Sun protection for every life and style HOYA sun lenses – enhanced vision and protection from UV rays. 03 WHY OPTICAL FRAMES MAY COST MORE Local manufacturer sparks controversy after border force wipes tariff concession. 26 RETHINKING CATARACT SURGERY PRACTICES How local ophthalmologists are reducing their environmental footprint with each surgery. 48 OPTOMETRISTS AND LASER SURGERY Kiwi optometrists welcome scope change, but does it raise medicolegal issues? AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 SEPT 2022
© 2022 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) New Zealand Distributor: Toomac Ophthalmic. 32D Poland Road, Glenfield 0627 Auckland New Zealand (Ph 0508 443 5347) SNX.0006.AU.22 For more information please contact your Bausch + Lomb Territory Manager or Customer Service 1800 251 150 COMPATIBLE WITH YOU Adelberg Scleral Fixation Forceps Engineered for Serrated grasping platform engages suturesshreddingwithout Compatible with a 25Ga cannula with sutures engaged SCLERAL TheFORCEPSFIXATIONAdelbergScleralFixationForcepsaredesignedto aid in the placement of scleral-sutured posterior chamber IOLs. The curved shaft has been designed to enable anterior access from the pars plana and to minimise wound distortion.
ODMA is reviewing its options in response to an Australian Border Force (ABF) decision to wipe a 5% tariff concession enjoyed by frames importers for almost two decades, as fresh details reveal how authorities came to the decision that has sparked controversy.
NZ OPTOMETRY SCOPE CHANGE FOR LASER SURGERY Optometry Australia (OA) has applauded its New Zealand counterparts for a major scope-ofpractice change that now allows the profession to perform two ophthalmic laser surgery procedures, as the Australian peak body continues to push for its own reform. It comes after the New Zealand Optometrists and Dispensing Opticians Board (ODOB) approved a proposal now authorising optometrists with Specialist Optometrist Scope of Practice – Ophthalmic Laser Surgeries on their registration to use a Nd:YAG laser for capsulotomy and/or peripheral iridotomy in an approved hospital setting.
DECISION CATCHES IMPORTERS OFF GUARD
EYEWEAR
RATIONALE BEHIND NZ OPTOMETRY LASER SURGERY DECISION Insight delves into the reasons behind why the New Zealand Optometrists and Dispensing Opticians Board went ahead with the scope-of-practice change despite ophthalmology opposition.
The move now requires importers of eyewear from markets where there is no free trade agreement – like Europe – to pay a full 5% duty rate. It caught local wholesalers off guard who say it could lead to tens of thousands of dollars in unexpected tax that would be difficult to absorb.
continued page 8
“We congratulate the New Zealand optometry sector on pursuing an evolution of scope that can support better patient access. We look forward to seeing how this change [to ophthalmic laser surgery] impacts practise and eyecare access in New Zealand,” OA CEO Ms Lyn Brodie“Theresaid.isready opportunity to utilise Australia’s highly skilled optometry workforce more effectively to support better community access to eyecare.
AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 SEPT 2022
The Optical Distributors and Manufacturers Association of Australia (ODMA) revealed it held private negotiations in an attempt to resolve the revocation of TCO 0315725.“Assoon as ODMA became aware that an application had been made, research was conducted to identify the party involved given that detail was not publicly available,” the association said.
“This was to enable ODMA to take action as soon as possible and to find a solution hopefully before the concession was revoked. On discovery that the party involved AS TARIFF
ODMA REVIEWING OPTIONS
The still-unfolding series of events was initiated by Port Macquariebased spectacle frames manufacturer Optex Australia, which successfully sought revocation of Tariff Concession Order (TCO) 0315725, gazetted by the ABF on 13 July.
The policy came into effect on 1 July and follows a pilot study within the ophthalmology department at Auckland’s Greenlane Clinical Centre, in addition to consultation with the sector, which included opposition from ophthalmology. In Australia, OA has not been advocating for optometrists to perform Nd:YAG laser surgery. But in recent times, it has been pushing for optometrists to be permitted to prescribe oral medications –something Kiwi optometrists have done since 2014 – and the piloting of care models using optometrists to enhance access to intravitreal injections for macular disease.
page 8
Meanwhile, Optex Australia – one of few manufacturers of eyewear in Australia – doesn’t think the decision will make a monetary difference to its business, but hopes it will bring attention to local manufacturing options.Theoriginal tariff concession on eyewear has been in place since 2003 and meant importers of acetate frames were exempt from paying the full duty rate. ODMA was influential in its establishment at the time. At their core, TCOs are government revenue concession when there are no known Australian manufacturers of substitutable goods. In its decision, the ABF ruled Optex Australia did, indeed, produce substitutable goods (spectacle frames) in the ordinary course of business, and came to the decision after considering its application and visiting its factory. It is back dated to 13 May 2022, however provisions apply if goods were already in transit to Australia by that day. Because there is a similar TCO for metal spectacle frames (TCO 0315708), customs authorities are set to remove that as well.
Optometry Australia continues to advocate for system changes to make full use of optometrists within eyecare pathways, and for the scope of optometric practice to evolve to meet community need.”
The tariff concession on acetate frames has been revoked. Image: Optex Australia.
In its decision, the ODOB said allowing some optometrists to perform minor laser surgeries would continued
page 48
References: 1. Steven, Philipp, et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease – A Prospective, Multicenter Noninterventional Study.” Journal of Ocular Pharmacology and Therapeutics 31 (8), 498-503 (2015). 2. Steven, Philipp, et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease Due to Meibomian Gland Disease.” Journal of Ocular Pharmacology and Therapeutics. 33(9), 678-685 (2017). Sponsored by Novaliq GmbH. NovaTears ® Eye Drops (Perfluorohexyloctane 100% v/v, 3mL) are for the lubrication and relief of dry and irritated eyes. Do not use NovaTears ® with contact lenses. If using any other eye medication, allow at least 15 minutes between using the other product and applying NovaTears ®. NovaTears ® should not be used in children under 18 years. NovaTears ® should not be used while pregnant or breastfeeding. AFT Pharmaceuticals Pty Ltd, Sydney. ABN 29105636413. to
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Recent survey results published in RANZCO's journal Clinical and Experimental Ophthalmology revealed around 65% of Australian and New Zealand ophthalmologists agreed that public health systems should have sustainability as a performance indicator.
EYE ON SUSTAINABILITY
SUSTAINABLE SURGERY
Where the hole in the ozone layer was once perhaps the most pressing environmental concern in Australia and New Zealand, today we’re more mindful of plastic waste and carbon emissions.Inthisissue, we look at sustainability from two perspectives: manufacturing contact lenses, and performing cataract surgery. These two different facets of eyecare share the same goal: to reduce unnecessary waste in our industry.
MYLES HUME Editor FEATURES SEPTEMBER 2022 INSIGHT September 2022 5 07 UPFRONT 09 NEWS THIS MONTH 53 OPTICAL DISPENSING 54 ORTHOPTICS AUSTRALIA 55 MANAGEMENT 56 PEOPLE ON THE MOVE 57 CLASSIFIEDS/CALENDAR 58 SOAPBOX EVERY ISSUE
But practical changes are being implemented to make cataract surgery more sustainable, as three ophthalmologists share how they have improved the carbon footprint and waste generated from eachAlsosurgery.inthisissue, optometrists and ophthalmologists continue to share their clinical expertise in our regular CPD articles. They discuss how, even with the latest technology, accurately diagnosing glaucoma is made even harder when other pathologies masquerade as the disease. On the subject of technology, Dr Mali Okada explores the use of OCT-A in macular conditions. We hope you enjoy this issue.
Plastic and packaging waste is also a problem in cataract surgery, with some surgeons arguing wasteful practices have become accepted as the norm, in part due to the belief that ‘singleuse’ surgery will be better and safer.
Local ophthalmologists are leading the way to reduce cataract surgery waste.
Thinking, but more crucially, acting sustainably has become a higher priority in the ophthalmic sector, with corporations and consumers each shouldering their share of responsibility.
Has the migration to working from home presented an industry-wide opportunity?
CooperVision’s ANZ general manager discusses why the industry is reliant on plastic and what steps the company is taking towards a world where plastics are responsibly used, recovered, and reborn in perpetuity.
46 NET ZERO PLASTIC CooperVision has embarked on a major project to make its one-day contact lenses plastic neutral.
GLAUCOMA OR NOT?
IN THIS ISSUE
Dr Lewis Levitz says even with the latest technology, true diagnosis can remain stubbornly difficult.
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And if you’re craving for a meaningful career full of growth, we offer world-class training and development programs from graduate to partnership that will unlock your potential. We will provide you with a host of professional development opportunities from our ophthalmology-led education programs to our clinical conference and 24/7 access to our MyCPD Portal from the beginning of your time with us.
We also offer market-leading technology and above market salaries, supplemented by additional benefits covering extra annual leave, relocation allowances, and AHPRA fees.
Whether you’re looking for your first job, new opportunities or feel ready to take that next step to partnership, we have a variety of roles and locations to suit your needs. Be part of the growth and secure your future at Specsavers.
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IN OTHER NEWS, Dr Margaret Lam, who was recently appointed national president of Optometry Australia (OA), has announced she will stand down from the positions of national president and New South Wales president of the Cornea and Contact Lens Society of Australia (CCLSA) at the organisation’s November annual general meeting. Lam will continue to serve on CCLSA’s national board as a vice president and on the NSW state committee. Lam became the OA president in July after Mr Murray Smith resigned seven months into the role for personal reasons.
FINALLY, Glaukos Corporation has received clearance from the US Food and Drug Administration for its iStent infinite trabecular micro-bypass system. The novel system is indicated for use in a standalone procedure to reduce elevated intraocular pressure (IOP) in patients with primary open-angle glaucoma uncontrolled by prior medical and surgical therapy. The iStent infinite includes three heparin-coated titanium stents preloaded into an auto-injection system that allows the surgeon to inject stents across a span of up to approximately six clock hours around Schlemm’s canal, the eye’s primary drainage channel. time its 30-plus-year
UPFRONT Just as Insight went to print, the LIONS EYE INSTITUTE opened a state-of-the-art clinic in Midland, Western Australia, ensuring people in Perth’s eastern corridor have access to high quality eye health services. While LEI has operated a clinic in Midland since 2016, under the leadership of Dr Hessom Razavi, it now has a permanent address in the Midland Specialist Centre, located across from the historic Midland Railway Workshops precinct. “We have been working in the area for more than six years, but this new purpose-built facility will provide us with the opportunity to expand our service offering and work even more closely with the local community in ensuring they have access to the best possible eyecare,” Razavi said.
history, ProVision’s national conference will be open to non-member optometrists and students. optom.provision.com.au/conference THIS 2022SCCMONTHHYBRID 10 – 11 SEPTEMBER The Specsavers Clinical Conference is returning as a virtual two-day, ophthalmology-led event across Australia, with 20 hours of CPD. anz.cpd@specsavers.com Complete calendar page 57. insightnews.com.au STAT Published by: 11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreative.com.au Chief Operating Officer Christine christine.clancy@primecreative.com.auClancy Group Managing Editor Sarah srah.baker@primecreative.com.auBaker Editor Myles myles.hume@primecreative.com.auHume Journalist Rhiannon rhiannon.bowman@primecreative.com.auBowman Commissioning Editor, Healthcare Education Jeff Megahan Business Development Manager Luke luke.ronca@primecreative.com.auRonca Client Success Manager Justine justine.nardone@primecreative.com.auNardone Design Production Manager Michelle michelle.weston@primecreative.com.Westonau Art Director Blake Storey Graphic Design Michelle Weston, Kerry Pert, Louis Romero Subscriptions T: 03 9690 subscriptions@primecreative.com.au8766ThePublisherreservestherighttoalteroromitanyarticleoradvertisementsubmittedandrequiresindemnityfromtheadvertisersandcontributorsagainstdamagesorliabilitiesthatarisefrommaterialpublished.©Copyright–Nopartofthispublicationbereproduced,storedinaretrievalsystemortransmittedinanymeanselectronic,mechanical,photocopying,recordingorotherwisewithoutthepermissionofthepublisher. GENDER DISCRIMINATION AND BIAS Seventy per cent of Australian optometrists surveyed said they felt uncomfortable when spending time in a darkened consulting room with patients of another gender. Page 25. INSIGHT September 2022 7
n WONDERFUL Contact lens wearers in Ireland can now access grants of up to €1,000 (AU$1,440) towards the cost of medically required lenses every two years. Previously, according to local media outlet Irish Independent, the support was provided every four years to employees and the self-employed who required contact lenses for medical reasons.
n WACKY AFL’s Essendon champion Matthew Lloyd has revealed he’s been diagnosed with Bell’s palsy. Speaking to the Herald Sun, Lloyd recounted how his right eye wouldn’t stop watering during a visit to his parents, and his subsequent diagnosis. “I can’t blink, the eye might shut about 40-50% and it dries out so I have to lubricate the eyes every hour."
n WEIRD Researchers at York University and several other institutions examined the eyes of southern leopard frogs to find out how tadpoles’ vision adapts at a molecular level from seeing underwater to seeing on land. They found 42% of genes in the eyes of tadpoles changed, or were differentially expressed, once it metamorphosised into a frog.
in
WHAT’S ON NEXT CONFERENCEPROMONTHVISION 21 – 23 OCTOBER For the first
It noted the presence of acetate cutting machinery, a storage area for various types, colour and size of cellulose acetate, and a spectacle arm cutting and wire hinge inserting/attaching machine, among other equipment.“Although there may be imported components, in the singular these components are not a spectacle frame. None of the components … are simply bolted, screwed or attached in a pre-set formula, but are constructed following specific (often bespoke) engineered technical instructions and component fabrication lists,” the authority ruled.
Lyn Brodie, Optometry Australia. time of writing, but the Australian Society of Ophthalmologists vice-president Dr Peter Sumich said the New Zealand branch of RANZCO was looking into it.
Asked if the TCO revocation was fair, given that demand meant it could not all be met by local producers, he said this was “a very narrow view of the decision”.
“At this stage it raises medicolegal and ethical concerns for both the optometrist involved and the ophthalmologist who runs the clinic. NZ has no Medicare system and public hospital quality of care is patchy between regions. I doubt whether it is applicable to our health system,” he said. n million-worth of eyewear from Europe each year, this would increase my costs by $50,000 per year. Why and to what end? How does that benefit Optex’s business by increasing my import costs by so much? They’ll sell more eyewear as a result? I think not.”
n 8 INSIGHT September 2022 “WE HAVE HAD TO DIVERSIFY EYEWEAR”MASS-PRODUCEDBACKDROPINCREASINGAGAINSTREMAINCOMPETEINCAPABILITIESINTERESTSOURANDORDERTOANDVIABLEANOF GREG OPTEXFRENCH,AUSTRALIA
“It’s about understanding, valuing, and supporting local manufacture. The jobs and innovation this creates keeps talented minds from being lured overseas and leaving our industry.”
ODMA said it offered Optex access to its various promotional channels – including access to digital and print media as well as live industry events for members or nonmembers – in the hope they would provide more benefit than any competitive advantage gained by pursuing the revocation.
“The issue is not about fairness or that one manufacturer is expecting to produce all the eyewear in Australia,” French said.
Mr Greg French, managing director or Optex Australia, told Insight that Australia had negotiated free trade agreements across many eyewear manufacturing regions globally which were unaffected by the“Whatdecision.[revocation of] the TCO does offer a local manufacturer, is it has people stop and think about engaging local options. Like many local manufacturers, we have had to diversify our interests and capabilities in order to compete and remain viable against an increasing backdrop of mass-produced eyewear that is not being produced under the same workplace restrictions and laws that we all expect manufacturing businesses to comply with here in Australia,” he said.
Until there’s a European free trade agreement, he said importers would need to pay more for frames from there.
RANZCO did not wish to comment at the was Optex, over the next few weeks, ODMA engaged in multiple discussions and negotiations with Optex to identify a mutually beneficial solution for both local manufacturing and those that import and distribute product. Optex declined the offers made and the revocation was passed.”
“Understandably, the TCO may have an impact on some smaller importers. This is something that does concern me, and it may require further consultation, additional discussion and consideration between [ABF] and the parties affected.”
Mr Aaron McColl, of Queensland-based eyewear wholesaler Aaron’s Eyewear, brought the issue to light after stock from Europe was recently held up at the border. It was ultimately released with the TCO applied, but the backdated decision now means he will pay the 5% duty. He was frustrated that the inability of local manufacturers to meet industry demand isn’t factored into such decisions.
NEWS MOVE RAISES MEDICOLEGAL ISSUES, ASO SAYS reduce the burden on the private and public ophthalmology sector, and lower geographical barriers to accessing care requiring an ophthalmologist. During the consultation phase there were 23 submissions, most in favour of the proposal. However, the proposal did not receive unanimous support. Those opposed “were from an ophthalmology perspective, and hinged on the following four themes” (more details can be found on pages 48-49).
FORCE VISITED
continued from page 3 continued from page 3
“This is not simply a screw and bolt together operation, but a series of engineered and production processes that transform the singular components to a new product ... At the very simplest, cutting, inserting and attaching the components can’t easily be undone, and would constitute a substantial transformation with value being added through the local production process.”
“Unfortunately, many ODMA members now find themselves in a situation that will either squeeze their business margins and/or increase the price to retailers and therefore consumers at a time when economic pressures are escalating such as increased fuel prices and wages, to mention just a couple,” ODMA stated.
“Hypothetically speaking, if I bring in $1
“I’ve always said that Optex and anyone manufacturing locally should be applauded, but there is no reason to punish everyone else in the industry in the process,” he said.
ODMA said it was currently engaging with numerous industry members to gain feedback and reviewing all alternative courses of action.
“The quick nature of how this concession was able to be overturned and the little value placed on the volume capacity of the manufacturer making an application for a revocation is also of concern as ODMA appreciates businesses attempt to plan and budget ahead for the future.”
BORDER OPTEX PRODUCTION SITE
OPTEX EXPLAINS DECISION
“Ask any business owner if they will ‘just absorb’ an additional $50,000 in increased costs per year without passing some, if not all, of it along. No one wants or needs this additional cost burden in this inflationary economic climate.”
IMPORTER QUESTIONS RATIONALE
The ODOB addressed each of these points in its final summary, most notably stating that “concerns regarding safety are not supported by published literature of international experience, and patient experience is at least as high when an optometrist performs the procedure”.
THE ABF DECISION To make its decision, ABF visited Optex’s headquarters to verify that at least one substantial process of manufacture occurred.
Yang continued: “I found the team at G&M are very dedicated and supportive with their professionalism. I thoroughly recommend the G&M partnership to any independent optometrists.”
“I think it is a perfect business model for an independent practice as we can spend more time with our customers and patients for a better experience. I no longer need to worry about payroll, invoicing, marketing, advertising, system security and competitions and the list goes on.”
G&M’s general manager of partnerships Ms Cassie Gersbach said being local and connected was key to success and the Menai and surrounding residents would continue to be cared for by the team, who will be supported by G&M’s patient-first strategies and initiatives.
Jason Yang (right) and Denise Chen, of Optometrist Menai. George & Matilda (G&M) Eyecare earlier welcomed Albany Creek Optometrists and independent optometrist Mr Philip Brinin to its community.
One week after announcing the addition of Albany Creek Optometrists in Brisbane to the George & Matilda (G&M) Eyecare network, another new partnership has beenOptometristrevealed.Menai, an independent optometry practice located within Menai Marketplace in Sydney’s south, has joinedPracticegroup.manager Mr Jason (Daesong) Yang said the team at Optometrist Menai were excited, from the initial interest to when G&M offered to partner with the“Aspractice.G&Mis fast-growing and a leader in the optical industry in Australia, our business will be supported more than ever. It is very simple; we continue to look after our customers and patients, and G&M will do the rest,” he said.
“It's exciting for all of us here at Albany Creek Optometrists to be starting a new chapter in our ongoing story of caring for the eye health and visual needs of our community,” Brinin said.
The practice has serviced the Albany Creek and surrounding areas in Brisbane’s north for more than 32 years, presenting an ideal fit for partnership with G&M, the company stated.
GEORGE & MATILDA EXPANSION CONTINUES
n
Together, Brinin and G&M will continue to pay respect to the practice’s heritage and build upon existing loyalty in the localAccordingarea. to G&M, this will be complimented with sophisticated platforms, strategies to grow the business, and strong industry partnerships, making it mutually beneficial for Brinin the local team and ultimately the patients of Albany Creek.
“G&M’s experience and deep understanding of independent’s needs at all stages of their professional and personal lives, combined with their ability to have adapted in an everchanging world and a proven model that is mutually beneficial, continues to make them an appealing choice for many independents as they consider their next steps,” she said.
NEWS
10 INSIGHT September 2022 NEWS n TRADIE TROUBLES
IN BRIEF
n UBER
Durkin said Gregory was an ideal fit for the role, given his time as an Eyecare Plus director for more than a decade, and vast experience across all areas of the optical industry.
PROVISION BOSS RESIGNS; ACTING CEO APPOINTED Martin ProVision.TonyEyecareGregory,Plus.Jones, MARTIN GREGORY ELECTED EYECARE PLUS CHAIRMAN
New research has revealed 65% of tradies in New Zealand are putting their hearing at risk and 51% are putting their eyesight at risk by not wearing protective equipment. The research, commissioned by Specsavers, revealed only half of respondents (49%) said they always wore goggles when appropriate to protect themselves from projectiles or dust particles. Despite New Zealand having one of the highest UV rates in the world, only 20% of tradies surveyed were always wearing sunglasses during the winter months when UV levels are still high. Only 62% of respondents said they had visited an optometrist in the last two years, the recommended timeframe for adults, and only 44% over 40 had been for a hearing test during the same period. CONTROVERSY
ForSight Robotics, a pioneer in ophthalmic robotic surgery, has raised $55 million to advance the first surgical platform for fully robotic cataract surgery, Oryom. It hopes the platform will increase accessibility to surgery and ultimately transform the future of eye surgery. “It will raise the bar for high quality procedures with superhuman submillimeter accuracy – 10 times more accurate than the human hand – delivering ultimate consistency, for extremely safe surgeries with optimal refractive outcomes,” the company said. "We are pleased to be able to advance our technology with this investment to bring robotics into the world of ophthalmic surgery to help millions of patients who have to wait unnecessarily for procedures."
