ is coming to an end!
For select opportunities across ANZ, final year optometry students will be eligible for either a $30,000 or $20,000 sign on bonus when they sign an employment contract before June 30 2024. Specsavers are the largest employer of Graduate Optometrists across Australia and New Zealand and we have continued to develop our comprehensive two-year Graduate Program to focus on your development.
Regional Locum Opportunities
Specsavers are seeking experienced optometrists to locum across regional stores in Australia, allowing you to choose your own days and locations. This is an opportunity to combine work and travel. We have a variety of locum across Australia, starting now and going throughout 2024. Whether you’re locally based and looking to fill up your diary with that regular one day a week or to escape the cold and work in the sun for a few weeks, Specsavers has you covered with all travel and accommodation provided and booked for you.
People on the move
Queensland’s OKKO Eye Specialist Centre has had a fourth ophthalmologist join its ranks. Dr Delia Wang ophthalmic cataract microsurgery. She is fluent in Mandarin and Cantonese. Dr Wang is now practising
Mina You has been appointed as a Senior Optometrist at the Surgical Treatment and Rehabilitation Service (STARS), a specialist public hospital in Brisbane. She will be involved in delivering high level optometry clinical services within the ophthalmology service and a multidisciplinary team. You was previously the Manager of Daily Operation for the Australian College of Optometry.
role of Director, Communications and Awareness at Optometry Australia (OA). With experience in digital engagement and strategy, he is now leading the team to enhance digital communications, focusing on member engagement and consumer awareness. This role encompasses developing and implementing comprehensive digital strategies, overseeing content management and driving public awareness and
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