“After three terms in the role, it was time for me to retire and I’m delighted this will be a seamless transition, and to be able to hand over with confidence that Eyecare Plus will continue to go from strength-to-strength,” Durkin said. Gregory was honoured to have been elected as the new chairman.
n ROBOTIC
A 19-year-old blind woman was left stranded when an Uber driver refused to take her home because she had her guide dog with her. The woman told 3AW Mornings the driver refused to take her because they were concerned her dog would “shed too much hair” in his car. “This is not a new issue. This happens to hundreds and hundreds of disabled people,” she said, adding that the driver would have known about her guide dog when he accepted the fare.
Mr Martin Gregory, a director of Eyecare Plus for the past 11 years, has been unanimously elected by the Eyecare Plus Board to replace chairman Mr Justin Durkin who has retired after nine years. Gregory started working as a ‘delivery boy’ in 1982 (when he was 14 years old) in the same Wagga Wagga optometry practice he is now a partner of, when it was owned by Eyecare Plus founder Mr TonyToday,Hanks.heis a practice owner and qualified accountant with an MBA and 40 years’ experience in optometry as an optical dispenser, optical wholesale executive and practice owner.
“I’m incredibly proud of what Eyecare Plus has been able to achieve over the past 22 years and I look forward to playing a role in helping to shape the next 22 years." n
An Uber spokesperson said it continues to develop strong policies to prevent incidents like this from happening. SURGERY
ProVision has secured Australian of the Year Mr Dylan Alcott AO, business growth thought leader Mr Keith Abraham, marketing expert Ms Katrina McCarter, motivational speaker Ms Amanda Gore, and Australian futurist Mr Steve Sammartino. The event will also host conference workshops including Practice Management System User Groups where attendees can engage with Optomate and Sunix developers, and view demonstrations of Optomate Touch’s new integration with ProVision’s ProAccounts system that is generating major stock management efficiencies for practices. There will also be Future Focused Workshops addressing topics such as future planning, succession planning, digital marketing and changes in consumer behaviour. A dedicated workshop for early career optometrists and those interested in a career in the independent industry will also delve into the mechanisms for starting an independent practice. On the back of this, there will be a dedicated student/early career optometrist and independent practice owner networking opportunity. n
ProVision CEO Ms Frances Mirabelli has resigned, after commencing in the role in February this year. Mr Ian Bluntish, ProVision chairman, said the board has asked its merchandise manager, Mr Tony Jones, to assume the CEO role in an acting capacity until a new CEO is appointed.“Tonyhas served ProVision for 10 years, has a broad knowledge of the optometry business, and is well known to our members and suppliers,” BluntishMirabellisaid.replaced Mr Steven Johnston earlier this year who spent 10 years in the role. During her sixmonth tenure, Bluntish said she worked to reinvigorate ProVision’s strategic direction and to re-engage with members after the COVID-19 lockdowns of recent years. She was also instrumental in a decision to invite non-member optometrists to ProVision’s biennial national conference this year for the first time in its 30-year history. The conference is taking place Friday 21 to Sunday 23 October at the Pullman Melbourne, Albert Park, and will feature a world class speaker line-up.
T: +61 8 8444 6500 Optos.com Get Optos off your And into your practice “We are quite stuck for space and our impression was that an optomap® required a lot of room. This is not the case. We wish we had realised sooner how little space the optomap needed...” Peter Weston | Eyewear on Pako
According to the ODMA website, Grills’ ophthalmic career began in 1960 as a dispensing optician at OPSM before rising to become the principal of the Guild of Dispensing Opticians Optical Dispensing Training Course. In 1978, he founded Designs For Vision, starting with two optical dispensing outlets before changing from a retailer to a distributor of ophthalmic products in 1982. Designs For Vision (now a Paragon Care brand) remains one of the leading distributors of ophthalmic and optometric products throughout Australia and New Zealand. Up until his death, he was the director New Australian Government data of organ and tissue donation shows eye donations are up 12% year-on-year, but a leading eye bank director says stress on the health system is contributing to lower rates compared to prepandemic levels.
AUSTRALIAN DONATIONS INCH CLOSER TO PRE-PANDEMIC LEVELS
“We do not know how we could ever possibly fill the void that he leaves in ODMA and the optical industry. We have lost a true champion of optics and an amazingly talented, humble, caring and creative human being,” Carey said. n
Last year, Insight reported how COVID-19 lockdowns and elective surgery shutdowns negatively impacted eye donation rates across Australia. In some cases, donation rates halved, with only 30-50% of usual corneal surgeries being performed depending on their urgency.
The latest ‘Australian Donation and Transplantation Activity Report’ shows in 2021 there were 1,472 deceased eye donors, up by 154 compared to 2020. As a result, there were 2,413 corneal transplants, which was 6% more than 2020 when 2,277 were performed. While the numbers are trending up, they still lag behind 2019 rates when 1,505 eye tissue donations were reported. However, 2021 is comparable to 2019 in terms of corneal transplants undertaken (2,413 vs 2,414).
Queensland had the highest rate with 479, followed by New South Wales (383), Victoria (300), South Australia (147), Western Australia (135), Tasmania (16), and ACT (12).
“The donation rates are intimately associated with the degree of stress that our hospital/health systems have endured during the pandemic. It’s a complicated interplay of many factors.”
Of the nation’s 1,472 decease eye donors, 1,154 people donated their eyes only, 127 were eye and tissue donor, 97 were organ, tissue and eye donors, and 94 were organ and eye donor. n
12 INSIGHT September 2022 NEWS VALE RICHARD GRILLS – AN OPTICAL INDUSTRY STALWART
According to Pollock, these include:
“For our particular eye bank – Lions
EYE
The latest 2021 report also had a stateby-state breakdown of eye donations.
“And during recovery it will be a case of the donation agencies (organ, tissue and eye) having to re-build and repair some of the referral pathways – there is some hard work ahead,” he said.
Richard Grills. Over 26,000 Aussies have received corneal transplants since 2009.
of ODMA, having previously served as its chair for 10 years, a director of the Genetic Eye Foundation from its inception, a director of the Macular Disease Foundation Australia from its foundation and the chair of the former Essilor Vision Foundation. He was also a member of the Visiting Advisory Board at both UNSW School of Optometry and Vision Science and UTS orthoptics school.
Since 2009 – when there were only 922 eye donors – more than 26,000 Australians have received a corneal transplant.LionsEye Donation Service (LEDS) director Dr Graeme Pollock, who founded the Melbourne-based organisation in 1991, said the organ and tissue donation sector would not recover until the health system was in better shape.
In addition, lockdowns put pressure on donor referral systems out of hospitals, which rely on staff having donation front-of-mind. COVID-19 restrictions made bereavement more challenging for families, with donation sometimes considered too complicated to consider at such difficult time.
1. A stressed health system places stress on referral systems for donation, and results in fewer referrals coming through as potential donation.
2. The potential donor pool is somewhat decreased due to the current high incidence of COVID (which is a contra-indication to donation).
“This stress, less donation, has been felt across all sectors of donation – organ, tissue and eye,” Pollock added.
3. Although difficult to completely evaluate, it does appear the additional stresses placed on families during COVID (less access to visitors at hospitals etc) means that the consent rate for donation has been slightly decreased.
Eye Donation Service – we have seen lower donor rates in 2022 than we saw in 2020 and 2021. It’s the result of health systems stress and community fatigue.”
Mr Richard Grills, an Optical Distributors and Manufacturers Association (ODMA) board director and former chair, and founder of Designs For Vision, has passed away, aged 80. “On behalf of the board of ODMA it is my sad duty to advise the community that optical industry stalwart, Richard Grills, has passed away suddenly at Kareena Private Hospital, 12 July 2022 just a few days past his 79th birthday,” ODMA CEO Finola Carey said. “Richard had been battling respiratory issues for a number of years. [He] was first and foremost a family man and we extend our deepest sympathies to his wife Faye, son Brad and all the family.”
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Nova Eye Medical announced it has established the iTrack Global Data Registry in collaboration with the International Glaucoma Surgery Registry (IGSR). The registry will be jointly led by Kerr, from Eye Surgery Associates in Melbourne, with world-renowned surgeons Dr Iqbal Ike K. Ahmed and Dr David Lubeck, with the support of an educational grant.
Kerr presented an interim data analysis for the registry during the Asia Pacific Glaucoma Congress, which took place in Malaysia from 4-7 August 2022.
The International Society for Manual Small Incision Cataract Surgery (ISMSICS), with chapters in 14 countries, will launch in Australia and New Zealand at the RANZCO Annual Scientific Congress in October. The college said this would pave the way for fellows, trainees, as well as colleagues from the surrounding south and western Pacific countries, to engage with an expert group, marking a major step“Manualforward.Small Incision Cataract Surgery (MSICS) is the most commonly carried out cataract surgery in the world. Through constant evolution, MSICS refractive results are coming very close to those achieved with phacoemulsification. In the last two decades, the attention that MSICS has achieved is considerable,” RANZCO president Professor Nitin Verma“Whilesaid.many ophthalmologists in Australia and New Zealand are familiar with the technique, many more would like to learn more. It is important for all of us to be familiar with MSICS it so that it can be used when the situation requires it. Phacoemulsification is not always an available or appropriate course of action for cataract surgery.”
CANALOPLASTYSPEARHEADSOPHTHALMOLOGISTGLOBALDATAREGISTRY
The CFEH’s inaugural director Professor Michael Kalloniatis left the organisation in March, after 13 years, amid a strategic review of the centre’s operations.
14 INSIGHT September 2022 NEWS
n
Australian ophthalmologist Dr Nathan Kerr is spearheading the development of a global data registry to collect prospective, multicenter, longitudinal data for canaloplasty in glaucoma treatment.
According to Lubeck, the registry will ensure full utilisation of canaloplasty in daily clinical practice.
CENTRE FOR EYE HEALTH APPOINTS GENERAL MANAGER
“Despite 14 years and tens of thousands of procedures performed globally there is still much to be learned about the nuances and versatility of the canaloplasty procedure,” Lubeck said.
The Centre for Eye Health (CFEH) has appointed Ms Sarah Holland as general manager to lead the achievements”frommodel,neworganisation'soperatingfollowingonher“outstandingasexecutive manager over the last two years.
Holland’s appointment comes as part of a new operating model that will see Guide Dogs NSW/ACT overseeing responsibility for clinical services, with research and education managed by UNSW, although both entities will continue to work in partnership.
The medical technology company said the iTrack Global Data Registry will capture real-world clinical evidence for canaloplasty across Europe, the Asia Pacific and North America.
Nitin RANZCO.Verma, SMALL INCISION CATARACT SOCIETY
A subsidiary of Guide Dogs NSW/ACT, in partnership with University of NSW (UNSW), the Centre for Eye Health (CFEH) was established in 2009 to provide a high quality, evidence based clinical service, aimed at reducing preventable blindness and vision loss through the early detection of eye disease.
“The iTrack Global Data Registry is providing high-quality, real-world evidence of the effectiveness and safety of canaloplasty to treat glaucoma and ocular hypertension,” he said.
The new general manager position will work with the head of clinical operations role to ensure CFEH remains an industry leader, collaborating with key stakeholders and industry experts and facilitating cutting edge clinical services influenced by research with UNSW.
"It will make a major contribution to our understanding of the clinical effectiveness of canaloplasty and will enable evidencebased decision making."
LAUNCHING ANZ CHAPTER AUSTRALIAN
“Importantly, it provides a robust means by which to collect uniform data to evaluate specified outcomes across the spectrum of glaucoma.
The iTrack Global Data Registry will follow outcomes for a minimum of 24 months and enroll over 300 patients.
“The ongoing partnership with UNSW will allow for continued facilitation of both undergraduate education and clinical research which are both integral to the CFEH model," Holland said.
n
The ISMSICS launch is happening during the congress on 29 October 2022 in Brisbane. n
“[There] is already a significant amount of work undertaken within the sector across a number of stakeholders including Glaucoma Australia and the Macular Disease Foundation Australia; it is my hope that we will continue to work in a collaborative manner ensuring maximum impact,” Holland said.
The newly created senior leadership position is responsible for leading CFEH, contributing to the new strategic direction, further developing community collaborations and managing clinical operations with a focus on the unmet need of servicing vulnerable population groups through early detection.
The company’s portfolio of proprietary canaloplasty devices – the iTrack and iTrack Advance – will feature in the registry.
Sarah Holland, CFEH. iTrack Advance is designed to improve the efficiency of the canaloplasty procedure.
Want to learn more? Scan the QR code or visit cyliteoptics.com The power of 1,008 Hyperparallel OCT technology is redefining anterior segment imaging by: • Simultaneously scanning a snapshot grid of 1,008 beamlets, instead of just one. • Each snapshot covering the entire region of interest, enabling true volume images. • Scanning at over 300,000 scans per second, minimising motion artefacts. Traditional OCT with a single scanning spot Hyperparallel OCT with 1,008 simultaneous scanning spots
Data and analytics company GlobalData’s latest report on the glaucoma surgery devices market for 2015-2030, predicts 9% compound annual growth rate (CAGR) for MIGS devices between 2022 and 2030. Australia will be followed by New Zealand at 5% growth and Taiwan at 4.5%. Over many years, MIGS has worked its way into the glaucoma treatment paradigm, proving efficient in the reduction of intraocular pressure (IOP), as well as demonstrating enhanced safety, rapid recovery and reduced dependency on medications.
Dr Michael Robinson, vice president, global therapeutic area head of eyecare at AbbVie, said the alliance was an important step.
ABBVIE AND iSTAR MEDICAL FORM GLAUCOMA ALLIANCE
“The Australian Government’s MBS might provide public funding for Nova Eye Medical’s iTrack to be approved as standalone MIGS procedure. This support will significantly boost the MIGS devices market."
iSTAR Medical is currently enrolling a US premarket approval study (STAR-V) to enable commercialisation in the US.
"As a leading company in eyecare
Ophthalmologists believed the measure didn’t go far enough, which led to the current item number 42504, introduced in May 2020, which allows for standalone MIGS. Australia subsequently became the world’s first universal healthcare system to allow this.
AUSTRALIA BOASTS APAC GROWING MIGS MARKET
iSTAR MINIject.Medical's with a commitment to a broad and diverse portfolio from the front to the back of the eye, along with our global footprint and infrastructure in glaucoma, we are well-positioned to support bringing this MIGS offering to patients and glaucoma specialists through this strategic alliance," he said. Under the terms of the agreement, iSTAR Medical will receive a $60 million (AU$85 m) non-dilutive upfront payment and will continue to develop and commercialise MINIject. AbbVie will hold the exclusive right to acquire iSTAR Medical and lead subsequent development and commercialisation.
“MIGS is yet to be approved as a standalone procedure in other APAC countries,” GlobalData medical devices analyst Ms Chetna Kaushik said.
“MIGS, being approved as standalone procedure, provides benefits such as reduced operative time, less scarring, fewer operative complications and faster recovery. Intrusive procedures such as trabeculectomy and tube shunt surgery, on the other hand, takes approximately six weeks for recovery and could result in complications."Thereportalso noted other drivers of MIGS market growth included government initiatives, growing awareness of minimally invasive procedures among patients, and Australia’s aging population.
Biopharmaceutical company AbbVie and Belgium medical technology manufacturer iSTAR Medical have announced a strategic alliance to further develop and commercialise iSTAR Medical's MINIject device, a new minimally invasive glaucoma surgical (MIGS) device.
Australia’s minimally invasive glaucoma surgery (MIGS) devices market is set to be the fastest growing in the AsiaPacific (APAC) region, buoyed by the Australian Government’s 2020 decision to reimburse MIGS as a standalone procedure, according to a new report.
n
The Glaukos iStent is one of few MIGS procedures reimbursed as a standalone procedure.
n
The deal will support iSTAR Medical's development and commercial efforts for MINIject, as well as provide an opportunity to expand AbbVie's eyecare business, building on its glaucoma portfolio which includes drops, sustained release implants, and stent offerings. Abbvie owns Allergan.
“The Australian Government has been fully supportive of MIGS. As well as making MIGS a standalone procedure, the country’s Medicare has been providing reimbursements for MIGS,” Kaushik said.
Australia surgeons began using MIGS in 2014 but this was performed under MBS item 42758 (goniotomy). Its popularity soared from 138 claims in 2013/14 to 3,809 in 2016/17, which prompted the government to step in and change the descriptor and effectively halt its use in a large proportion of glaucoma patients. Following extensive advocacy from the sector, the issue was partially addressed in October 2018 when the government approved a new item number but limited its availability to those simultaneously undergoing cataract surgery.
16 INSIGHT September 2022 NEWS
“We will benefit from AbbVie's strong global experience and knowledge base already established in glaucoma, and we are excited to be working with such a world class team,” the company’s CEO Mr Michel Vanbrabant said.
"MIGS IS YET TO BE APPROVED AS A COUNTRIES"INPROCEDURESTANDALONEOTHERAPAC GLOBALDATAKAUSHIK,CHETNA
GlobalData reported MIGS devices allow for personalised treatment for mild-to-moderate glaucoma. According to Tham et al., the number of people with glaucoma worldwide is expected to reach 112 million in 2040, with GlobalData figures showing APAC accounts for the largest number of glaucoma cases worldwide, despite having a lower disease prevalence.
REGION’S FASTEST-
MINIject received CE marking approval to commercialise in European countries in the last quarter of 2021 and launched commercially in select European countries in early 2022.
DV1307-0822 Call 1800 225 307 dfv.com.au Meet the Family: • Pentacam® The Gold Standard tomographer • Pentacam® HR High-resolution Scheimpflug images • Pentacam® AXL Included optical biometry • Pentacam® AXL Wave Wavefront, biometer and tomographer anteriorStillPentacam®theGoldStandardineyesegmenttomography Since its introduction in 2002, the OCULUS Pentacam® has proven itself an indispensable part of ophthalmic practices and has come to represent the “Gold Standard” worldwide. Within just two seconds the Pentacam® supplies you with precise diagnostic data on the entire anterior eye segment. • 20 years of normative data and peer reviewed publications • Belin-Ambrosio Keratoconus Screening and Progression analysis • Corneal and Anterior segment volume data • Corneal and optical lens densitometry • Updated: Cataract Pre-operative analysis with total corneal data • NEW - optional Cornea Scleral Profile (CSP) Report • Biometry & Total Cornea IOL Calculation • Total eye wavefront refraction and lens retro-imaging Cataract Pre-Op display WAVE Wavefront Overview Corneal Densitometry
It said that with myopia on the rise globally, an increasing number of children may require the higher Australian patients could soon be benefitting from a novel drug which improves vision with fewer treatments for people with neovascular age-related macular degeneration (nAMD).
The Pharmaceutical Benefits Advisory Committee (PBAC) recommended the Authority Required listing of Roche’s Vabysmo (faricimab) for the treatment of nAMD at its meeting in May 2022.
astigmatism.CooperVision
Comparable reductions in central subfield thickness (CST) were observed with Vabysmo given at intervals of up to four months versus aflibercept given every twoNomonths.newsafety signals were identified and Vabysmo continued to be well tolerated, with a favourable benefitriskTheprofile.primary analyses at one year formed the basis of recent nAMD approvals in the US, Japan, the UK and several other countries around the world. Vabysmo is also approved in these countries for diabetic macular edema (DME). n
18 INSIGHT September 2022 NEWS
“With the potential to require fewer injections over time, Vabysmo continues to represent an important step forward for people with vision-threatening retinal conditions, and these data exemplify our commitment to redefining standards of care and reducing treatment burden.”
“The PBAC considered that there should be no extra cost to government given the PBAC’s acceptance of the faricimab administration frequency, based on an analysis of the faricimab administration frequency in the first year of treatment, which was derived from the average doses in the first 48 weeks of treatment in the TENAYA and LUCERNE trials.”
“Even older children starting with MiSight 1 day have seen their myopia progression cut by half.” n
MiSight boasts amongcontactlongest-runningthesoftlensstudychildren.
Dr Levi Garraway, chief medical officer and head of global product development at Roche, said the longer-term results reinforce confidence in Vabysmo (faricimab) and support its continued use in people with nAMD.
MiSight 1 day contact lenses are supported by the longest-running soft contact lens study among children.
prescriptions that MiSight 1 day lenses willCooperVisionoffer. director of global professional affairs, myopia management, Ms Elizabeth Lumb, said while early treatment is best, it’s never too late to “Everystart.diopter matters, particularly for children whose myopia progression may have already placed them at a higher risk for conditions such as myopic maculopathy and glaucoma,” she said.
Nearly 80% of people receiving Vabysmo could be treated every three months or longer.Patients treated with Vabysmo received a median number of 10 injections over the two years versus 15 injections for those patients treated with aflibercept, potentially decreasing the number of injections.
"THE GOVERNMENT"EXTRASHOULDTHATCONSIDEREDPBACTHEREBENOCOSTTO COMMITTEEADVISORYBENEFITSCEUTICALPHARMA-Vabysmo has the potential to require fewer injections over time, its manufacturer says.
VABYSMO TWO-YEAR TRIAL CONFIRMS FEWER TREATMENTS NEEDED FOR NEOVASCULAR AMD
“The clinical trial has proven that MiSight 1 day works for nearly all children with myopia, cuts myopia progression by half, works at any age a child starts treatment (8+), works for as long as the child wears them, and that myopia control benefits from MiSight 1 day are retained after treatment,” the company said.
It comes as new two-year data from two studies, known as TENAYA and LUCERNE, reinforced Vabysmo’s longterm efficacy, safety and durability in treating nAMD.
CooperVision has announced its MiSight 1 day contact lenses are now available in higher prescriptions, making myopia control accessible to more children than was previously possible.
“The PBAC considered that, based on the clinical evidence provided, the claim of non-inferior comparative effectiveness and safety of faricimab compared to aflibercept was acceptable,” the PBAC outcome explained.
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IN HIGHER PRESCRIPTIONS
The expanded range, covering -0.25D to -10.00D (0.50D steps after -6.00D), means that MiSight 1 day covers 99.97% of prescriptions for Asian children – and likewise for Caucasian children – who have myopia and less than 1D of said the diopter extension would allow even more children to benefit from myopia management.
PBAC’s recommendation for listing was based on, among other matters, its assessment that the cost-effectiveness of faricimab would be acceptable if it were cost-minimised to PBS-listed antiVEGF treatments such as aflibercept and ranibizumab for the same indication.
In the latest, two-year data from the two trials, more than 60% of people receiving Vabysmo could be treated every four months – which represents an increase from 45% at year one – while achieving comparable vision gains versus aflibercept given every two months.
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“Mean habitual binocular visual acuity (logMAR) was 0.32 before surgery, 0.15 after first eye surgery, and 0.07 after second eye surgery.” Keay said that cataract remained a leading cause of vision impairment in Australia, despite the effectiveness and availability of cataract surgery.
Australian researcher Scientia Associate Professor Nicole Carnt has spearheaded a new study demonstrating that daily disposable contact lens wear is four times safer than reusables. Recently published in Ophthalmology, the trial was designed to establish risk factors for Acanthamoeba keratitis (AK) for daily disposable contact lens users compared to daily wear reusable lens users.“This is important because in many major economies contact lens use is the principal cause of microbial keratitis of which AK accounts for around 50% of cases with sight loss. Determining these AK risks informs practitioner advice and consumer behaviour,” the authors wrote.
STUDY DETERMINES HIGHER SAFETY IN DAILY DISPOSABLE CONTACT LENSES AMD TYPE STRONGLY ASSOCIATED WITH HEART DISEASE AND STROKE
“Age- and sex-adjusted fall incidence prior to surgery was 1.17 falls per year, 0.81 per year after first eye surgery, and 0.41 per year after second eye surgery,” reported Professor Lisa Keay, head of the UNSW School of Optometry and Vision Science, reported with colleagues.
Patients with a specific form of agerelated macular degeneration (AMD) are at significant risk for cardiovascular disease and stroke, according to new research from New York Eye and Ear Infirmary of Mount Sinai.
“Major disparities in access to cataract surgery have been reported in Australia and other high-income countries. Our study adds to the body of evidence supporting investment in timely access to cataract surgery for older people, as it is cost-effective for improving vision and preventing falls," the authors wrote.
“The problem has been exacerbated by deferral of elective surgery during the coronavirus disease 2019 pandemic, and particularly affects people who rely on public hospital services."
“We foresee that in the future, as an improved standard of care, such patients will be considered for early referral to a cardiologist for evaluation and possibly treatment,” he added. n Around 40% of AMD patients had cardiovascular disease or a past stroke, with 66% of them having subretinal drusenoid deposits.
“For the 118 participants who underwent second eye surgery and participated in all follow-up visits, age- and sex-adjusted incidence before (0.80 falls per year) and after first eye surgery (0.81 falls per year) was similar but was lower after second eye surgery (0.32 falls per year).
The study also assessed risks unique to disposabledailyusers. Cataract surgery in both eyes led to a reduced falls risk.
20 INSIGHT September 2022 RESEARCH UNSW STUDY OFFERS NEW INSIGHT INTO CATARACT SURGERY AND REDUCED FALL RISK
n
The study analysed 126 patients with AMD using OCT. Patients also answered questionnaires about their health history including heart disease and stroke. In total, 62 had SDD and 64 had drusen; 51 of the 126 total patients (40% ) reported having cardiovascular disease or a past stroke, and most (66%) of those patients had SDD. By contrast, of the 75 patients who did not have known heart disease or stroke, just 19% had SDD. In statistical terms, patients with cardiovascular disease or stroke were three times more likely to have SDD than patients without. If ophthalmologists care for someone with the specific subretinal drusenoid deposits form of AMD, but who otherwise seem well, Smith said they may have significant undetected heart disease, or possibly carotid artery stenosis that could result in a stroke.
This study, published in the July issue of Retina, is said to be the first to demonstrate a link between the disorders.“Forthelast three decades researchers have suggested an association between AMD and cardiovascular disease, but there has been no conclusive data on this until now,” lead author Dr R. Theodore Smith, Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai, stated.
“Our retinal team answered this important question by focusing on two different varieties of AMD that can be seen with advanced retinal imaging. We discovered that only one form of AMD, that with subretinal drusenoid deposits (SDD), is tightly connected to high-risk vascular diseases, and the other form, known as drusen, is not,”
Older Australians with cataract can wait for substantial periods for both first and second eye surgerythatresearchsystem,publicsurgerycataractinthehospitaldespiteshowingthesecondisessential to reducing the incidence of falls. Published in the Medical Journal of Australia, the research analysed data from people aged 65 years or more referred for bilateral age-related cataract surgery during 2013–16. This was for a maximum of 24 months after study entry or until six months after second eye surgery, whichever was shorter.
The study also assessed risks unique to daily disposable users and found they were: reusing, sleeping and showering in lenses and less frequent optometrist follow“Safeups.contact lens use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users these measures can be expected to have public health benefits,” the authors stated. n
MyDay sphere | toric | multifocal The first range of plastic neutral contact lenses The first range of plastic neutral contact lenses MyDay® toric Your 1st choice for more astigmatic patients1* • Optimised Toric Lens Geometry™ delivers the consistent centration, stable fit and excellent visual acuity both you and your patients can depend on • Around-the-clock axes enable you to provide coverage for most astigmatic patients* MyDay® toric contact lenses provide vision correction for 88.9% of astigmatic patients1 *Around the clock axes in 10° steps from Plano to -6.00DS in -0.75DC, -1.25DC and -1.75DC. #Range defined as all 1-day brands and segments: sphere, toric and multifocal. CooperVision® data on file, 2021, 2020–2023 Plastic Bank Contract Agreement. One-day contact lenses are defined as orders for those products and includes product sold and distributed by CooperVision in Australia and New Zealand. Plastic neutrality is established by purchasing credits from Plastic Bank. A credit represents the collection and conversion of one kilogram of plastic that may reach or be destined for waterways. CooperVision purchases credits equal to the weight of plastic in our one-day contact lens orders in a specified time period. One-day contact lens plastic is determined by the weight of plastic in the blister, the lens and the secondary package (outer carton), including laminates, adhesives, and auxiliary inputs (e.g. ink). 1. CooperVision® data on file 2021; Rx coverage database n=83,540 eyes; 14 to 70 years. MyDay® and CooperVision® are registered trademarks of the Cooper Companies, Inc. and its subsidiaries. EMVCOO0819 ©2022 CooperVision. 2580 prescription options
Safilo Group will next year introduce Eastman Tenite Renew in its sunglass and prescription collections, and in doing so will become the first player in the market to use all Eastman Renew materials in its eyewearEastman,portfolio.achemical company based in Tennessee, US, is a global specialty materials provider and pioneer in molecular recycling technologies. This year, Safilo launched Eastman Acetate Renew and Eastman Tritan Renew in its sunglass and optical product range.
“By being the first player in the eyewear industry using all Eastman Renew materials for this application – Acetate Renew, Tritan Renew and Tenite Renew –Safilo can provide our customers with a variety of differentiated options that meet their high standards for both design and sustainability,” said Mr Vladimiro Baldin, chief licensed brand and global product officer at Safilo Group. n Safilo is launching Levi's Tenite Renew in January Marcolin2023.isbased in Italy, with operations in Australia.
Hoya, Bausch + Lomb, CooperVision and Safilo Group are among its preferred suppliers. n
The new lens portfolio falls under Rodenstock’s B.I.G. Vision For All philosophy that was introduced in 2020 and which stands for a paradigm shift in individual progressive lenses, the manufacturer said.
Mr Ken Rogers, director of Eyebenefit, said the company was proud to announce a partnership with Rodenstock Australia.
22 INSIGHT September 2022 COMPANY RODENSTOCK AUSTRALIA AND EYEBENEFIT STRIKE SUPPLY DEAL Ophthalmic ahaveannouncedtwoEyebenefit,buyingsupplierasbeenAustraliaRodenstockmanufacturerlenshasnamedapreferredtonationalgroupasthecompaniestheyenteredintostrategicsupplyagreement.Rodenstockgeneralmanager
According to the company, these figures validate a positive performance recorded in the first quarter of 2022. Looking at the net sales figures for 1H19, there was an increase of 10.1%, “which confirms a robust recovery of the market”. Compared to the same period of the previous year, the group increased sales in all geographical areas (at current exchange rates), notably in EMEA (+17.4%) and the Americas (+18.8%), which together account for almost 90% of consolidated net sales. It also recorded strong results in high-potential geographical areas such as Asia (+5.3%) and the rest of the world (+51.2%).
“The results were made possible by an excellent sales mix, both in terms of brands and distribution channels, and by a continuous drive for production and procurement efficiency despite the difficulties related to the negative effect of inflation, which mainly impacted transport costs (with respect to the increase in electricity costs, which although present, did not have a significant effect on margins),” the company reported.
SAFILO EXPANDS SUSTAINABLE MATERIALS WITH EASTMAN TENITE RENEW
“We are excited to bring this new alliance to light, expanding options and reward to our members. Rodenstock’s values align seamlessly with ours at Eyebenefit and we see them as the perfect addition to our ever-growing group supporting independent practice,” he Headquarteredsaid.in Moorabbin, Victoria, Eyebenefit has been operating as an optical buying group for independent owner-operated optometry stores for more than 10 years. By leveraging the collective power of a national buying group, it aims to reduce costs for optical businesses with exclusive access to deals and discounts.
Global eyewear manufacturer Marcolin has reported €283 million (AU$411 m) in net sales for the first six months of the year, representing a 19.6% increase against the same period in 2021.
Adjusted EBITDA rose to €40 million (AU$ 58 m), up 21.3% compared to the same figure as of 30 June 2021.
Eastman Tenite Renew, to be introduced in January 2023 in Safilo’s licensed brand Levi’s collections, will be rolled out across the group’s portfolio, both for sunglasses and prescription frames, further asserting the company’s commitment to sustainability and its efforts to bring more recycled materials to the eyewear industry.
MARCOLIN REPORTS STRONG RESULTS AS MARKET REBOUNDS
Rodenstock recently updated its lens portfolio.
Produced via Eastman’s carbon renewal technology, using hard-torecycle plastic waste in place of fossil fuel, Tenite Renew is composed of minimum 42% bio-based content and minimum 20% recycled content. Safilo said the resulting material offers the same premium feel and comfort of acetate with the additional unmatched fit adjustability that optical dispensers need to create a personalised eyewear fit.
Mr Tim McCann said he believes there is a “natural alignment” between Eyebenefit and Rodenstock, and the partnership will further strengthen independent optical practices.
n
The company recently unveiled the latest innovations in its ophthalmic lens portfolio in Australia, featuring new B.I.G. NORM lenses that incorporate a precise AI-based biometric model of the eye using only the four standard refraction values.
Carl Zeiss Meditec has revealed a new partnership to develop fabricated corneal tissue, leveraging a new 4D bio-fabrication platform that is set to address a major unmet need in ophthalmology.
The company's ophthalmological pipeline consists of three products, the two cornea products that are the subject of the collaboration with Carl Zeiss Meditec, and a retinal implant for agerelated macular degeneration, all of which demonstrated successful results in animal models.
According to Precise Bio, its technology combines engineering, biomaterials, cell technology, bioengineering, and 3D printing into a 4D bio-fabrication platform for transplantable organs and tissues.
"The technology has the potential to advance treatment options for corneal disease, as well as for elective procedures – furthering enabling optimisation of patient care."
"This strategic agreement leverages Zeiss' global leadership in ophthalmology and Precise's innovative and unique 4D biofabrication platform technology. We are confident that the synergy between the two companies will allow us to develop breakthrough solutions for recovering patients' eyesight, bringing hope to hundreds of millions of patients worldwide."
Precise Precisecornea.bio-fabricatedBio'sImage:Bio.
ZEISS FOCUSES ON BIOFABRICATED CORNEAL TISSUE
Under the terms of the agreement, Carl Zeiss Meditec will invest in Precise Bio and fund the further development of Precise Bio's two cornea transplant products and has exclusive worldwide commercialisation rights for these products. Financial terms were not"Thisdisclosed.investment in Precise Bio is expected to complement our leading portfolio of cataract and corneal refractive workflow solutions," Mr Euan Thomson, president of ophthalmic devices and head of the Digital Business Unit for Carl Zeiss Meditec, said.
The company's ophthalmological products address global markets exceeding $10 billion annually.
Overcoming multiple technology challenges, Precise Bio stated its 4D bio-fabrication technology enables it to reliably scale up tissue engineering for clinical use, and produce large quantities in a reproducible, quality controlled and cost-effective process.
Specifically, the two companies will develop and commercialise fabricated corneal tissue for transplants in patients requiring endothelial keratoplasty and natural lenticule transplants for treating keratoconus and vision correction.
The company's proprietary platform technology allows it to fabricate tissues by 'printing' cells in a single-cell resolution and spatial accuracy, enabling complex organoid constructs with both structural integrity and long-term cell viability.
n
Mr Aryeh Batt, co-founder and CEO of Precise Bio, said the company was excited about the partnership.
The German ophthalmic medical device maker announced on 18 July it had signed a deal with US-based Precise Bio, which describes itself as a regenerative medicine company advancing the use of bio-printed tissues and organs.
A/Prof Peter Hendicott, World Council
“We are currently evaluating the commercialisation strategies which includes talking to interested parties.” n
A virtual fitting service for Kering eyewear is provided by Lotte Internet Duty Free using augmented reality (AR) technology, according to Inside Retail Lotte Internet Duty Free also plans to implement a virtual reality (VR) tool allowing customers to view the boutique in 360 degrees without physically needing to visit the store. Kering Eyewear’s luxury portfolio, supplied by Sunshades Eyewear in Australia, comprises several brands including Gucci, Cartier, Saint Laurent, Bottega Veneta, Balenciaga, Montblanc, and MCQ. n
More information, including the names of the faculty, will be available soon.
Theof Optometry.boutiquewill be located in Lotte Duty Free’s store in Busan.
Dry eye is one of the most common ocular surface disorders, with approximately 18 million Americans diagnosed with DED. Inflammation and immunologic processes play a key role in the pathology of the disease.
18 Americansmillionhave
diagnosed
COMPANY SEEKS FDA APPROVAL OF NEW CYCLOSPORINE German ophthalmicnewapproval(FDA),AdministrationFood(NDA)DrughascompanybiopharmaceuticalocularNovaliqlodgedaNewApplicationtotheUSandDrugseekingforacyclosporinesolution for dry eye disease (DED).Theproduct, called CyclASol, has demonstrated in two pivotal studies fast onset of therapeutic effect in the indication, clinical meaningful improvement of ocular surface damage, and excellent tolerability, the company stated. Results from a 12-month long-term study confirmed that the effects are maintained, and even improved for most sign and symptom endpoints.
Luxury brand Kering Eyewear has launched its first store in South Korea, which has become its largest retail presence in Asia. Located on the eighth floor of Lotte Duty Free’s store in Busan, the boutique features a giant media wall showcasing new products.
The WCO and Alcon dry eye disease initiative will feature the collected insights of several world-renowned opinion leaders, and a simplification of the latest research covering different aspects of related, easy-to-implement educational materials.DrCarla Mack, global head of professional affairs for Alcon, said the impact of dry eye on quality of life is comparable to other disabling conditions, and even mild to moderate dry eye can reduce quality of life.
Novaliq, which produces the Novatears range supplied by AFT Pharmaceuticals in Australia and New Zealand, is producing ocular therapeutics based on its pioneering water-free technology called EyeSol.“Thisis the first submission of a novel product category of water-free topical drug therapies utilising EyeSol as a drug carrier,” Novaliq CEO Mr Christian Roesky said. “CyclASol is a first-of-a-kind drug therapy and aims to expand treatment success for patients with dry eye disease and their eyecare professionals. If approved by the FDA, CyclASol addresses important unmet medical needs in DED through its ocular surface healing effect combined with high comfort of administration.”
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“We are very proud to see another product rapidly moving to the market, which marks yet another important inflection point and milestone in Novaliq’s growth trajectory,” Dr Mathias Hothum, board member and managing director of dievini, said.
“By raising the conversation around dry eye, the eyecare community can collectively improve outcomes from a condition that can significantly affect people’s vision and lives.”
24 INSIGHT September 2022 INTERNATIONAL
“We’ve joined forces with the World Council of Optometry to bring the leading experts in the field and the latest science to the forefront. We’re excited to help more optometrists access the latest data and world-class faculty so that more patients who suffer from dry eye disease find treatment and relief.”
Some been DED.
KERING EYEWEAR OPENS FIRST SOUTH KOREA STORE DRY EYE EDUCATION PARTNERSHIP TO SUPPORT OPTOMETRISTS
The World Council of Optometry (WCO) and Alcon have partnered to form a global, evidence-based dry eye disease education initiative designed to raise optometrists’ understanding of dry eye prevalence, diagnosis, and practical management.Dryeyedisease reportedly impacts 1.4 billion people worldwide and is becoming more prevalent in line with factors such as increasing use of technology, environmental triggers, and an aging Unveiledpopulation.duringJuly, which is Dry Eye Awareness Month, WCO president, Australia’s Associate Professor Peter Hendicott, said it was the ideal launching point for the year-long program.
“We are excited to partner with Alcon in supporting the education of optometrists globally about practical measures to better address dry eye, a condition that without proper diagnosis and treatment can lead to ocular surface disease,” he said.
6%
In March, in direct response to a challenge set by International Women’s Day 2022 to #BreakTheBias, OA invited members to provide feedback on their experiences with gender bias, discrimination, harassing and/or aggressive behaviour in the workplace.
Almost 320 optometrists completed the survey, offering a snapshot of this type of behaviour within the profession.
“Over the coming months, we are committed to working with [members] to create thenecessary tools, policies, education and training that will help our profession to challenge bias and promote cultures of inclusion within our sector,” the organisation stated.
She said OA would roll out a suite of customised resources and tools suitable for employees and employers in their practice. It has engaged HR lawyers to develop a range of resources such as sample policies.
INSIGHT September 2022 25 REPORT
“We are also developing a specific section of our website so that you will have access to all these tools at the click of a mouse.” n
“These new resources will be designed to provide you with the information you need to make your workplace safer, and to help you reduce the uncertainty about how best to respond. They will supplement those resources already available to all members such as our flexible workplace and career and employment guides.
KEY FINDINGS • Are all genders in optometry treated equally? 45% disagreed 13% neither agreed or disagreed • Should
“We will also produce a range of patient-facing campaign materials and deliver webinars and tips to help you navigate this complex area,” Brodie said to OA members.
take on
27%
•
70%
Concerningly, 15% have experienced physical abuse once or sometimes, and 70% feel uncomfortable when spending time in a darkened consulting room with patients of another gender.
Asked if transitioning back into the workforce following a career break, such as parental leave, is well supported in optometry, 40% agreed and 27% disagreed.Fifty-fiveper cent encountered insulting or offensive terms about men or women used in their current or previous workplaces, and 73% have felt that patients have treated them differently because of their gender.
While there were some encouraging results within the report, Optometry Australia said a number of them indicated more work was needed to make optometry workplaces safer for all practice staff.
A new report showing that 64% Australian optometrists surveyed have encountered gender bias, discrimination, harassment and aggressive behaviour in the workplace, with 27% in fear of speaking out about such incidents, is “confronting and unacceptable”, says Optometry Australia (OA).
Other findings showed 45% of respondents disagreed that all genders in optometry were treated equally, with 43% agreeing there is salary parity between genders in optometry (versus 35% disagreed).
Other findings of the organisation’s new #BreakTheBias report also show that while patient behaviour was cited as the most common cause (80%), almost one-third (28%) had experienced some form of bias, discriminatory or aggressive behaviour from a practice owner or manager. The is despite almost two-thirds stating their workplace had a harassment and bullying policy.
Eight per cent fear going to work due to gender bias, discrimination, harassment and/or aggressive behaviour.
OA CEO Ms Lyn Brodie said the organisation was committed to working with optometrists to help drive real long-term change in this area.
OPTOMETRY SURVEY SHEDS LIGHT ON GENDER BIAS, DISCRIMINATION AND HARASSMENT
•
roles? 48% agreed, 42% neither agreed or disagreed • Is there salary parity between genders in optometry? 43% agreed, 35% disagreed • Would
To algin with the global theme for International Women’s Day this year, #BreakTheBias, Optometry Australia sought to better understand areas where gender bias exists within optometry – and there were some alarming findings. there be more opportunities in optometry for women to leadership speaking out on gender bias, discrimination, harassment and/or aggression damage your chances of career progression? said yes Have you encountered insulting or offensive terms about men or women being used in your current or previous workplaces? have encountered it often, 49% have encountered it sometimes. Do you feel uncomfortable when you have to spend time in a darkened consulting room with patients of another gender? said yes. Eight per cent of respondents feared going to work due to gender bias, discrimination, harassment and/or aggressive behaviour.
“Around 65% of Australian and New Zealand ophthalmologists agreed that anthropogenic climate change is a public health issue requiring urgent mitigation,” Gale says.
Bag of waste after a single cataract surgery in New Zealand. Dr Jesse Gale
Image:
In ophthalmology, cataract surgery is a major cause of carbon emissions and waste, from single-use disposable equipment to energy use in the facility itself. RHIANNON BOWMAN speaks to three surgeons who are implementing more sustainable practices.
They are jointly behind an app currently in development, known as Eyefficiency, designed to measure the triple bottom line.
“And a similar percentage agreed that public health systems should have sustainability as a performance indicator.” Gale, who spoke on a sustainable future for ophthalmology at
“In healthcare, the biggest contributors to carbon emissions are energy (heating and cooling especially) and transport (of patients, staff and supplies).
F or Dr Jesse Gale, decarbonising the healthcare system is not a matter of if, but when. A general ophthalmologist with specialist expertise in cataract surgery, glaucoma and neuro-ophthalmology, Gale is a consultant at Capital Eye Specialists in New Zealand’s capital, Wellington, and a senior clinical lecturer at the city’s University of Otago campus. In 2021, he was appointed inaugural chair of RANZCO’s Sustainability Committee, formed following the launch of the college’s Sustainability Charter. Prior to his appointment, Gale co-authored two papers, published in RANZCO journal Clinical and Experimental Ophthalmology on Australian and New Zealand ophthalmologists’ opinions on climate and sustainability.
The coalition includes Dr Cassandra Thiel of NYU, London ophthalmologist Dr Peter Thomas and Dr Andrew Cassels-Brown who also acts as medical director of the Fred Hollows Foundation.
26 INSIGHT September 2022 SUSTAINABILITY
“It collects data on throughput and efficiency, which is interesting to surgeons and managers, but has also been designed to collect and calculate information on travel, energy use, and procurement to provide a carbon footprint,” Gale says. Gale recently led a project using the Eyefficiency methods to measure the carbon footprint of cataract surgery in six public and private hospitals in Wellington. The project’s outcomes were published in the New Zealand Medical Journal in September 2021.
RANZCO’s virtual congress in February, is also part of a broader coalition striving for change.
PERFORMING CATARACT SURGERY … sustainably
INSIGHT September 2022 27
“Wellington’s footprint now is roughly equivalent to Cardiff’s nearly 10 years ago but there is one main difference; New Zealand uses renewable energy. Our greatest source of emissions is procurement and the consumption of single-use supplies, and excessive packaging,” Gale says.
In a letter to the editor published in Clinical and Experimental Ophthalmology in January, Gale explained how he and three colleagues estimated the carbon footprint of 226 intravitreal injections at four public injection-only clinics in the Wellington region.
PUBLIC HEALTH PROBLEM SPARKS OPPORTUNITY
Gowns and drapes packaging can be a major source of waste in cataract surgery.
He says some of his colleagues on RANZCO’s Sustainability Committee were disappointed to discover that some ophthalmologists were using large and expensive single-use drapes to cover the patient’s whole body, for cataract surgery.
“Next we’re doing a survey of ophthalmologists across Australia on the equipment they are using for anti-VEGF injections. It seems there is quite a variety of techniques been used, ranging from minimalist injections in the clinic chair with very little equipment, to elaborate use of sterile supplies in the operating theatre.”
Hamilton Eye Clinic has 10 consultants plus support staff, in a standalone
By comparison, the carbon footprint of cataract surgery in Cardiff, UK, was estimated to be 182kg CO2e (measured in 2013, and including travel for postoperative visits), whereas the footprint at the Avarind Eye Care System of Southern India was only 6kg CO2e (in 2014).
Renewable energy (predominantly hydro) accounts for 82% of New Zealand’s energy supply, compared to only 47% of the UK’s, according to Gale’s report. It named surgical supplies such as gauze, dressings, gowns and gloves, blades, lens implants, tubing and tips as contributing to emissions from procurement (83%).
McKelvie is a consultant ophthalmologist with subspecialist fellowship training in cornea, anterior segment, cataract and refractive surgery. He is a consultant at Hamilton Eye Clinic, Waikato District Health Board, and the University of Auckland.
Measuring the carbon footprint of cataract surgery in Wellington has helped Gale steer RANZCO’s Sustainability Committee’s Preferred Practice Guidelines for improved sustainability, launched on Earth Day (22 April 2022).
“We only need the drape to cover the face to prevent contamination of the field. We hope surgeons would consider using the smallest, lightest drape, or even a re-usable drape. Another waste-saving idea is to use a topical anaesthetic instead of injecting, to avoid using extra syringes and discarded pharmaceuticals,” he says.
“Reducing carbon can save money and improve public health. The Preferred Practice Guidelines, which have been approved by RANZCO’s board, detail what ophthalmology operating theatres can implement immediately, such as stop administering unnecessary medications, without compromising patient care,” Gale says. “Cataract surgery patients are often prescribed post-operative topical antibiotics as well as topical steroid, but some large registries have found the antibiotics makes no difference to the rate of serious infections, when antibiotics are given inside the eye during surgery.
Gale is now turning his attention to measuring the carbon footprint of intravitreal injections.
Further north in New Zealand, in the Waikato region, ophthalmologist Dr James McKelvie is following in Gale’s footsteps.
“I’m interested in innovation. I attended RANZCO’s congress in Christchurch last year and heard Dr [Jesse] Gale speaking, and was inspired by his message of sustainability,” McKelvie says.
“Afterward, I spoke to co-ordinators in the Waikato region’s private and public hospitals because I wanted to measure the region’s carbon footprint. They were enthused for the first few weeks, contacting their suppliers as a first step. But I found that the more I asked, the less interested suppliers were. It soon fell into the ‘too hard’ basket and it came to a dead end for a number of suppliers,” he says. That experience led McKelvie to reconsider his approach.
“I thought maybe I should start with only private clinics. I went back to smaller suppliers and said this – sustainability – will be a big issue in the future, so work with me. There are other benefits besides the obvious benefit to the environment, and I found the smaller players were motivated. We tried hard and did a lot of work on CO2 emissions associated with supply chains,” McKelvie says. As he recalls, Gale’s report on the carbon footprint of cataract surgery in Wellington was published around this time. Inspired, he convinced his colleagues at Hamilton Eye Clinic to look at the clinic’s own carbon footprint.
“OUR GREATEST SOURCE OF EMISSIONS IS PROCUREMENT AND THE CONSUMPTION OF SINGLEUSE SUPPLIES” DR JESSE GALE CAPITAL EYE SPECIALISTS
McKelvie is also CEO of CatTrax, an award-winning health IT company designed to improve visual outcomes following cataract surgery. The technology will soon be available in Australia.
“Each bottle of topical antibiotics costs only around $1. By ‘stopping the drop’, clinics can save on shipping and packaging costs too. It’s an important first step, even if it’s a small step. Our message to surgeons is to consider what you’re using, and don’t use what you don’t need.”
Wellington’s cataract carbon footprint was estimated to be 152kg of carbon dioxide equivalent (CO2e), and the great majority of that footprint was from procurement of surgical supplies and medications.”
Gale hopes to use differences in techniques to guide the development of preferred practice guidelines to reduce waste in giving intravitreal injections.
“The term ‘Green Clinic’ applied to a review of how our consulting clinic – Eye Surgery Consultants in East Melbourne – was run to reduce its environmental impact by reducing waste and greenhouse gas emissions, and to maximise recycling,” he says. “As part of this, I employed a consultant who looked at energy consumption across the rooms and we then instigated changes to reduce energy consumption overall.”
Beyond the clinic, Loughnan and his wife Jacinta have been rehabilitating a previously drained wetland at Aireys Inlet along Victoria’s Surf Coast and revegetating the area to provide habitat for native animals.
Loughnan is also a visiting medical officer (VMO) with Cura, the largest group of private day hospitals in Australia, which performs 60,000 cataract
“We thought it was an ideal opportunity to try and do things differently, in a more sustainable way. We had developed a sustainable strategy around consumables and reducing use of disposables and medications, and removing anything we could without compromising patient outcomes.”
Image: Dr Jesse Gale
“With what we’ve achieved over this period of time, we hope will make it easy for others to follow,” he says.
“A lot of things were done differently for the 500 cohort. For example, we made the process of patient check-in fully digital, and we re-designed the custom pack of consumables that includes drapes, gowns, syringes and cannulas. We took out everything we didn’t feel was absolutely essential for routine cataract surgery,” he explains.
“It’s a win-win-win situation. It requires bold steps and to challenge your thinking, and admittedly, not everybody was instantly on board, but implementing sustainability measures is beneficial for a number of reasons. We substantially reduced our carbon footprint with the help of Ekos. The clinic was over 200kg CO2e at baseline – we are significantly lower now.”
“Initially, we used Gale’s calculations, or metrics, and similar methods to him (although not the Eyefficiency tool). It was not perfect, but it was a start,” he says.Instead, Hamilton Eye Clinic turned to Ekos, a New Zealand company that helps businesses measure and verify their carbon footprint, then use this footprint measurement to develop and implement a carbon reduction plan and offset carbon emissions that could not be reduced.
He continues: “The cohort meant Hamilton Eye Clinic had a specific contract with a set number of patients and could trial a protocol that reduces the carbon footprint of cataract surgery.”
As a member of RANZCO’s Sustainability Committee, he believes enhancing the sustainability of ophthalmic practice can be best achieved through a strongly science-based approach.
“IT REQUIRES BOLD STEPS AND TO CHALLENGE YOUR THINKING … BUT SUSTAINABILITYIMPLEMENTINGMEASURESISBENEFICIALFORANUMBEROFREASONS” DR JAMES MCKELVIE HAMILTON EYE CLINIC Surgical waste from a single anaesthetic during cataract surgery.
He has previously presented at the RANZCO Annual Congress on ‘The Green Clinic’ and recently co-authored a manuscript on the views of RANZCO fellows and trainees on climate change and sustainability.
McKelvie says anyone wanting more information about how Hamilton Eye Clinic decarbonised cataract surgery can contact him at james.mckelvie@ hamiltoneye.co.nz.
McKelvie says the surgeons involved in the trial of the 500 cataract patients – whose surgery had to be performed in a certain way in order to offset the carbon footprint – were incredibly positive about the experience.
“Fortunately, my colleagues are progressive and supportive, and were on board with auditing the business from a sustainability standpoint and coming up with a strategy to reduce emissions. It was a detailed process, with a number of staff working on it,” McKelvie says.
Although the clinic had not completed surgery on all 500 cataract patients at the time of writing, McKelvie says the trial reduced the overall cost of surgery, and the clinic was able to invest the savings to offer cataract patients better quality lenses instead.
“We’re seeing the trial as a new way of doing cataract surgery. We’re now carbon zero. I believe we’re the first carbon zero ophthalmology provider in NewMcKelvieZealand.”willpresent a one-year update on the clinic’s journey to carbon zero at RANZCO’s New Zealand branch meeting in 2023.
“Waikato Hospital couldn’t perform all public cataract patients in-house and decided to outsource to Hamilton Eye Clinic, sending a cohort of 500 patients to us,” McKelvie says.
28 INSIGHT September 2022 SUSTAINABILITY building about 15-years-old, with two operating theatres and consulting rooms all housed in the same facility.
“We changed the type of anaesthetic we use, so all the patients in the cohort had a topical anaesthetic, which only requires one drop instead of a subtenons set that includes a syringe, and instruments that require sterilisation, and we eliminated most of the eye dressings following surgery.
Ekos certified Hamilton Eye Clinic as carbon zero within 12 months.
“Having seen first-hand the benefits of the trial, one of the surgeons has told me they have changed the way they perform cataract surgery on their private list of patients, because it can be done environmentally sustainably in a structured and safe way, and still get great results.”
Coincidentally, when Ekos delivered the report, a unique opportunity to test the clinic’s proposed carbon reduction plan arose.
LEADING BY EXAMPLE Dr Michael Loughnan, a surgeon at Eye Surgery Consultants in East Melbourne, has a long-standing interest in issues surrounding sustainability and the environment.
“First, generally speaking, sustainability and cost has not been seriously considered. Second, there is the concept that ‘single-use’ surgery will be better and/or safer – but there is almost no evidence to support that,” he says.
Loughnan is chairman of Cura’s Sustainability Committee.
Within Cura, three of the group’s 26 hospital sites have been reviewing their processes, including admissions, nursing, capital expenditure, and anaesthesiology, with an eye on sustainability.
“We’re looking to make it more sustainable, and we’re doing it in a collegiate manner. We don’t want a talkfest,” Loughnan explains. “Each month or two we assess a practical item, this instead of that. For example, we’ve started using a sterile kidney dish, made of sugar cane, which is biodegradable, instead of a plastic kidney dish. We’re looking at practical, straight-forward measures that can be easily implemented and the quality of patient care is not compromised.”
The three Cura sites taking part in the review have also opted not to use an anaesthetic block for cataract surgery patients. Loughnan says that by eliminating the needle, they eliminate risk, as well as waste, which also strips cost.
operations per year across its 26 sites nationwide.
“As James [McKelvie] demonstrates, the typical model for cataract surgery is notably wasteful. By controlling or reducing waste, you can reduce cost, and then invest money elsewhere,” Loughnan says.
“We’re trying to make surgery more sustainable. We want to reduce greenhouse gases, and reduce waste, particularly medical landfill, and cut the cost of surgery. Medical Consumer Price Index (CPI) runs several percentage points higher than general CPI. With wage increases, eventually surgery will be economically unsustainable,” Loughnan says. He believes wasteful practices have become accepted as the norm in cataract surgery for two reasons.
“Change is challenging in our profession. We’re in a period when change is everywhere, it’s constant. RANZCO’s Sustainability Committee’s role is to make it easier for surgeons to adjust.”
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“THERE IS THE CONCEPT THAT ‘SINGLE-USE’ SURGERY WILL BE BETTER AND/ OR SAFER – BUT THERE IS ALMOST NO EVIDENCE TO SUPPORT THAT” DR MICHAEL LOUGHNAN EYE CONSULTANTSSURGERY
“We want surgeons to pause and ask themselves, do they need to open a single-use drape, for example. The guidelines are there for surgeons who wish to change their approach to surgery. It gives them guidance and support. It’s an evaluated policy of best-practice, for the patient and the environment, for the surgeon seeking to change but looking for evidence to go by,” he says.
He says RANZCO’s Sustainability Committee’s Preferred Practice Guidelines are designed to get ophthalmologists thinking about their systems and processes in terms of waste and recycling – and crucially, what they can easily change.
OCCUPATIONAL LENSES:
• Hoyalux WorkSmart Room is an entry-level occupational lens with a distance range up to four metres, enabling the wearer to switch effortlessly between their computer screen and keyboard, while having a clear overview of their desk all day long. It offers swim and sway reduction and a stable image perception in a dynamic environment.
As a result, Hentschel says the category has been calling for a more simplified portfolio with obvious positions such as: good, better, best. There’s also the need to provide clear differences between occupational lenses and PALs and for practices to have a second pair strategy that is going to benefit the right HOYA’spatients.newoccupational lens range, which replaces its previous indoor designs, seeks to overcome these challenges, with key features including:
Several factors have prevented occupational lenses from realising their full potential, but a portfolio recently launched in Australia is helping optical practices approach the category in a whole new way. T general public (57% in one survey), yet data shows it has lagged behind in terms of market penetration at around 3-4%.
30 INSIGHT September 2022 LENSES
• Although you do not need any correction for far vision, do you feel that your current reading glasses are able to provide good vision for intermediate distance?
orkStyle 3 is a premium lens designed for the clearest, most comfortable and natural vision when switching between different digital devices at the near to far intermediate distances up to one, two or six metres. It is available in three individual designs (Close, Screen, Space) based on visual preferences. It is equipped with premium trademarked Binocular Harmonization Technology verified with HOYA’s Binocular Eye Model and AdaptEase technology for wider fields of vision.
lenses differ from progressive addition lenses (PALs) with unlimited powers that generally provide clear vision to the wearer in the intermediate to near range. On the other hand, PALs gradually progress from far to near, with the intermediate section said to be more of a by-product of the lens design.
But with increasing demands on near and intermediate vision due to changing work environments and more time spent indoors, lens manufacturers like HOYA are developing more advanced designs to meet this new challenge and supporting optical practices to communicate the benefits toOccupationalpatients.
• Have you been irritated by visual discomfort, unnatural posture or eyestrain due to prolonged near work?
HOYA Lens Australia national training and development manager Mr Ulli Hentschel says some key barriers have held back the occupational lens category. But new insights have informed the company’s new occupational lens portfolio launched in July 2022, comprising Hoyalux iD WorkStyle 3, Hoyalux WorkStyle Business, Hoyalux WorkSmart Room and the SUPEREADER.“Somekeybarriers and implications we have seen in occupational lenses, among eyecare professionals, include confusion over which lens is appropriate for each scenario – it’s been too complicated,” he explains.
• Would you enjoy the convenience of moving around indoors without having to remove your reading glasses?
• Could you see a benefit from having lenses that are specially designed to cater to your specific visual needs and working distance?
• Just like shoes, occupational lenses have different designs for different functions and activities.
No longer the hard sell
“Some are also unfamiliar with the difference between PAL and occupational lenses and therefore lack the confidence to sell them, and there’s also a concern of being perceived as delivering the ‘hard sell’ for a second pair to regular customers. Among patients, there’s a lack of awareness about occupational lenses compared to other lens types, and an expectation that PALs will be an all-in-one spectacle, hence there is no need for another pair.”
orkStyle Business is a mid-tier solution for progressive lens wearers who would like wide vision areas when working on near and intermediate vision distances, up to two or four metres. It includes View Xpansion technology which maximises the visual fields to the periphery of the lenses and offers swim and sway reduction.
HOYA launched a new range of occupational lenses in July 2022.
• SUPEREADER is designed for heavy readers. This lens offers support at near distances and is said to have a much better depth than ordinary reading lenses. It includes Quic focus technology, providing natural head posture for less head rotation for near work.
HELPFUL QUESTIONS TO ASK CUSTOMERS
A SECOND PAIR STRATEGY
While there’s a common perception occupational lenses are a second pair product, Hentschel says some practices might want to think about it another“Dependingway. on the person, you could argue that an occupational lens, in fact, should be the primary pair, and the progressive lens could be the second pair. That’s because a lot of people are spending the majority of their day sitting in front of a screen,” he says. “And then when you're driving home, maybe from work or going out to the shops, you may not need to have the most advanced progressive lens, so having a more advanced occupational lens may actually be of more benefit to that person.” n
generally provide clear vision
Everyoneisinvited
In Australia, Hentschel says traditionally either premium or basic-level occupational lenses have been offered, which has excluded a portion of the market.That’s why HOYA has released a new mid-tier product (Hoyalux WorkStyle Business) that is financially more palatable, while including lens technology that’s sits just below the company’s new premium offering (Hoyalux iD WorkStyle 3).
SPEAKERSKEYNOTE ABRAHAMKEITH MCCARTERKATRINA ALCOTTDYLAN AO GOREAMANDA SAMMARTINOSTEVE Register at optom.provision.com.au/conference LOOK FORWARD ProVision National Conference Melbourne 21-23 October 2022 Occupational lenses differ from progressive lenses, with unlimited powers
the wearer in the intermediate to near range. Image: HOYA Lens Australia.
“This means if someone is prescribed progressive spectacles, and is then sold a more affordable version of our occupational lenses, they're still going to get the benefit from it. And then maybe next year, they will be tempted to try the premium version,” he explains. When explaining occupation lenses to patients, Hentschel says it’s important to understand the customer’s visual requirements, asking openended questions about what sort of screens they use for work (laptops are the most common work-from-home device), and whether they were experiencing discomfort in their neck and back, or headaches and eyestrain. Another key question could be to ask if they spend more than two hours indoors stationary behind a screen daily.
The company recently held a continuing professional development session with Optical Dispensers Australia to explain these methods in more detail. It has also developed a range of consumer brochures, desk mats, posters, fact sheets with easy-to-follow graphics that allow practices can clearly demonstrate the benefits of each HOYA occupational lens type.
For the first time in our 30+ year history, we’re giving Members, Non-Member Optometrists and Optometry Students alike the opportunity to experience this not-to-be missed biennial event showcasing the very best that independent optometry has to offer. that to
“And then you can use that information to drill down into what type of lenses they are using for screen use. And that's really important, because we have a range of different lenses that people can select from, that will suit various tasks.”
The correct terminology should be used to avoid any misunderstandings, Daras says, who has been in the optical industry since the 1970s and is currently course coordinator of Certificate IV in Optical Dispensing at TAFE NSW. He is the longest serving optical dispensing teacher in Australia, and second longest in the world, second only to Professor Mo Jalie. He says early iterations of degressive lenses were known as enhanced readers or extended focus readers.
“These can range from single vision lenses prescribed for a set working distance, to other lens types like occupational versions of bifocal and trifocal designs, starting with the first occupational multifocal designs being the executive bifocal and trifocal lenses, followed by flat-top (or D-seg) bifocal and trifocal lens designs.”
32 INSIGHT September 2022 LENSES
And if practices are still recommending outdated occupational-style lenses – still popular with many practitioners as a security blanket – then patients, and practices, are losing out, dispensing expert Mr Steven Daras
He continues: “These days a lot of people in our industry use the term occupational lenses to mean degressive lenses which are reading lenses that progressively weaken (or degress) by a certain power (or shift) as the wearer looks up the lens from the reading area. These give far more generous intermediate zones, being much wider and longer than progressive lenses.”
Beforesays.discussing how the latest occupational lenses can generate capital growth for eyecare practices, Daras clarifies a common misunderstanding.“’Occupationallenses’
As the workforce has migrated to working from home and adapted to multi-screen computers, clear vision at arm’s length – but much wider – is needed, presenting an industry-wide opportunity.
HOW OCCUPATIONAL LENSES ARE hitting the sweet spot
Occupational lenses are experiencing a renaissance, as advances in technology have resulted in newer lens designs that provide advantages their predecessors did not.
is an umbrella term that covers all lenses specifically prescribed to allow someone to see clearly to do their ‘work’, be it occupation, vocation, or hobby,” Daras, a director of the Australian Dispensing Opticians Association (ADOA), explains.
“We now have occupational degressive lenses that allow further vision than the original degressive shifts. Most major lens manufacturers have ‘families’ of occupational degressive lenses and continually spend
Designed to meet demand as people spend increasingly more time on digital devices both at home and work, each lens in the new range has its own unique attributes, allowing eyecare professionals to customise a solution that fits each wearer’s needs.
“Younger people can usually accommodate from one distance to another, but older people aren’t so fortunate. Anyone suffering from presbyopia would benefit from at least an enhanced reader, even if they do have some accommodation left, as these are far better than single vision reading lenses,” Daras says.
“For example, one lens manufacturer offers an online office lens range selector where practitioners can input data on the required visual range and prescription and get a tailored lens recommendation of that company’s office lenses for that person’s visual needs.”
“We need to educate the public in this as a high percentage of consumers do not know there are special lenses available for them. That’s an industry-wide opportunity for optical dispensers to create a dispensing plan.”During COVID-19 lockdown, Daras points out, many people learnt to work from home and in doing so, many adapted to multi-screen PCs.
“Then there are the longer intra-room lenses that allow vision from near at 40cm up to four or five metres, depending on the prescription, that allow people to glance around their office. These do not provide full distance vision and should not be used as a distance correction. They give wide stable intermediate (computer use) and near, more so than progressive lenses,” Daras says.
“The moment we introduce the distance prescription into the lens, it drastically changes the front lens geometry, and intermediate and near areas are greatly reduced. Progressives are a great all-rounder, and you may wear them at the computer, but they won’t be good over a long period of time,” Daras says, just as shoes worn in the workplace won’t be comfortable on the hockey pitch.
“IT’S ABOUT BREAKING DOWN THE STIGMA THAT AN OCCUPATIONAL LENS ISN’T ONE OR THE OTHER – SINGLE VISION OR PROGRESSIVE –IT’S A THIRD OPTION” BONITA EASON EVOLVE OPTOMETRY
For Daras, who ran an independent practice for 16 years, any eyecare professional who is looking after the wellbeing of their patients will advise them that their varied visual needs require specific help. This means certain lenses for certain tasks. He uses a shoe analogy to demonstrate his point.
“Students, high school but more so university students, whose distance vision might be perfect, often need accommodation for reading. If they only opt for a straight pair of reading glasses, for example, they’re going to miss out on being able to look up and see a lecturer or whiteboard clearly, so an occupational lens is popular for this cohort,” Eason says. “THIS IS AN AREA WHERE MOST PRACTICES CAN GENERATE GROWTH AS VERY FEW PEOPLE ARE OFFERED DIFFERENT LENSES FOR DIFFERENT TASKS” STEVE DARAS
“However, younger people still put a lot of stress on their accommodative processes looking from the TV to a smartphone. The closer the phone is held, the greater the demand on their accommodation. Anti-fatigue or Digital Assistance Lenses (DAL) are ideal for people under 40 in this case, and you could include viewing a gaming console here. DALs have a distance portion and very weak adds and not much progression, so they’re more like a bifocal than a progressive lens. However, they help younger people by taking the strain or stress away from their accommodation.”
With increasing reliance on digital devices from smartphones to tablets, workstation PCs to widescreen flat TVs, Daras says people of all ages need clear vision at different distances.
This means clear vision at arm’s length where greater width is needed, and Daras notes some lenses can offer this better than others. He says everyone who has progressive lenses should also have degressives to suit their visual needs. Good practitioners should also be asking these questions during the eye examination.
In a 2020 study into remote work, McKinsey Global Institute analysed 2,000 tasks, 800 jobs, across nine countries, and found the finance, management, professional services, and information sectors have the highest potential for remote work. Not surprisingly, activities with the highest potential for remote work included interacting with computers.
Ms Bonita (Bonnie) Eason is practice manager at Evolve Optometry’s Batemans Bay and Ulladulla practices, and an advisory board member of Optical Dispensers Australia. Eason completed a degree in fashion design before moving into the optical industry as a dispenser and progressing into the role of practice manager.
“When I ask my students how many shoes they have, the response is usually six pairs or more (male students) and 12 pairs or more (female students). They understand that one pair might be comfortable to wear at work but may not be suitable for playing hockey. You need to wear something more appropriate for that activity. The same applies with lenses; while progressive lenses are a great all-rounder, they are not specifically designed for computer and other digital device use,” Daras says.
“This is an area where most practices can generate growth as very few people are offered different lenses for different tasks. Most get a pair of progressives and a pair of readers, when there are better alternatives,” he says.Occupational degressive lenses (or families of degressive lenses) generally range from 40 to 70cm, suitable for working on a laptop, to 40 to 100cm, suitable for a typical workplace desktop PC workstation.
BREAKING DOWN THE STIGMA
She says the occupational lens market has grown in response to changing work and study environments as a result of COVID-19, and as lens technology improves, occupational lenses are becoming a more popular type of vision correction.
In July, HOYA Vision Care launched a new range of occupational lenses, replacing its previous indoor designs, which help to improve the wearer’s vision comfort and ergonomic posture, allowing them to work or focus on near and intermediate vision areas in a more relaxed and comfortable way.
ADOA has a short education module on occupational lenses, accessible to members only. For more information, visit www.adoa.com.au.
INSIGHT September 2022 33 on research and development to improve their product offerings in this competitive field,” Daras explains.
TAFE NSW/ADOA
Ms Catherine Leetch is practice manager at Eyescan, an independently owned practice established in 2010 by ophthalmologist Dr Harry Unger, which provides ophthalmology and optometry services.
Leetch joined Eyescan, located in Melbourne’s Toorak Village, as an optical dispenser after moving from Sydney five months ago, and recently stepped into the practice manager role. She agrees with Daras and Eason that occupational lenses have come New working from home arrangements due to the pandemic has increased demand for occupational lenses.
“In general, if you’re wearing progressive lenses while working at a computer, you tend to find you have to put yourself in an uncomfortable position to see the screen clearly. Recent analysis has shown a lot of people are straining or suffering back problems because, with progressives, you tend to tilt your head back to try and focus your vision in the intermediate zone,” Eason says.
“If a patient is coming in and saying, ‘I’m straining to see the computer screen’, or ‘I’m having trouble seeing the TV and trying to read’ you can start a conversation about the benefits of occupational lenses. If an optometrist starts the conversation in a consultation, they’re more likely to get more of an insight into why that may be the case. Following the handover between optometrist and dispenser, a dispenser can really pinpoint what sort of distance clarity they need, whether it’s for up-close work, or looking at their computer screen, or if they want to look across the room. It is really important to ask those questions.”
Eason says patients wearing occupational lenses are reporting less eye fatigue, eye strain and headaches because they’re getting a much larger space in the intermediate zone that they’ve previously been missing outButon.public awareness of the benefits of occupational lenses is still relatively low.
34 INSIGHT September 2022 LENSES
“They’re also popular among 30- to 55-year-olds, people most commonly working in an office or home office environment, where they’re predominantly needing sharper vision in the intermediate zone. Several different occupational lens designs are becoming available, so we’re getting more interest from different segments in the community.”
“Or, if you’re wearing single vision lenses or readers, you’re probably getting way too close to your computer screen. With the increase in working from home and online learning, a lot more people are wanting to be more comfortable and more productive, and therefore more willing to spend money to achieve that.”
“It’s about breaking down the stigma that an occupational lens isn’t one or the other – single vision or progressive – it’s a third option. I like to explain to patients that when wearing this type of lens at their computer, they’re going to be able to look up from their screen and see, in focus, the lecturer, or they will be able to see in focus a few metres away without compromising their computer-distance vision. If they’re working at a desk and someone walks by, they’re going to be able to see them clearly – but they’re not going to be able to drive a car, because their distance vision will be Easonblurry.”saysMarchon, Shamir, Opticare, Zeiss, Hoya, Rodenstock and Essilor are just some of the lens manufacturers releasing new and improved occupational lenses, more customisable than previous generations.“Previously, you might have had a couple of options where there were set shifts that you had to determine, whereas now we’re getting greater choice and can tweak the shift, whether it’s optimised for looking at a phone, at a screen, or looking a few metres away,” she says.
START WITH THE END RESULT
“I think a lot of patients coming into the practice automatically think that option isn’t there or are confused about what it is, exactly. Some of the language around lenses can be a little confusing, so you want to make it as simple as possible, in a way that they can understand without being too confused,” Eason says.
Eason says the main benefit of occupational lenses is clearer vision in the intermediate zone, something lacking in single vision and progressive lenses, which pays dividends for screen-based activities.
“Now, patients are more open to being shown lenses that fulfil all their visual needs. It’s about finding out exactly what the patient wants the end result to be, and then demonstrating how an occupational lens in addition to a progressive lens can achieve that end result.”
At G&M we have several opportunities for Optometrists looking to leave the hustle and bustle of the city and head to more relaxing regional locations.
“Historically, I think patients would opt for a full progressive lens, thinking it will provide clear vision evenly, but now, particularly with the rise of the work-from-home environment, and living in a digital age, people have realised there has to be something better out there,” she says.
OPTING FOR FREQUENTLYLENSESOCCUPATIONALFARMORENOWBECAUSETHEY’RESEEINGTHEBENEFITSTHATWEREN’TTHEREINTHEPAST”
“From a dispenser’s point of view, I think we have to know what a patient wants the end result to be, and then explain what lenses we can provide, and their limitations and benefits, such as eliminating tense shoulders or neck strain or eye strain a patient may be experiencing when they’re trying to find the sweet spot looking at their computer screen wearing a full progressive lens.”
to the fore as workplace and lifestyle circumstances have changed.
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“It’s about educating them that the best solution might not be what they had assumed, and setting an expectation, so they’re clear on what product – or products – they’re going to receive,” she says.
“You can explain that a progressive lens will be fine to wear on the weekend, to pop into the shops, to drive, to do a bit of everything. But when working, an occupational lens is going to provide the clearest vision. We know everyone – young, old, in between – if they have a higher reading add, they’re really going to struggle wearing a full progressive lens for computer use. They would benefit from purchasing both a progressive lens and an occupational lens,” she says.
“As the retirement age is changing, generally people are working longer, and we’re seeing people opting for occupational lenses far more frequently now because they’re seeing the benefits that weren’t there in the past, and it wasn’t something big in the industry,” Leetch says.
CATHERINE LEETCH EYESCAN
opportunities@georgeandmatilda.com.auTimetogetoutoftheratrace!
“Start with what they want the end result to be, base your recommendations on their expectations, and explain fully the limitations they may experience if they only purchase one lens, such as a progressive.“It’snotahard sell, it’s a matter of explaining how an occupational lens is going to benefit them, in achieving their desired result. And that’s going to be something that helps maintain those patients because they feel like you listened.” SEEING PEOPLE
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Leetch says younger presbyopia patients, who may associate progressive lenses with ageing, are often more receptive to occupational lenses.
n “WE’RE
Leetch says the optical profession can’t expect patients to know in detail how lenses work or the range of options available or subtle differences between lenses in the same range.
At the completion of this CPD activity, optometrists will have developed their knowledge of pathologies mistaken for glaucoma.
FACO
Vision
CPD 36 INSIGHT September 2022 Figures
With glaucoma on the rise, clinicians are increasingly finding that even with the latest technology, true diagnosis remains stubbornly difficult. As the authors point out, the diagnosis gets even harder when other pathologies masquerade as glaucoma.
D ifferentiating visual field defects caused by non-arteritic anterior ischaemic optic neuropathy (NAION) from those caused by unilateral glaucoma can often be difficult in subtle and longstanding cases. The classical altitudinal field defect noted with NAION may be only partial, and therefore difficult to distinguish from an arcuate scotoma characteristic of glaucoma. Furthermore, patients may have overlapping background risk factors such as sleep apnoea or nocturnal hypotension.
UNILATERAL GLAUCOMA OR HISTORIC NON-ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY (NAION)?
Knox,
LEARNING OBJECTIVES: ABOUT
Differentiating between NAION and unilateral glaucoma is important as the management is very different. Glaucoma often requires lifelong treatment and follow-up, which is costly, time consuming and sometimes associated with local and systemic side effects. On the other hand, there is no proven treatment forThisNAION.case report discusses the potential future benefit of the use of optical coherence tomography angiography (OCT-A) in the diagnosis of NAION. Also, it emphasises the importance of a visual field assessment on initial presentation to the optometrist or ophthalmologist.
• Recognise differentiating clinical features between NAION and unilateral glaucoma
• Know the symptoms and features that distinguish NAION from Giant cell artertis (GCA) THE AUTHORS: Dr Lewis Levitz FRANZCO FRCSEd FCS(SA)Ophth MMed MBBCH Eye Institute, Melbourne Leanne Nguyen BOptom, PostGradDipAdvClinOptom, PostGradCertOcTher, Specsavers Melbourne Australian College of Optometry, Melbourne Co-authors: Z Kurtz (BOptom Specsavers Epping, Melbourne), D Levitz (Monash Medical School) 1A and 1B. Patient’s right visual field (Figure 1A) showed what appeared to be a larger superior arcuate scotoma close to fixation. The left visual field (Figure 1B) was normal.
• Review some of the symptoms and features of NAION in a presenting patient
• Understand the role that OCT-A has in the diagnosis of NAION
Including:
• Swollen optic nerve
Differentiating unilateral glaucoma from a longstanding NAION can be challenging. Many of the risk factors are similar, including sleep apnoea and nocturnal hypotension and hypoxemia of the optic nerve.5,6
Colour vision loss in keeping with visual acuity
• Normal ocular motility
CASE REPORT
WHY UNILATERAL GLAUCOMA WAS SUSPECTED OCT performed at the time showed thinning in the inferior retinal nerve fibre layer in the right eye. This was consistent with the visual field loss. Disc asymmetry was noted, with cup-disc ratios of 0.7 in the right eye and 0.6 in the left eye. In light of all of these findings, a diagnosis of glaucoma was considered.
• Crowded optic disc in fellow eye: ‘Disc at risk’
Normal anterior segment examination with normal ocular Altitudinalmotilityfield defect
• Sudden unilateral painless visual loss
Table 1. The main features of non-arteritic anterior ischaemic optic neuropathy (NAION).
FINDINGS Visual acuities were measured as 6/6 in each eye. His intraocular pressure measured 17mmHg in both eyes. His visual fields were repeated (Figures 1A and 1B) and OCT (Figure 2) and OCT-A (Figure 3) exams were performed. A combined report was generated on the proprietary software (Figure 5).
• Relative afferent pupil defect
• Normal anterior eye examination
DISTINGUISHING NAION FROM UNILATERAL GLAUCOMA
September 2022 37
Diagnostic features suggest of NAION
The prompt referral of the patient by the original optometrist in 2015 allowed for the visualisation of the swollen optic nerve. This information was critical in supporting the diagnosis in 2022, especially because the patient was unaware of their visual field defect. Having the second optometrist re-refer the INSIGHT
Sudden unilateral painless visual loss
At the time, other differential diagnosis included a previous NAION and possibly an old resolved branch retinal vein occlusion (BRVO) or branch retinal artery occlusion (BRAO).1,2 Other causes of pseudo-glaucomatous field loss such as a tilted disc, optic nerve coloboma, retinoschisis and retinal pigment epithelial hyperplasia were ruled out on dilated fundoscopy. OCT-A showed decreased perfusion inferiorly. This can be found in both normal tension glaucoma (NTG) and NAION.3,4 PATIENT HISTORY
Swollen optical nerve
Figure 3. OCT-A showing decreased perfusion inferior to the right optic nerve compared to the left optic nerve.
• Colour vision loss in keeping with visual acuity
Supporting findings
Figure 2. OCT showing thinning of the right inferior retinal nerve fibre layer (RNFL).
• Altitudinal visual field defect
Relative afferent pupil defect
One of the main differentiating clinical features between NAION and glaucoma is that NAION presents with sudden onset of visual loss with a swollen optic nerve while glaucoma presents more insidiously with optic nerve cupping. A swollen nerve is not always found in NAION, as some patients present late when clinical findings relating to an acute insult to the optic nerve have already resolved. The visual field can also look similar with the arcuate scotoma of glaucoma resembling an incomplete altitudinal field loss of NAION.Some of the features of NAION are:
On presentation to the ophthalmologist, the patient stated that he had no history of hypercholesterolaemia, hypertension or diabetes which are risk factors for a retinal vascular occlusion. He did remember seeing an ophthalmologist in 2015, but he could not recall the details of his previous visit.
DIFFERENTIALS IN ADDITION TO UNILATERAL GLAUCOMA
A 62-year old Caucasian male was referred by his optometrist to the ophthalmologist in 2022 following the detection of a right superior visual field defect. The visual field exam was performed by his optometrist due to a suspicious optic nerve appearance on fundoscopy and corresponding abnormal OCT. The referral stated that the patient had a right superior field defect, thinning of his right retinal nerve fibre layer and increased optic nerve cupping of 0.7 in the right eye. The patient’s intraocular pressures were measured at 17mm Hg in the right eye and 19mmHg in the left. There was initial clinical suspicion of unilateral glaucoma affecting his right eye.
Fortunately for our patient, a diagnosis could be made once notes from his original referral were retrieved.Hisprevious notes showed that he was referred by an optometrist to another ophthalmologist seven years earlier in 2015 with a sudden one-week onset of superior visual disturbance in his right eye. This was described by the patient as ‘a shadow with a yellow stripe.’ The optometrist then suspected a right eye retinal detachment. Examination by the ophthalmologist at the time revealed vision of 6/6 in both eyes, no colour vision defect, IOP of 22mmHg both eyes and a right optic nerve which was ‘swollen’ inferiorly. A posterior vitreous detachment was noted in the right eye. OCT at the time showed an elevated right inferior nerve fibre layer (Figure 4). This corresponded with the area of retinal nerve fibre layer loss noted seven years later with the resultant visual field defect (Figure 6). The patient was diagnosed as having had a previous NAION seven years previously which led to the development of the superior visual field defect.
"Disk at risk" - crowded disk
The majority of patients with NAION have small optic discs with small or absent cups. The affected eye presents with optic disc oedema which may be diffuse or localised. There may also be nerve fibre layer haemorrhages. Optic nerve swelling may appear weeks to days before Table 2. Differentiating Non-arteritic anterior ischaemic optic neuropathy from Giant Cell arteritis from GCA 8
New MuscleWeightheadachelosspain
No systemic features
Optic disc hyperaemia and swollen Pale swollen disc ‘Crowded disc’ in other eye Normal disc in fellow eye
Retinal examination usually normal Arteriolar occlusion or cotton wool spots
Figure 4. Initial OCT from 2015 showing swelling of the right inferior retinal nerve fibre layer.
patient seven years later allowed the patient to have an OCT-A scan, which was not available in 2015. OCT-A showed mild decrease in retinal circumpapillary perfusion density3 which may have been more marked if he had suffered from glaucoma. The OCT-A findings strongly suggested a diagnosis of NAION. The patient was referred to his GP for a full physical examination to exclude diabetes and sleep apnoea. NAION is not associated with arterial risk factors for ischaemic vessel disease or smoking, but these, as well as hypertension should be managed if present.1,7 Follow-up after an acute NAION is usually planned at two weeks to review the visual field. This may be done with either the co-managing optometrist or ophthalmologist to ensure no progression of further visual field loss. Vision and visual fields are assessed again at four months. DISCUSSION NAION is thought to be caused by ischaemic damage to the optic nerve. No treatment is currently considered effective, visual improvement is unimpressive and the pathophysiology is largely unknown.7 It usually presents with acute, painless visual loss accompanied by an afferent pupil defect (APD) and disc oedema. Certain risk factors are thought to be associated with NAION and these include diabetes and obstructive sleep apnoea.5
CPD Non-arteritic ischemic optic neuropathy (NAION) Arteritic ischemic optic neuropathy (AION) also known as Giant cell artertis (GCA) No diplopia Diplopia: transient or permanent No scalp tenderness Scalp tenderness
INSIGHT September 2022 39 the visual loss presents, which may suggest an aetiology other than an acute arterial event.
Arteritic ischaemic optic neuropathy (AION), also called Giant cell arteritis (GCA) or temporal arteritis, should also be excluded although the aetiology and clinical findings between AION and NAION differ. Giant cell arteritis may be associated with systemic features such as scalp tenderness, headaches, jaw claudication and polymyalgia rheumatica.8 The infarcted optic disc in GCA is usually elevated, pale and can be associated with cotton wool spots (Table 1).
While GCA is known to be due to arterial occlusion and infection of the prelaminar optic nerve, NAION may be due to obstruction of venules draining from the optic nerve into the central retinal vein. This would explain the hyperaemic appearance of the optic nerve that resolves to leave a relatively preserved disc structure.7,9 It would also explain why NAION occurs in patients with hypoperfusion states such as diabetes and possibly sleep apnoea.
DISTINGUISHING NAION FROM GIANT CELL ARTERITIS In NAION, the degree of colour vision impairment corresponds to the visual acuity deficit.5 The relative sparing of colour vision and the lack of pain on eye movement suggests a diagnosis of NAION rather than optic neuritis.
Figure 6. Swelling of the right inferior RNFL in 2015 resulting in thinning of the RNFL noted in 2022.
Figure 5. Combined report showing correlation between the inferior retinal nerve fibre loss and corresponding superior visual field loss.
People you know.....Products you trust Telephone: (02) 96437888 Toll Free: 1800804331 Email: Website:sales@bocinstruments.com.auwww.bocinstruments.com.au Optomed Aurora IQ • Leader in hand-held Fundus Imaging • Expanded 50 degree field of view • Sleek modern design • Versatile and compact • Clear Fundus & Anterior Eye imaging • High resolution quality display screen • Autofocus and AutoExposure • Integrated image q uality analysis • 9 Internal fixation points f or Peripheral imaging • WLAN or USB connectivity CPD Differentiating between normal tension glaucoma and a previous NAION is difficult. Patients with these two conditions may have overlapping risk factors as both are thought to be associated with optic nerve hypoperfusion. NAION may be caused by transient nonperfusion or hypoperfusion of the optic nerve head.10 The intraocular pressures may be in the same ‘normal’ range for both conditions. The field defects may be similar with a partial altitudinal scotoma of NAION being mistaken for an arcuate scotoma associated with glaucoma. New technology might allow for the differentiation to be easier as our understanding of these two conditions evolve.
In a recent study OCT-A was used to compare the optic nerve morphology in patients with either NAION, NTG or normal subjects matched by age, axial length, and optic disc area.10 Certain parameters, such as lamina cribosa depth and lamina cribosa curvature index were noted to be larger in NTG than in NAION or in healthy optic nerves. Unfortunately, these measurements are not usually reported on OCT or OCT-A. The retinal nerve fibre thickness did not differ between NTG andTheNAION.studyshowed that optic nerve cupping is significantly larger in NTG than in NAION even though the retinal nerve fibre layer (RNFL) loss and visual fields are very similar. The authors postulated that the fundamental pathology between NAION and NTG is different. NAION was considered to be a condition of transient optic nerve head hypoperfusion eventually leading to optic nerve pallor whereas NTG seemed to be due to mechanical stress on the lamina cribosa resulting in optic nerve cupping.10 OCT-A is also being used to differentiate NAION from NTG. Early findings seem to suggest that both NTG and NAION have reduced peripapillary perfusion. The lower perfusion densities in NTG may indicate greater vascular changes in NTG. Patients with NAION should have diabetes, hypertension and hypercholesterolaemia excluded. Patients younger than 40 years should be referred for homocysteine level assessment and to exclude a systemic vasculitis.8 The treatment of NAION is challenging. There are no class one studies showing benefit from either medical or surgical treatments.11 Therapies aimed at secondary prevention of fellow eye involvement in NAION remain of unproven benefit.11 Suggested treatment to try to ‘protect’ the other eye may include treating ocular hypertension and some patients may have aspirin prescribed although there is no evidence of benefit.8
Differentiation unilateral glaucoma from longstanding or subacute NAION may be challenging. For the best patient outcomes, it important that a comprehensive eye examination including colour vision testing, field testing and OCT be conducted on the initial presentation. In the future, there may be a role for OCT-A to distinguish between these two conditions. n
NOTE: Optometry Australia members can scan the QR code or visit the online version of this article at insightnews.com.au/cpd/ to enter their details to have their CPD hours automatically updated to their Learning Plan. Event ID: 90002770.
NOTE: A full list of references can be found in the online version of this article.
A patient with NAION can be advised that the chance of a similar event occurring in the other eye is about 15%12 and the chance of the NAION recurring in the same eye is low (5%).13
CONCLUSION
OCT-A is fast, reproducible and typically takes seconds to complete (compared to five to 10 minutes for a standard FFA).2 This is particularly useful in the paediatric population and those with poor vascular access such as diabetic or elderly patients. It can also be used in pregnant women where traditional invasive FFA is a relative contraindication.3Consequently,it can be frequently repeated and used for both diagnostic and monitoring purposes in the office including in optometry practices,
INSIGHT September 2022 41
DR MALI OKADA explores its benefits and the limitations, as well as conditions where OCT-A provides insight that surpasses traditional optometric imaging devices.
LEARNING
At the completion of this CPD activity, optometrists will understand the clinical utility of optical coherence tomography angiography (OCT-A). Including: • Understand the importance of choosing the appropriate OCT-A scan protocol depending on the pathology in question
• Discern the the benefits of OCT-A technology in comparison to fundus fluorescein angiograms (FFA)
• Recognise the conditions where OCT-A imaging is most clinically-beneficial OBJECTIVES: which are restricted in their ability to do FFA. Aside from ease-of-use, the major advantage of OCT-A is its ability to provide high-resolution detail as well as depth information down to the micron level. It can show the relationship between the vessels to its surrounding tissue architecture through the B-scan slice. Compared to FFA, which typically can only show the superficial capillary plexus (SCP), OCT-A can visualise and separate out the deeper vascular layers as well as
OCT-A IN MACULAR DISORDERS: TIPS, TRICKS AND PRACTICAL CLINICAL USE
ABOUT THE AUTHOR: Dr Mali Okada MMed, FRANZCO Royal Victorian Eye and Ear Hospital, Melbourne, Australia Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia CPD Figures 1A-1E. Comparison of FFA and OCT-A images of the left fundus of the same patient (A), FFA in early venous phase using Optos angiography (B), Zeiss Angioplex 8 x 8 mm OCT-A image of the same area and Zeiss angioplex 6 x 6 mm OCT-A image of the superficial capillary complex (C), Deep capillary plexus (D), and choriocapillaris (E).
CLINICAL CPD HOURS
O phthalmic imaging, specifically retinal imaging technology, has seen remarkable advances over the last two decades. From basic 30-55 degree colour fundus photography and fundus fluorescein angiogram (FFA), clinicians now have access to a suite of multimodal imaging techniques including: optical coherence tomography (OCT), fundus autofluorescence, ultra-wide field 200-degree fundus imaging, and more recently, optical coherence tomography angiography (OCT-A).
In contrast to conventional FFA, OCT-A imaging is non-invasive and because no dye injection is required, risks of allergy or adverse reactions (such as nausea, vomiting and dye extravasation around the cannuala) for the patient are avoided.
Figure 2: Optos wide field colour imaging (A) and fluorescein angiography (B) to 200 degrees field of view.
In particular, OCT-A has been instrumental in allowing repeated non-invasive cross-sectional imaging of the eye. The technology builds upon standard OCT by using motion-contrast scans to produce detailed volumetric maps of both retinal and choroidal microvasculature.1
This activity meets the OBA standardsregistrationforCPD
• Understand the inherent limitations of OCT-A technology
OCT-A has emerged as a pivotal imaging technology. But despite its clinical utility for detailed viewing of the retinal and choroidal microvasculature, many optometrists have been slow to adopt it.
COMPARISON OF OCT-A VERSUS FFA
DISADVANTAGES OF OCT-A
Additionally, because OCT-A relies on motion to generate structural images, it does not provide any assessment of leakage. This aspect can be beneficial in cases where the fluorescein dye in FFA leaks and obscures underlying structures but can be a drawback if flow information is required (for example, in assessing patency of thrombosed retinal macroaneurysms with slow flow). It also cannot show the point of leakage of lesions such as focal leaks in central serous retinopathy (CSR) that may be amenable to laser treatment and is less useful for detecting polypoidal lesions than indocyanine green angiography.
TIPS AND STEP BY STEP PROCESS FOR OCT-A INTERPRETATION
Although the OCT-A device will automatically segment enface images into various predefined layers (superficial capillary plexus, deep capillary plexus (DCP), avascular layer, RPE layer, choriocapillaris layer), the algorithm used to detect boundaries may not always represent the true anatomical layer.7 When pathology is present (for example: in high myopia or eyes with large pigment epithelial detachment), the normal architecture can be severely disrupted and manual readjustment of the segmentation lines may be required to visualise the appropriate layer. In some cases where this is not possible, awareness of the limitations of the segmentation needs to be considered when interpreting the scan output. Similarly, other artifacts such as projection artifacts can give the impression of vessels (typically from more superficial layers) being erroneously visualised in deeper layers. One strategy that can minimise this is to subtract the SCP from the enface image of the DCP.5 Enface versus volumetric assessment Although OCT-A images are typically viewed from its enface output, it is helpful to remember that a key benefit of OCT-A technology is it provides a volumetric and depth-resolved image. The retina is not flat but a three-dimensional structure, and images should be viewed with this in mind to fully appreciate the interrelation between various vessels and tissue structures. While sophisticated
There are different ways to analyse OCT-A images, but some general points to consider when performing and interpreting scans include: Scan size Acquisition areas of modern OCT-A devices range from 3 x 3 mm to 12 x 12 mm and even wider field using montage functions of newer models (15 x 9 mm).6 It is important to choose the appropriate scan protocol depending on the indication and likely pathology as there is a trade-off between increased field of view and lower resolution of fine vasculature.Forexample, for choroidal neovascularisation (CNV) in age related macular degeneration (AMD), a scan protocol of 3 x 3 mm is ideal as it can help detect smaller lesions and segmentation can be more finely tuned. In contrast, for diabetic retinopathy assessment, ultra-wide field scans of 12 x 12 mm provide a broader view of retinal ischaemia, delineating areas of capillary nonperfusion and neovascularisation elsewhere.
Figure 3. OCT-A imaging demonstrating choroidal neovascular lesion in the left eye of a patient with neovascular age-related macular degeneration. (A) Angiography analysis with enface image at the level of the RPE and cross-sectional structural B-Scan showing increased blood flow. (B) Enlarged view of the avascular plane with prominent neovascularisation.
As with all technology however, OCT-A does have some inherent limitations. Compared to FFA, it can be more prone to imaging artifacts. These include signal to noise artifacts from media opacities (such as cataracts), movement artifact (such as patient blinking or saccades) and projection artifacts (for example: from intraretinal lipid exudates).2 Segmentation errors can also provide a false representation of the vasculature, particularly if viewed in a single enface image.5 This can be a problem particularly if there is significant anatomical changes such as large pigment epithelial detachments or posterior staphylomas in high myopes which can obscure any underlying choroidal neovascular membranes (CNVM).
42 INSIGHT September 2022
CPD the choriocapillaris (Figure 1).4 As such, OCT-A technology has been used to provide insight into abnormalities in retinochoroidal vascular structure such as neovascularisation as well as disorders of perfusion.
Furthermore, although newer experimental models of OCT-A can provide wider field of view beyond the macula, as yet, it cannot match the 200 degrees provided by ultrawide field devices such as the Optos FFA when assessing peripheral pathology as such as peripheral ischaemia or leakage (Figure 2). In these situations above, where a lesion is suspected on OCT but not evident on OCT-A or is in an area not readily imaged by OCT-A in the periphery, it would be advisable to still obtain or refer to an ophthalmologist or clinic for a traditional FFA.
Segmentation and artifact minimisation
Figure 4. Quiescent or non-exudative choroidal neovascular membrane in a treatment naive myopic patient. (A) Structural OCT shows the macula is dry but with evidence of increased flow in the sub-RPE space. (B) Normal superficial capillary plexus on OCT-A. (C) A small neovascular lesion is seen in the avascular and RPE-fit layer of the OCT-A.
CONCLUSION
n
NOTE: A full list of references can be found in the online version of this article.
3.
Although OCT-A imaging can be performed in any macular disorder, there are some conditions where this technology is particularly high yield and beneficial. Neovascular age-related macular degeneration
(A) Optos ultrawide field fundus imaging demonstrating proliferative diabetic retinopathy of the right eye. (B) A 6 x 6 mm Zeiss Angioplex OCT-A image of the same macula revealing reduced vessel density and patchy areas of capillary non-perfusion and neovascularisation. retinal capillary ischaemia in many retinal vascular disease such as diabetic retinopathy and retinal vein occlusions. In patients with diabetic retinopathy (DR), 3 x 3 mm macula OCT-A scan provides accurate assessment of the foveal avascular zone (FAZ), demonstrating FAZ enlargement and perifoveal capillary dropout in both the SCP and deep capillary plexus.14
The role of OCT-A is perhaps best highlighted in patients with neovascular AMD (nAMD) as it can accurately image CNV lesions (Figure 3). This can be used for diagnostic purposes but also to monitor response to therapy with antivascular endothelial growth factor (anti-VEGF) injections over time.9 As there is no obscuration from dye leakage, quantitative and qualitative measurements of the lesion can be made. In particular, CNV lesions can show regression in linear size as well as pruning of the peripheral capillary tufts with treatment.10
Diabetic retinopathy and retinal vascular ischaemia - Aside from CNV detection, OCT-A has also shown significant promise in assessing
INSIGHT September 2022 43 Figure
More recently, OCT-A has identified a new entity, ‘non-exudative’ or ‘quiescent’ CNV – lesions that are detectable on OCT-A as abnormal vascular networks above Bruch’s membrane but show no evidence of leakage either on OCT or FFA (Figure 4). This is of particular relevance in patients with a history of CNV in one eye, with studies showing subclinical CNVM in up to 14% of fellow eyes with presumed intermediate only AMD.11 For these patients, the risk of conversion to exudative or active disease at one year was 15 times higher than those without subclinical lesions.11 As such, closer follow up and patient counselling for symptoms is recommended in this cohort.
It can often be difficult to tell if a patient is progressing from natural history or from the development of a secondary CNV. In this situation, OCT-A can be used to screen for presence of a CNV complex. Similarly, patients with posterior uveitis can have active inflammatory lesions as well as a secondary CNV. As both can leak on FFA and ICGA, OCT-A may be used to help differentiate these two lesions, an important distinction given the contrasting treatment approaches.13
5. Look through corresponding cross-sectional scan for areas of increased/decreased flow and correlate with the enface image 6. Follow with a fly-through visualisation to appreciate the relationship between structures INDICATIONS FOR OCT-A IMAGING IN MACULAR DISORDERS
It can also demonstrate other features of DR including quantifying microaneursyms and neovascularisation (NV) at the disc and elsewhere without the need for traditional dye angiography. Although used mostly as a research tool, newer wide field OCT-A can be used to both detect and monitor more peripheral NV lesions and areas of ischaemia without the need to montage images.16
Retinal imaging technology has and continues to evolve rapidly. Although currently OCT-A may not be required for daily management of most macular disorders, it can provide helpful insight above and beyond traditional imaging and its role is likely to expand as we continue to understand the wealth of information this imaging technology provides.
Other secondary causes of choroidal neovascularisation
2. Check the signal-to-noise ratio for image quality Manually readjust the segmentation lines if necessary to ensure best fit 4. Look through each enface segmentation output
Polypoidal choroidal vasculopathy
Summary of suggested steps when approaching 1.OCT-A:Choose the correct scan protocol for desired indication
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 CPD log book. 5.
The development of OCT-A imaging has also been of benefit in screening for secondary CNV lesions. For example, in patients with central serous retinopathy, adult vitelliform dystrophy or macular telangiectasia type 2, there can be fluid or hyporeflective spaces on structural OCT and leakage or pooling of the dye on FA can be an inherent part of the macular disorder.
OCT-A can also be a useful adjunct to help differentiate polypoidal choroidal vasculopathy (PCV) lesions from nAMD. Studies have shown when combined with the structural OCT image, OCT-A can reveal localised increased flow in the subretinal pigment epithelium space, providing high sensitivity and specificity for diagnosing PCV without requiring the use of FFA or indocyanine green angiography (ICGA).12
This is particularly useful in patients with seemingly mild or early disease, where OCT-A can reveal significant pathology such as vascular remodelling and capillary drop out.15
3D rendering is now possible using OCT-A,8 viewing the angiographic analysis as a fly-through video from superficial-to-deep in one continuum can help with this spatial interpretation. Vascular lesions should also be correlated with their corresponding image on structural OCT scan.
A few years later, in 2013, de Dona’ Zeccone was having a coffee with a friend in Danks Street in the hip inner Sydney suburb of Waterloo, when an idea was born.
When she was 15 years old, de Dona’ Zeccone got her first job in an eyewear factory, putting in rivets and small parts, exposing her to new skills in manufacturing. But she discovered she didn’t like working in the optical industry, and moved into fashion, managing a clothing store in Italy for four years.“In2003, I finished a degree in accounting and my father asked me to drop off my CV at the local bank. I did, but I asked them not to call me. I went to a travel agency instead, and bought a ticket to Australia.”
De Dona’ Zeccone is a qualified optical dispenser and trained Reiki Master – a Japanese form of energy healing – and sound healing; both services she offers at her retail store, but it is her knowledge of colour that makes her stand out, as well as her ability to deploy colour as an image colour consultant.Sheisalso a board member of the newly formed organisation, Optical Dispensers Australia, and was a highlight among the presentations at OSHOW22 in Sydney in May where she shared her expertise on understanding the power of colour in eyewear styling.
De Dona’ Zeccone followed her dreams to Australia in 2004 and worked as an agent for renowned Australian eyewear designers such as Jono Hennessy Sceats, and Matrix Eyewear. This gave her the opportunity to understand the Australian market for eyewear, realising there was a massive”‘style gap” in consumer demand and supply.
POWERTHE of colour
E yewear image consultant Ms Emanuela de Dona’ Zeccone is the creator and director of optical retail store Face Furniture Eyewear, which recently moved to new premises in the inner-city Sydney suburb of Redfern.
“My family had a little laboratory under the house where my father made frames. I remember him doing a lot of work with crystal,” de Dona’ Zeccone recalls.“When I was growing up, my father would come home [from Silhouette] and ask me to clean a sample bag – it was all rimless frames back then.
“I wanted to open my own store and call it Face Furniture and I realised then that this is where Face Furniture Eyewear & Other Things should live.”
Her dream became a reality – but her initial foray into business was doomed.“Myfirst store was located in an arcade in Danks Street, with no passing foot traffic, and expensive rent. The financial details were not taken into consideration. I messed up big time,” she says. Undeterred, de Dona’ Zeccone found a smaller – much smaller; only 20 square metres – retail space down the road with reasonable rent, where she relocated her business and remained for the following nine years.
44 INSIGHT September 2022 PROFILE
In a nod to the area’s cultural heritage, she commissioned an Indigenous artist to paint a spiritual mural on an interior wall of herShestore.has continued to invest in herself and her business, training in professional styling in 2014 and completing an optical dispensing course at the Australasian College of Optical Dispensing (ACOD) in 2018. She then hired holistic business coach, Ms Leigh Jane Woodgate, during COVID lockdown last year, recreating her business model, including her values, purpose, and vision. “I describe myself as an ‘insideEmanueladeDona’Zeccone.
Colour analysis begins with finding the person’s undertone and determining whether they favour warm or cool colours.
Eyewear runs in the blood for De Dona’ Zeccone. She is the second of five siblings born in Cadore, a historic region in the Dolomites in northern Italy. She says Cadore is known for eyewear designers and creators, a place described at times as the ‘incubator’ for Italian eyewear. The first frames factory was founded there in 1878 and over the years many industrial and artisan companies relating to eyewear sprung up to create an industrial district.Thede Dona’ Zeccone family became involved in eyewear in 1971; Emanuela’s father has worked for Silhouette for 45 years and her brother, A Sydney eyewear retail business owner, who hails from an Italian town famous for eyewear designers, shares how she uses colour theory to set her customers and business apart.
In November last year, de Dona’ Zeccone received a letter that the building would soon be demolished. She again upped stumps, moving her store to Redfern which opened in January this year.
“Those nine years were an opportunity to learn how to run a business without the stress of paying expensive rent and suppliers, unlike in my previous location.”
She returned to Italy in 2009, reconnecting with her father, while sourcing what she describes as funky, colourful eyewear.
Andrea, operates a wholesale eyewear business in Cadore.
“I’ve brought my own style and ideas to the craft, always collecting ideas and colours to send to my brother, who brings creative eyewear ideas to life.”
out stylist’. I take clients on a personal journey, bringing out their inner self. It’s about knowing your colour,” she says.
1
Minimum Product Information: XALATAN® (Latanoprost 50 μg/mL) Eye Drops. Indication: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Contraindications: Hypersensitivity to ingredients. Precautions: Change in eye colour due to increased iris pigmentation, heterochromia; eyelid skin darkening; eyelash and vellus hair changes; aphakia; pseudophakia; macular oedema; other types of glaucoma; contact lenses; severe or brittle asthma; herpetic keratitis; driving or using machines; elderly; children; lactation. Pregnancy: Category (B3) Interactions: other prostaglandins, thiomersal. See PI for details. Adverse Effects: Iris hyperpigmentation; eye irritation (burning, grittiness, itching, stinging and foreign body sensation); eyelash and vellus hair changes (increased length, thickness, pigmentation and number of eyelashes); mild to moderate ocular hyperaemia; punctate keratitis; punctate epithelial erosions; blepharitis; eye pain; excessive tearing; conjunctivitis; blurred vision; eyelid oedema, localised skin reaction on eyelids; myalgia, arthralgia; dizziness; headache; skin rash; eczema; bronchitis; upper respiratory tract infection; abnormal liver function. Uncommon: Iritis, uveitis; keratitis; macular oedema; photophobia; chest pain; asthma; dyspnoea. Rare: periorbital and lid changes resulting in deepening of the eyelid sulcus; corneal calcification. See PI for details and other AEs. Dosage and Administration: One eye drop in the affected eye(s) once daily. Other eye drops should be administered at least 5 minutes apart. (Based on PI dated 2 March 2021)
“I built my business by referral from other customers, through word of mouth. I create connection through colour. My clients are my business card,” she says n
Before prescribing please review Product Information available via www.aspenpharma.com.au/productsorcall1300659646.
If clinically necessary for the treatment of your patient, prescribe by brand and disallow brand substitution2✔ A first choice for glaucoma management
De Dona’ Zeccone describes herself as a specialist colour analyst and uses her insight into skin tones and seasons to help clients choose flattering frames. This technique of understanding the power of colour –and how it can be applied in eyewear styling, in de Dona’ Zeccone’s case – is known as ‘Armocromia’.
PBS Information: Xalatan (latanoprost 0.005% eye drops, 2.5 mL) is listed on the PBS as antiglaucoma preparations and miotics. Before (left) and after image of a customer. The concept of ‘Armocromia’ is applied to choose eyewear for customers’, taking into account their skin, eye and hair colour.
References: 1. NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma 2010 2. Australian Commission on Safety and Quality in Healthcare Active Ingredient Prescribing Guide - list of medicines for brand consideration December 2020 Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma. com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2021 Aspen group of companies or its licensor. All rights reserved. Prepared: June 2021 AF05768 ASP2528
De Dona Zeccone says Armocromia is a “test” of sorts that allows clients to understand which colours gives them more and which less, based on a series of factors such as skin undertone, eye colour or hair. She says wearing the wrong colours can make people look older or tired, accentuate blemishes and skin imperfections. In contrast, wearing the right colours can add radiance, making people look younger and help camouflage imperfections and soften facial features.
Working directly with clients at her Redfern store, de Dona’ Zeccone says she doesn’t feel the need to employ an optometrist, but does refer her clients to optometrists in her local area at times, and outsources lens fitting to City Optical. Her niche is creative professionals, people that want to see clearly and confidently express their unique style. She is also a business consultant to help other businesses to grow and be different.
”Make people notice you first, not the colours you are wearing,” she"Almostsays. all colour analysis begins with the essential step of finding your undertone, which means determining whether you favour warm or cool colours. Once you know this you immediately narrow down your options. Cool? You’re either a Summer or Winter. Warm? You’re either a Spring or an Autumn.”
Armocromia has recently come back into vogue after Ms Angelica Pagnelli, an image consultant, AICI member and eyewear style strategist revamped the idea of colour analysis.
The theory was first developed by American cosmetologist Ms Bernice Kentner through the book Colour Me A Season published in 1979, according to which people are divided into four types: Winter, Summer, Spring and Autumn, based on their skin, eye and hair colour.
PLASTIC NEUTRAL
“With the expanded scale into other countries this year, including Australia and New Zealand, the program is expected to prevent the equivalent of nearly 90 million plastic bottles from reaching oceans in 2022 – that’s
“We see the need to do better and there is no single approach that achieves sustainability, so we need to manage plastic use on many fronts, from our manufacturing and production processes to our plastic neutrality initiative.”Asoneof the world's leading contact lens companies, serving eyecare professionals and lens wearers in more than 130 countries, sustainability has been a key part of CooperVision’s ambition in recent years. It has developed what it describes as best-in-class manufacturing processes, from award-winning conservation efforts in Puerto Rico, to earning sustainability certifications in Costa Rica, Spain and the UK, to operating with 100% renewable electricity resources at three sites in Rochester, New York. At its LEED* silver-certified facility in Costa Rica, more than 95% of the materials used in production are recycled – including almost 100% of the plastic generated. Plus, more than 95% of the plant’s electricity comes from renewable sources.
The equivalent of nearly 28 million plastic bottles were prevented from polluting the oceans one year after CooperVision established the first plastic neutral contact lens in the US with Plastic Bank.
“Not all plastic is bad, it’s the waste we need to address,” Ms Michelle North, general manager of CooperVision’s Australia and New Zealand operations, says.
contact lenses
In May, the company announced all CooperVision one-day contact lenses distributed in Australia and New Zealand are now plastic neutral. The initiative was made possible through a global partnership with Plastic Bank, a social enterprise that builds ethical recycling ecosystems in coastal communities.Foreverybox of CooperVision one-day contact lenses distributed in Australia and New Zealand, the company purchases credits that fund the collection and recycling of ocean-bound plastic into the global supply chain, that is equal to the weight of the plastic used in its one-day contact lenses, the blister and the outer carton packaging.Theprogram is already paying dividends in other parts of the world. One year after CooperVision established the first plastic neutral contact lens in the US with Plastic Bank, the equivalent of nearly 28 million plastic bottles were prevented from polluting the oceans (side-by-side, these bottles would stretch from New York City to Paris).
“While these actions are significant, once a contact lens order leaves our production line, we need to critically evaluate how we can address the impact of that lens order to close the loop in our shared global system. And this is what we are now working towards,” North says.
Contact lens wearers have become increasingly conscious of their environmental footprint, especially when it comes to keeping plastics out of the ocean. That’s why CooperVision has embarked on a major project to make its one-day contact lenses plastic neutral, offering a new sustainable option for practices.
46 INSIGHT September 2022 SUSTAINABILITY
A s a medical device, plastic plays a critical role in the hygienic delivery and sterile protection of contact lens products around the world. But although plastic has a legitimate function, it doesn’t mean manufacturers can ignore the negative impacts that unmanaged plastic waste has on the global community.
Because Plastic Bank collectors in the coastal communities receive a premium for the materials they collect, this helps them provide basic family necessities such as groceries, cooking fuel, school fees, and health insurance. The US initiative helped 171 coastal communities in this regard after one year.
ProVision’s merchandise manager Mr Tony Jones applauds industry initiatives like CooperVision’s. Over the past year, Australia's largest independent network has increased its focus on ensuring all preferred supplier partners continue to develop or improve on their current sustainability position.
INSIGHT September 2022 47 enough plastic to stretch from the North Pole to the South Pole,” North says.
“We’reorganisation.aimingfor the full circle, and while we will never eliminate all waste, we will do as much as we possibly can, and we invite contact lens wearers and the rest of the eyecare industry to join us,” North says.
FOCUS ON PREFERRED SUPPLIER PARTNERS
As society continues to witness the impact of climate change and pollution globally, and patients are generally more eco-conscious, Ng says it has become increasingly important to implement sustainable initiatives into Eye Trend’s business.
PROVIDE INCREASED VALUE TO PATIENTS
“This speaks volumes for patients who are concerned about the environmental impact of contact lens waste. Particularly for our practice in Burwood Brickworks – a shopping centre that has officially been recognised as the world’s most sustainable shopping centre – having a sustainable contact lens option enables us to provide increased value to our patients and indeed, meet the needs of those who have chosen to adopt a more sustainable lifestyle.”
Across all industries, CooperVision reports consumers are demanding more sustainable products with 78% being more conscious of supporting green/sustainable companies versus five years ago. The company’s own research has found 80% of contact lens wearers would choose a plasticneutral contact lens over a comparable non-plastic neutral lens, assuming both were recommended by their optometrist.
“Independent practices particularly have a close relationship with their patient base, and by partnering with suppliers such as CooperVision, they are able to educate their local communities and encourage local actions that support the sustainability journey.”
CooperVision’s four-pronged approach involves:
Plastic Bank team in Indonesia.
“Our plastic neutrality initiative is our immediate, measurable first step in a four-step program that ultimately aims to achieve a net zero plastic footprint for CooperVision, while also providing a positive impact to people who may never use our products – or even know about us as a company.”
North describes CooperVision’s new plastic neutrality initiative as one of many milestones in the company’s journey to ever-greater sustainability. For now, plastic neutrality is a way the sector can manage waste today while working on the innovation of tomorrow.
3. To ultimately reclaim packaging, including boxes and blister packs for recycling and encourage consumers to proactively return them for recycling
1. To become plastic neutral through the Plastic Bank partnership
“In the last two years more and more optical patients have been asking ProVision practitioners if they offer eco-friendly frame choices. This reflects a wider market trend towards responsible purchasing, and it’s been pleasing to see so many suppliers embracing a more sustainable direction, whether that be through product material choice or business practices such as increased recycling and energy reduction, for example,” he says. n
“With innovations in sustainable technologies still very much progressing in the optical industry, we are finding it essential that we spend time communicating the various sustainable developments taking place in optics to our patients as they may not have been aware of them before.”
Now, CooperVision's plastic neutral initiative is helping Eye Trend offer a sustainable solution in the contact lens space.
4. To continue to reduce all waste, wherever possible, across the
“Whether it be an intention to introduce more eco-friendly product or an increased commitment to adopt more sustainable business practices, the goal is to provide ProVision practices with greater confidence that their suppliers are on a shared journey with them,” he says.
*Leadership in Energy and Environmental Design (LEED) is a green building certification program developed in the US and used worldwide.
Tony Jones, ProVision merchandise manager.
2. To introduce non-virgin material to its entire manufacturing process
Five-practice Melbourne independent optometry business Eye Trend shares a long-standing business relationship with CooperVision, which marketing manager Ms Charlotte Ng says is due to an extensive contact lens portfolio that suits a whole range of ages, lifestyles and vision needs.
To further support independent practices in the ProVision network, in 2021 the organisation launched a sustainability webpage for all members called SustainPro, which is designed to help practices build a step-by-step execution strategy from inception through to patient engagement.“Asconsumers embrace sustainability more in the years ahead, ProVision practices will have access to a tool that ensures they remain relevant through the eyes of their local community and their patient base,” Jones says. He hopes sustainable measures – like plastic-neutral one-day contact lenses – continue to spread through the industry.
“It’s really impactful to be able to say to our patients that the same amount of plastic that goes into making their CooperVision one-day contact lenses is collected and recycled from the environment before it reaches the ocean,” she says.
“We also know that 84% of eyecare professionals would choose to prescribe the brand they believe is better for the environment when choosing between two comparable daily disposable brands,” North says.
“We envision a world where plastics are responsibly used, recovered, and reborn in perpetuity – and we are taking steps to get there,” she says.
During the past few years, Ng says Eye Trend’s sustainability efforts have included partnering with brands that produce sustainable eyewear, from their packaging to their frames, and offering quality products that last. The business has also partnered with a charity where customers can donate their pre-loved glasses to be gifted to under-privileged communities.
Expanded scope:
With there being sufficient optometrists in those areas, ODOB said allowing some to perform minor laser surgeries would reduce the burden on the private and public ophthalmology sector, and lower geographical barriers to accessing care.
It was decided by the country’s optometry regulator – the Optometrists and Dispensing Opticians Board (ODOB) – following a pilot and consultation with the sector, coming in effect on 1 July 2022.
The board said it reviewed and approved every phase in the proposed training program and scope and was ultimately satisfied that it could safely ensure the training and practise of these practitioners.
THE MOVE TOWARDS MEDICAL OPTOMETRY
The ODOB released a summary report, detailing the overarching themes of the 23 written submissions it received from organisations and individuals. It did not name those who lodged submissions, but said the seven organisational submissions included two from ophthalmology departments within District Health Boards (DHBs), two from key education and training providers of eye healthcare professionals (Australia and New Zealand), one from a New Zealand-based membership organisation and two were from Australian-based organisations – one membership organisation and the other a regulatory organisation.Accordingto ODOB, most of the submissions were supportive of the move.
After several meetings with key stakeholders, and a preliminary literature review, the board approved a pilot study to run in the ophthalmology department at Greenlane Clinical Centre, in Auckland. Its purpose was to ensure the board could safely introduce a specialist optometrist scope-ofpractice in ophthalmic laser surgery.
WHY NZ OPTOMETRISTS CAN NOW PERFORM LASER SURGERIES
48 INSIGHT September 2022 SURGERY
In recent years, Australia’s optometric sector has been pushing for scopeof-practice changes in respect to oral medications – permitted for Kiwi optometrists for eight years now – and new macular disease anti-VEGF care models, but this has come up against ophthalmology opposition.
According to ODOB, this required buy-in from various stakeholders and provision of training and close supervision from ophthalmologists in that area.
Despite objections from ophthalmology about safety and lost training opportunities for registrars, it’s hoped the move can help overcome a significant lack of ophthalmology cover in many areas across New Zealand.
“While favourable submissions from within the optometric community could be seen as biased, it is important to note that the profession of optometry is risk adverse and has been slow to adopt previous expansions in scope,” the board“Additionally,stated. previous consultations a few years ago about scope expansion revealed that not all optometrists were in favour of this move towards medical optometry. Therefore, the universally supportive responses from a wide range of practice backgrounds shows confidence in the training and abilities of their peers. This confidence was notably absent from most, but not all, of
The latest decision in New Zealand authorises certain optometrists, in approved hospital settings, to use a Nd:YAG laser for capsulotomy, a treatment for posterior capsular opacity (PCO) following cataract surgery. They can also perform peripheral iridotomy, creating a passage for aqueous humour to flow through the iris.
“This in turn would free up ophthalmologists to do the more complicated procedures, effectively reducing overall wait-times for all ophthalmic procedures, improving treatment efficiency, and reducing unnecessary impairment of vision,” the ODOB stated. “The patient experience would also be improved, as the same person who diagnoses the condition could then undertake the treatment, often at the same visit.”
Locally, the topic of laser surgeries is yet to be broached, but a scope-ofpractice change just across the ditch is likely to add fuel to the general debate around the optometry scope in Australia.
The regulator of Kiwi optometrists has approved a major scope-of-practice change allowing the profession to perform ophthalmic laser surgery, dismissing ophthalmology objections regarding safety and lost training opportunities for registrars. Insight delves into the rationale behind the decision.
New Zealand’s decision to expand its optometry scope-of-practice to now include two ophthalmic laser surgery procedures is turning heads in global eyecare circles. For some years, optometrists in other parts of the globe have been able to perform procedures, such as SLT in certain settings in the UK, while some US states have the most expansive scopes allowing some injectable eyelid drugs and anterior laser privileges.
The second theme was a belief that the proposed policy provided appropriate and safe training protocols and regulatory instruments to ensure safety to the community.
It also said issues regarding safety were not supported by published literature of international experience, and patient experience is at least as high when an optometrist performs the procedure.
“There was some concern that this change may be a gateway into other procedures, and that is certainly a possibility,” the board stated.
“This, coupled with the proposed pre-requisites of three years or 400 hours of relevant clinical experience while working under supervision with an ophthalmologist will sufficiently prepare optometrists to perform these procedures
The scope-of-practice change did not receive unanimous support, however. The report did not name those who lodged submissions, and RANZCO did not wish to comment at the time of writing. But the ODOB said those opposed “were from an ophthalmology perspective, and hinged on the following four Thethemes”.ODOB highlighted each of these concerns before laying down arguments against each. They were:
“It would only be done within a board-approved hospital or relevant clinics where a senior optometrist is working closely with an ophthalmologist,” ODOB said. “This will be supported by board-approved processes/guidelines, periodic approval, and ongoing monitoring.”
SUPPORT FOR THE SCOPE-OF-PRACTICE CHANGE
• A potential for misdiagnosis of the visual condition and the decision-making process about surgical intervention.
• Laser surgery is done with a surgical device with critical safety requirements and has the potential for complications.
OPHTHALMOLOGY OBJECTIONS
INSIGHT September 2022 49 the ophthalmology responses. They are however less familiar with modern optometry and its scope-of-practice.”
It continued: “Overseas experience has not shown an increased risk of harm to the public from an optometrist performing laser procedures, so there does not seem to be a valid foundation for these views that public safety may be compromised. The framework provides minimum standards, and it requires the supervising ophthalmologist to agree that the optometrist is competent, which is similar to, but far more rigorous, than UK ophthalmology training processes.”
“Because of this, compared to a primary care optometrist, they would be expected to have an even higher-level familiarity and understanding of surgical indications, options, and outcomes. The board also does not believe it will receive many applications for this new scope, as there are not that many practitioners who will meet the board’s requirement at present.”
“This may also encourage more (public) hospitals to employ and train senior optometrists to meet the need in their community, and highlighted that employment of more optometrists into public hospitals can be beneficial,” the board added.
According to ODOB, these procedures have been shown to be delivered safely by similarly trained optometrists in other countries, and there is “compelling evidence overseas that this is undertaken safely and effectively by optometrists, with high patient satisfaction”.
Afterregistrars.ODOB approved the policy change, the Australian Society of Ophthalmologists (ASO) said the New Zealand branch of RANZCO was looking into the matter. “At this stage it raises medicolegal and ethical concerns for both the optometrist involved and the ophthalmologist who runs the clinic,” ASO vicepresident Dr Peter Sumich said.
“New Zealand has no Medicare system and public hospital quality of care is patchy between regions. I doubt whether it is applicable to our health system,” heInadded.response to ophthalmology concerns, ODOB said concerns regarding diagnosis and management “appear dated and unsupported by the literature, and do not reflect the current optometry scope-of-practice where consideration for surgical referral is routine”.
“The optometrists who take on this specialised optometrist scope will be required to be working in a board-approved hospital or ophthalmology clinics and have many years of experience in this role,” ODOB stated.
Thirdly, supporters of the move considered the proposed training environment and practise requirements appropriate.
AUSTRALIAN
“Students within the Bachelor of Optometry undergraduate program already receive extensive training in the biology of the eye, optometric examination (including referral of conditions for surgical treatment), interaction of light (including lasers) with biological tissue, and of optics (including extensive use of non-surgical lasers),” the board stated.
• The proposed training is too short and not sufficient for optometrists to safely practise.
Finally, ODOB said issues with implementation costs were short-term in nature and quickly recovered, and enable efficiency gains in more complex areas of ophthalmology for which there is greater requirement for specialist care.
Regarding accountability and continuity of care, ODOB said these concerns were not novel or unique to this procedure, and were already part of the optometrist scope. Many models of co-management of conditions between ophthalmology and optometry already exist.
“However, changes to the listed procedures would be guided by evidence, and there are many layers of protection in place. This includes restrictions on eligibility, the requirement for ophthalmology sign-off and cooperation for training and supervision, ongoing regular auditing and minimum patient numbers, and board-oversight, who have a mandate to protect the public. As there is evidence of optometrists performing limited laser surgery is beneficial to the public with no increased risk of harm, then an argument against scope expansion would seem to be placing artificial barriers to accessing healthcare.” n
“AT THIS STAGE CONCERNS FOR BOTH THE OPTOMETRIST INVOLVED AND THE WHOOPHTHALMOLOGISTRUNSTHECLINIC” PETER SUMICH SOCIETY OPHTHALMOLOGISTSOF
• There may not be a need for additional capacity to perform laser surgeries and may take training opportunities away from ophthalmology training
Ultimately,safely.”ODOB said it would employ a conservative approach to the new scope roll-out and approve every phase of the training program. Registered practitioners will have to meet annual recertification requirements such as performing 20 completed surgeries per annum for each procedure and logbooks.
IT RAISES MEDICOLEGAL AND ETHICAL
In submissions in support of the move, ODOB said three themes were prominent.Thefirstrelated to greater public access to eye health services, addressing inequity, particularly in low-serving communities.
DR
A keen investor in new technology, Notaras established the practice in 1995 and has continually sought ways to make his service stand-out to a wdemographic largely comprised of office-based professionals in industries such as architecture, law, art and design.
Since acquiring the SBM instruments, Notaras has been impressed with the broad functionality of the IDRA device that has a small footprint and mounts to his existing slit lamp.
50 INSIGHT September 2022 DRY EYE
“It’s ideal for a practice of my size based in Surry Hills. It provides information for many aspects like tear meniscus height, non-invasive tear breakup time, auto 3D meibography,” he explains, noting additional functions such as auto interferometry test, blepharitis examination, break-up time staining test, white-to-white measurement and pupillometry.
More recently, through BOC Ophthalmic Instruments, Eyewear Youwear sought to elevate its dry eye diagnostic and treatment offering, acquiring instruments produced by SBM Sistemi, a firm in northwest Italy punching above its weight in terms of ophthalmic innovation.
In Notaras’ practice, Activa acts more as a second-line therapy, with IPL the
FOR YOUR PRACTICE
“As dry eye became more researched, and studies such as DEWS (Tear Film & Ocular Surface Society’s Dry Eye Workshop) came out, that piqued our interest, because we had patients always complaining about vision problems saying they could see clearly one moment and blurry the next, and they have to keep blinking to correct it,” Notaras explains.
Dry eye disease was an unknown phenomenon when Eyewear Youwear commenced operations 27 years ago, but as research in the field evolved, so did the practice’s interest in expanding its scope to accommodate its patient base.
“When it comes to dry eye, we see a big mixture of people. We tend to assess everybody that comes through the door, because even though most people will not tell you they have dry eye, particularly contact lens wearers, it's one of those things that creeps up and they just think it's normal until you show them otherwise,” he says.
Making dry eye work
The devices have been welcome additions for Notaras’ practice whose dry eye patients usually fall into two groups. Those with easier-to-manage dry eye caused by environmental factors, and those with anatomical problems such as rosacea, blepharitis and MGD, among other conditions.
The IRDA dry eye diagnostic tool (top) and Activa for meibomian gland dysfunction (bottom) from SBM Sistemi.
This has come in the form of IDRA, a diagnostic device launched in 2019 that is SBM’s most advanced ocular surface analyser. And earlier this year, the practice introduced Activa, SBM’s first treatment instrument for MGD, featuring an eye mask with heating and massaging technology.
Sydney optometrist HARRY NOTARAS has continually sought new technology to expand the scope of his practice. Dry eye is an area that’s delivered particular success for his patients, largely due to a willingness to invest in the latest instrumentation.
Indeed, Eyewear Youwear began evolving its dry eye suite. Over the years it added an intense pulsed light (IPL) machine from Lumenis, an eyelid warming goggle device incorporating heating capability for meibomian gland dysfunction (MGD) called Blephasteam, and meimbography imaging on its slit lamp. Pyliotis, the practice’s therapeutically-endorsed optometrist, can also prescribe prescription eye drops like ciclosporin and lifitegrast, often working in tandem with Notaras during the dry eye patient journey.
“As the research developed and told us more about how important treating dry eye is for visual function, it got us more interested. And as the early instruments emerged, we embraced them and now there's a huge amount of opportunity for manufacturers to diagnose and treat dry eye.”
“It also has blink rate detection, which can be recorded to assess whether patients are blinking correctly. IDRA has allowed us to go much more indepth with one instrument, instead of switching from one to another.”
Mr Harry Notaras and Dianne Pyliots – principal optometrists of Eyewear Youwear, a practice located in the upmarket Sydney suburb of Surry Hills – embodies the philosophy that differentiation and an ability to commercialise special interests will ultimately lead to the prosperity of independent optometry.
FITTING DRY EYE INTO THE PRACTICE WORKFLOW
“Dry eye, in particular, allows you to broaden the scope of your practice and reduce the monotony of performing refractions all day long. With dry eye, it made my day more interesting. I have more involvement with the patient and these patients are very appreciative of the extra time and effort you give them,” he says.
INSIGHT September 2022 51 last line. While it might not be as comfortable for patients as expected, Notaras has been impressed with the results in his“Thispractice.isone of the few instruments I’m aware of that does both – massage and heating. The other I’m aware of can be more invasive and very expensive for a consultation, whereas this is a far less expensive treatment option,” he“Thesays.Activa is a goggle-like device, but it’s more rigid, and you've got to be a bit more careful with how you use it on the patient and manage their expectations around comfort. The idea is that the vibration massages the meibomian glands, and as time goes on, that vibration increases. We’ve only been using it a matter of months, but have found that we’re able to express glands that we couldn't before. Over time, some patients are getting to a stage where the meibum oil is becoming more like olive oil rather than toothpaste.”Notarassays the therapy has also been effective on styes.
In terms of scheduling dry eye services, Notaras says if patients are suspected of it, they are recommended to attend a follow up appointment where a full work-up is completed. Pricing for this appointment needs to be tailored for the individual practices to suit their patient demographic, however he has heard that charges for this can exceed $100 per consultation. In regard to Medicare rebates, Notaras suggested contacting Optometry Australia for advice.
“If you want to stand out, I think it's time to adopt these types of services. There are courses and CPD articles and events offered all the time on dry eye and does not require a huge investment of your time.”
Soon, BOC hopes to begin importing SBM’s new topographer called the OS 1000, described as a dedicated dry eye platform with topography, featuring film analysis and 3D meibography. For this device, SBM still needs to obtain registration certifications for Australia, which it hopes to achieve in early“They2023.are a company that innovates by research – not by copying other technology that is out there – that’s why we have introduced them into the portfolio,” Cosentino says. n
“Based on what we find, we offer a package that highlights the importance of multiple treatments with the Activa. And depending on their condition, it could vary from four to six – and then topping that up every couple of months,” he explains.
While BOC Instrument’s relationship with SBM is one of its newest, dating back to 2017, the company now offers a suite of seven instruments from the manufacturer. SBM itself only entered the dry eye sphere in 2015. The entrepreneurial spirit of SBM was the catalyst for BOC managing director Mr Tony Cosentino opting to sign a distribution agreement for Australia.Inaddition to marquee products like the IRDA and Activa, the company’s latest releases include two new imaging modules: the DSLC200 which adds digital capabilities to slit lamps; and the Dry Eye Module (DEM 100), a software interface that attaches to the slit lamp and DSLC200 and offers a comprehensive set of dry eye diagnostics.
“In my experience this enhances patient loyalty. You are going to have an initial outlay, but it starts the process of you identifying those patients. They've come in, they want their treatment, they also require their routine refractions. You will see these patients more often and the result is a happy loyal patient which overall will expand your practice.”
A strong proponent of independent optometry, Notaras says it's areas like dry eye where practices like his can differentiate and ensure the viability of their business. While the investment is one that needs to be considered carefully, it becomes a no-brainer with a longer term view.
He continues: “I've never had a problem with buying instrumentation and technology. Our practice is highly motivated by this. And we've found that has bolstered our practice in all areas. You've got to be able to pay the instrument back over time, but it makes you work that little bit harder to make sure that you are not letting patients go with dry eye that end up somewhere else having their problem seen to.”
If practices haven’t incorporated some level of dry eye management, Notaras says it is a good time to start. There is an abundance of technology and therapies, and while they might require an initial investment, there’s plenty of support to upskill in this area.
Harry Notaras, Eyewear Youwear.
“The IPL is our last weapon of choice in some patients where we feel it may be beneficial. These patients could be suffering with such issues as MGD, orbital rosacea, demodex infestation and recurring styes. If IPL alone is not achieving desired results we would combine the other treatments using the massager and the steaming instruments as well, which allows us to express their glands that much better.”
PARTNERING WITH A DRY EYE INNOVATOR
The October 2022 issue will feature the Insight Dry Eye Directory, Australia’s most comprehensive source for dry eye care. Back by popular demand, this all-in-one resource is a valuable purchasing guide for practices, showcasing available Therapies and Diagnostics in Australia. It will also feature a comprehensive list of dedicated Dry Eye Clinics. Don't miss the next issue of Insight, to subscribe visit insightnews.com.au/subscribe www.insightnews.com.au Insight Dry Eye Directory returning in 2022 AUSTR A LI A’ S LE A DING OPHTH ALMIC M AGAZINE SINCE 1 975 COMPATIBLEWITHYOU WWW.INSIGHTNEWS.COM.AU 03 INDUSTRYEVENTSMARKRETURNTONORMALITY OSHOW22success taste what'stocomewhenAustraliahostsglobaloptometryevent. 26 PROVIDINGSPECIALISTEYECAREATSCALE VisionEyeInstitute'sCEOonrunningAustralia'slargestprivateophthalmologynetwork. JULY 2022 INSIGHT AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 JUL2022 studyStudy,EvidencedMiYOSMART:thesmartwaytotreatmyopiainchildren.bytheMiYOSMART6-yearFollow-UpClinicalthelongestmyopiamanagementspectaclelensintheworld!Accessthe6-yearFollow-upClinicalStudyARVO2022AnnualMeetingAbstractandpressreleasebyscanningtheQRcode.WWW.INSIGHTNEWS.COM.AU 03 OPTOMETRYSENATEINQUIRYINTOREGULATOR registrationsoverQuestionshavebeenraisedAhpra'sagilitytohandleandcomplaints. 20 MYOPIATHEVANGUARDOFMANAGEMENT lenstheCombiningatropineandorthok,benefitsofnewspectacleinterventions,plusmore. 35 STAFFINGFRONT-OF-HOUSETROUBLES staffrecruitSolutionstohelpyourpracticedispensersandotherinacompetitivemarket. AUGUST 2022 INSIGHT AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 AUG 2022
My approach toward dispensing is always to begin with the end in mind. When it comes to fitting a frame accurately, many dispensers do not take the appropriate measurements to enable them to adjust the spectacles to fit the customer prior to their collection appointment. Instead, many adjustments are completed while the customer is present. Have you ever thought about what the customer thinks or feels about that process?
Recent news about the current economic climate is filled with consumer spending uncertainty. Will this see customers leaving a longer gap between purchasing their spectacles? It’s now more important than ever that we make our last impressions count, ensuring they remember to return to your practice for their eyecare and eyewear needs.
Let’s put this into a different context. If a carpenter came to renovate your home to fit a new shelf or cupboard, how would you RHIAN EVANS
As a qualified dispensing and contact lens optician, having worked in a variety of independent and corporate practices over the last 20-plus years as a practitioner and a trainer, these experiences have given me a broad insight into common processes across practices both in Australia and New Zealand and further abroad.
Taking measurements in a timely manner enables dispensers to adjust a pair of spectacles to fit the customer prior to their collection appointment.
ABOUT THE AUTHOR: RHIAN EVANS is Dispensing Advancement Manager for Specsavers Australia and New Zealand. She has completed the Fellowship Dispensing Diploma (FBDO) course, run by the Association of British Dispensing Opticians and supported by Specsavers. feel if they merely looked at the space and guessed the size to cut the wood, but then kept recutting the wood until it fit? You would probably think that was strange and lose confidence in the quality of their work. We know that an experienced carpenter would accurately measure the space and cut the wood to fit; ‘measure twice, cut once’ is the phrase famous in the building industry. Preparation is essential to ensure spectacles will fit once their lenses are glazed into the frame and that visual clarity is maintained. For some it will also be the determining factor to ensure that they benefit from the correction appropriate for theirSomeneeds.measurements I always encourage stores to take include head and temple width which can be recorded using rulers, or ideally a pair of head-width callipers. Taken simply at the point of above the ear for the head, then at the temple, and with appropriate compensation, these measurements can be easily recorded and applied to the finished pair of spectacles, allowing the dispenser to adjust the angle of let back and any other parameters necessary in a way that ensure the spectacles fit like a glove, first time. This values the customer’s time and can be completed when the practice is quiet. Of course, this is not forgetting the additional measurements such as length to bend, angle of side, angle of drop, to name but a Everyfew.practice invests in marketing to attract new customers. We know there is no better advertisement than a customer having the best quality vision and frames that they love. Customers have the choice of where to go for their eyecare and eyewear, so reputation of your optical practice is vital. This is the perfect time to review the instore process to ensure your customer continues to receive the best vision, product and service resulting in a lifetime of loyalty from your customers. n
OUR ABSOLUTE BEST WITH COLLECTIONS AND AFTERCARE SERVICES TO KEEP OUR CUSTOMERS LOYAL TO OUR PRACTICES FOR LIFE? SPECSAVERS DISPENSING ADVANCEMENT MANAGER RHIAN EVANS SHARES HER VIEWS. A LIFETIME OF LOYALTY
DISPENSING INSIGHT September 2022 53
It is evident to the customer that optometric practices are embracing advancements in technology; whether through providing OCT scans, innovative lens demonstrations, utilising accurate measurement devices, or many more besides.Evenwith such advancements, in many optical practices the collection process has remained unchanged for many years. Perhaps now is the time for us to take a fresh look at this critical component of the customer experience.
MAINTAINED”VISUALFRAMEGLAZEDLENSESFITSPECTACLESTOIS“PREPARATIONESSENTIALENSUREWILLONCETHEIRAREINTOTHEANDTHATCLARITYIS
ARE WE DOING
While it is exciting that there are so many developments and changes within our industry, I believe it is equally essential to always remain attuned to developments affecting the customer.
ve that our industry is ever-evolving by producing more sophisticated lens designs and technologies, however these advancements do require dispensers to fit them correctly first-time to increase wearer acceptance and customer satisfaction.
CHILDREN WITH GLAUCOMA SHOULD BE PROVIDED WITH AN ACTIVE VOICE IN THEIR CARE TO REDUCE THE POSSIBILITY OF THEIR GLAUCOMA AS TEENAGERS, ORTHOPTIST LACHLAN KNIGHT EXPLAINS. CHILDREN WITH GLAUCOMA THEIR
To reduce the chance of this, a key recommendation of the study was that children should be provided with an active voice in their care. Encouraging shared parent-child glaucoma management as soon as the child reaches an appropriate level of maturity was further considered beneficial.
The study further observed a distinct shift in the childhood experience of glaucoma as a child entered adolescence. Teenagers often expressed that they disengaged from their glaucoma care and did not want to attend ophthalmic appointments.
RESEARCH LETS
More than half of the children interviewed stated they felt anxious when performing ophthalmic tests, such as the visual field test or intraocular pressure test. This is because they were often afraid that their glaucoma may have gotten worse.
Teenagers further started to consider what glaucoma meant for their adult life. They discussed issues with their career options, obtaining a driver’s licence, and whether they would pass on their glaucoma to future children. The study warned that the cumulative influence of these issues may lead teenagers to neglect their glaucoma care.
ABOUT THE AUTHOR: LACHLAN KNIGHT is an Orthoptist who specialises in paediatrics and genetic eye disease at Flinders Medical Centre and the Women’s and Children’s Hospital, Adelaide. He is also undertaking his PhD in the genetics of childhood glaucoma at Flinders University.
STORY 54 INSIGHT September 2022
Future research endeavours include evaluating the most effective strategies to facilitate a child’s transition from adolescent to adulthood ophthalmic services. A multidisciplinary model of care is currently proposed, which posits orthoptists and ophthalmologists as the primary personnel
This project forms one of many orthoptistled projects undertaken by the ANZRAG team. Other published research describes the impact on adults with childhood glaucoma, and the caregiver. The team is also working to validate the world’s first questionnaire which can measure quality of life in childhood glaucoma. This project was supported by the Australian National Health and Medical Research Council Centres of Excellence Grant (GNT1116360), Orthoptics Australia Research Grant, Flinders University Cross College Grant and Flinders Health and Medical Research Institute Higher Degree by Research Grant. The project received the Emmie Russell prize for best research paper by a recently graduated orthoptist at the 77th Orthoptics Australia Annual Conference. n Article reference: Knight et al. Quality of life in children with glaucoma: a qualitative interview study in Australia. BMJ Open. Published online 2022 July 21. doi: 10.1136/ bmjopen-2022-062754 delaide-based researchers have published the world’s first qualitative study detailing the child’s perspective of what living with childhood The project, led by orthoptist and Flinders University PhD candidate, Lachlan Knight, marks a milestone in the childhood glaucoma research space, as children have become active partners in the research process and were given a platform to voice The study builds upon previous works by the team at the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). Glaucoma is a diagnostic term all too often associated with the ageing population, resulting in little attention to the childhood form. Although rare, affecting approximately 1 in 30,000 children in Australia, childhood glaucoma contributes to about 7% of childhood vision impairment worldwide. With a diagnosis at any time from birth to 18 years, the condition can pose substantial visual and psychosocial challenges. These challenges were discussed by 18 children aged between eight and 17 years in the Flinders interview study.
NEGLECTING
More than half of the children interviewed stated they felt anxious when performing ophthalmic tests, such as the intraocular pressure test.
TELL
of children struggled with feeling misunderstood by their fellow peers because they had a rare condition. This highlighted the ongoing need to raise awareness that glaucoma can indeed occur in children.
As one study participant said, “When I try to explain [that I have glaucoma], no one understands and I have to keep explaining, explaining and explaining.”
In addition, many children were frustrated because of the blurred vision brought on by pupillary dilatation, stating that “everything is blurry for six or seven hours". This was particularly problematic for children when they returned to school after theirCliniciansappointment.should consider recommending that children undergoing cycloplegia consider bringing a pair of magnifying spectacles to assist with reading, rather than sunglasses for anticipated symptoms of glare. These experiences, however, were typically offset by children considering that they were ‘friends’ with their orthoptist or ophthalmologist, highlighting the value of creating a safe and friendly space for children at their appointments.
LACHLAN KNIGHT “THE DISTINCTOBSERVEDFURTHERSTUDYASHIFT IN THE ADOLESCENCE”CHILDGLAUCOMAEXPERIENCECHILDHOODOFASAENTERED
All ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community Visit: orthoptics.org.au
LAWYER RUANNE BRELL DISCUSSES WHAT TO CONSIDER BEFORE HITTING ‘SEND’. CAN’T YOU JUST EMAIL IT?
DOUBLE CHECK THE ADDRESS Private information being emailed to the wrong recipient accounted for nearly 18% of breaches reported to the OAIC in the last reporting period (June – December 2021).
PROTECT SENSITIVE INFORMATION
Always make sure: • which address the patient would like you to use – patients may not want health information sent to a work address or shared address • that you have typed in the correct address – be particularly careful about auto-complete errors that could see the software completing a recently or frequently used address instead of the one you started to enter. Ideally, contact the patient and ask them to email their request to you. You can reply to that address – which both ensures you’re using the correct address and confirms their consent.
Keep SALLY HAS LEFT A VOICEMAIL MESSAGE ASKING FOR A COPY OF HER PRESCRIPTION FOR HER UPCOMING TRIP, IN CASE SHE LOSES HER GLASSES. SHE DOESN’T HAVE TIME TO COME IN, CAN YOU EMAIL IT TO HER?
For example, if you need to give a patient bad news or communicate complex or difficult information, this will usually require a face-to-face discussion. You can send time-sensitive information by email, but make sure you have a process to check it has been received. Since email is not a secure form of communication, it will be inappropriate for some types of information, or in some circumstances. This applies even if the information itself seems relatively innocuous, such as an optical prescription, so use your judgement and your knowledge of the patient’s circumstances to determine if email is Inadvertentlyappropriate.disclosing personal information such as a home address to the wrong recipient would breach privacy and could potentially cause harm.
DOCUMENT AND COMMUNICATE YOUR APPROACH
Healthcare information is considered sensitive information under the Privacy Act, but that doesn’t mean email communication is prohibited. In fact, healthcare organisations may communicate with or about patients using unencrypted email, provided they take ‘reasonable steps’ to protect the information transmitted and the privacy of the patient.
include a privacy disclaimer as an added layer of protection.
Make sure someone in the practice is responsible for actioning any incoming emails appropriately and in a timely manner. All emails also need to be documented in the patient’s clinical record and stored appropriately. Your policy also needs to address how to manage and store any clinical images sent by email. If you have an email address on your website, be very clear how and when this address is monitored. You may need to add a warning that patients should not use email if they need an urgent response and provide an appropriate alternative emergency contact. This information could also be included in an autoreply for emails sent to that address.
IS IT APPROPRIATE TO EMAIL?
While you want to avoid sending email to unintended recipients, it is still useful to
EMAIL COMMS REQUIRES REASONABLE STEPS TO PROTECT PRIVACY
n
lectronic communication became even more essential for healthcare during COVID-19 isolations and lockdowns. However, there is still some confusion among practitioners about how to communicate by email without breaching patient privacy.
ABOUT THE AUTHOR: RUANNE BRELL is a senior legal advisor in the Advocacy, Education and Research team at Avant with almost 20 years’ experience in health and medical law. INSIGHT September 2022 55 a copy of their consent if they give it in writing. Or if the patient consents verbally, document this in the clinical record.
PERIOD"LASTTHEREPORTEDOFFORACCOUNTEDRECIPIENTTOBEINGINFORMATION"PRIVATEEMAILEDTHEWRONGNEARLY18%BREACHESTOOAICINTHEREPORTING MANAGEMENT
USE A PRIVACY DISCLAIMER
Always consider whether email is appropriate for the situation and the information you are communicating.
CONFIRM PATIENT CONSENT
Your policy should also address whether clinical or sensitive information should only be sent in an attachment, or sometimes in a password-protected file. You need a protocol for providing the passwords (for example, phone the patient with the password). It is always best to ensure there is no sensitive information in the body of the email.
Also check the patient understands email is not secure and confirm they still wish to have the information sent in that way.
Disclaimer: This article is intended to provide commentary and general information. It does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances.
The Office of the Australian Information Commissioner’s (OAIC) Guide to Securing Personal Information provides guidance on what steps are considered reasonable. Practices need to develop clear policies and procedures for using email and make sure staff understand these.
People
SAFILO APPOINTS ITS FIRST FULL-TIME TERRITORY MANAGER IN SA Paul Vessey will assume a newly established position of Territory Manager, South Australia, for Safilo. He will be located full-time in Adelaide, while Callan Meredith will continue with Safilo in Perth. Vessey has extensive experience in the optical industry, including positions of national responsibility with Hoya, Essilor and Optical Products. “This is a great step forward for Safilo; Paul’s experience and monthly bulletin to keep the Australian ophthalmic sector updated on new appointments and personnel changes, nationally and globally.
CAREER
ON THE MOVE
And as a Specsavers optometrist, you’ll have the chance to advance your skills and become part of a business that is focused on transforming eye health outcomes in New Zealand.
Interested in relocating to NZ? Specsavers has a range of opportunities for NZ optometrists looking to return home. From North to South, we have fantastic opportunities for optometrists at all levels.
There’s no place like home – so if you’re ready to return, let us help you.
Graduate Recruitment Team are currently looking for new graduates to join teams in Regional NSW Whether it be for a new challenge or relocating for different lifestyle – this could be your first step in opening doors for your professional career. Providing generous bonus’ along with a competitive regional salary and relocation package, all Specsavers stores are equipped with the latest optometry catering for our diverse patient base.
Optometrist Joint Venture Partnership opportunity – Hornsby, NSW Optometrist partnership opportunity in Hornsby with a with a 1/3 shareholding on offer! Hornsby is a metropolitan suburb located 25km north-west of Sydney’s CBD. Specsavers Hornsby is ideally located in Westfield Hornsby, home to retail drawcards ALDI, Coles, Woolworths, Kmart and Chemist Warehouse. As the main commercial hub in the area, Hornsby attracts customers from the surrounding residential suburbs. The store opened in 2009 and offers 6 Optical test rooms, has 1176 frames on display and newly fitted backlit and digital displays, Audiology services, and state of the art equipment including OCT. a Optometrist opportunities across Melbourne Due to exciting growth several upcoming expansions, Specsavers has great Optometrist opportunities available across Melbourne. We offer flexible rosters to support work/life balance including part-time, fixed term or locum work, we’ll give you access to the latest technology and equipment (including OCT in every store) and we’ll pay you a competitive salary. We can also provide you with excellent opportunities for career development and progression – including pathway to Partnership. Highest package ever! $180,000 for the growing Mobile Optometrist Role Specsavers is growing our community based Mobile Optometry Team across Australia. With an amazing $180,000 package on offer including 5 weeks annual leave, professional registrations, and travel/accommodation are covered. You will experience a wide variety of cases, whilst being able to explore different regions of Australia. We are looking for someone who has the desire and flexibility to travel.
& QLD.
Be equipped with the latest ophthalmic equipment (including OCT in every store for use with every patient) and develop your clinical experience across a range of interesting conditions and an ever-growing patient base.
our
2022 CALENDAR To list an event in our calendar myles.hume@primecreative.com.auemail: SPECSAVERS – YOUR CAREER, NO LIMITS SPECTRUM-ANZ.COMVISIT SO LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership opportunities enquiries: Kimberley Forbes on +61 (0) 429 566 846 or kimberley.forbes@specsavers.com Australia Optometrist employment enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134 Locum employment enquiries: Cindy Marshall cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard –Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499 Graduate employment apac.graduateteam@specsavers.comenquiries:
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 which provides newly qualified Optometrists with a dedicated Mentor, support network and structured program to assist you in your development.
You’ll also have the support of an experienced dispensing and pre-testing team, the mentorship of store partners and access to an exemplary professional development program.
storesSpecsaversAllnowwithOCT SEPTEMBER 2022 BARCELONA SPECS Barcelona, Spain 3 – 4 September barcelonaspecs.com SPECSAVERS CONFERENCECLINICAL 10Australia–11September scc2022.com.au INTERNATIONAL VISION EXPO WEST Las Vegas, US 14 – 17 September west.visionexpo.com EUROPEAN SOCIETY OF CATARACT & REFRACTIVE SURGEONS Milan, Italy 16 – 20 September congress.escrs.org SILMO PARIS Paris, France 23 – 26 September silmoparis.com OCTOBER 2022 CCLSA ICCLC 2022 Sydney, Australia 15 – 17 October icclc2022.com.au PROVISION CONFERENCENATIONAL Melbourne, Australia 21 – 23 October eventbrite.com.au EYECARE PLUS NATIONAL CONFERENCE 2022 Broadbeach, Australia 28 – 30 October web.cvent.com RANZCO 53RD SCIENTIFIC CONGRESS Brisbane, Australia 28 October – 1 November ranzco2022.com ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE Brisbane, Australia 28 – 31 October orthoptics.org.au NOVEMBER 2022 HONG KONG INTERNATIONAL OPTIC FAIR Hong Kong 9 – 11 November event.hktdc.com ASIA OPTOMETRICCONGRESSOPTOMETRIC&AEGEANCONFERENCE Kuala Lumpar, Malaysia 15 – 16 November asiaoptometriccongress.com/ 3rd-asia-optometric-congress FEBRUARY 2023 ANZGS CONGRESS Queenstown, New Zealand 16 – 19 February anzgsconference.com APRIL 2023 ARVO 2023 New Orleans, US 23 – 27 April arvo.org/annual-meeting SEPTEMBER 2023 O=MEGA23 & 4TH WORLD CONGRESS OF OPTOMETRY Melbourne, Australia 8 – 10 September omega-event.org
The CERA-UniMelb collaborative team have achieved exactly this by utilising the physical properties of water which absorbs and is energised by near infrared light with peaks at 1490 nm and 1940 nm. Thus, dehydration of the subretinal space around the tear is achieved by the laser aided by a coaxial low flow air stream to displace liberated water molecules. With the retina and RPE in contact, photocoagulation seals the tear intraoperatively. The retina can reattach itself physiologically. In their most recent paper, using an in vivo RD model, the team shows that the RTF approach achieved stable retinal reattachment.8
In terms of next steps, the funding for translation of this method to clinical care includes the development of a precommercial laser/air stream console and a preclinical trial recruiting 10 patients with “macula off” rhegmatogenous retinal detachment from the Royal Victorian Eye and Ear Hospital (East Melbourne, Victoria) in early 2023. Should the retinal thermofusion technique prove beneficial in a clinical trial, it should be a significant step forward in patient care.
n
The RTF approach being independent of tamponade has the potential for better visual outcomes, a faster return to normal activities for most patients, and should eliminate the need for a second procedure for liquid tamponade removal in those with more complex problems.
For over a century, RD repair has been based on the principles established by Jules Gonin,2,3 which involves thermally injuring the retinal tear(s) and underlying tissues and bringing them into contact. Tissue injury creates a “glue” but for wound healing to create a seal, both tissues must be held in contact for Intraocularweeks.gasblurs vision and a liquid (usually silicone oil) requires additional surgery to remove it. The current methods not only delay return to normal activities, prohibit air travel, and sometimes necessitate additional surgery, but can also have a negative impact on the quality of vision. Draining subretinal fluid to create space for the gas or oil is increasingly being recognised as causing worse visual acuity, more distortion, retinal fold formation or even macular displacement.4,5
R blindness when fluid flows through a tear or hole like a tyre deflating from a puncture. The most common repair method nowadays is to remove the intraocular vitreous gel, reposition the retina and fill the cavity with supportive gas or oil while the laser “spot welding” of the tear Revisitingmatures.thebasic principles of tissue repair led to the concept that the tear could be fused to the underlying tissue by eliminating the fluid separating them before laser photocoagulation, a method called retinal thermofusion (RTF).1 Intraocular gas prohibits aeromedical evacuation of injured personnel and prompted the US Army Medical Research and Materiel Command to prioritise the development of a method for RD repair independent of gas tamponade. Based on the RTF concepts, a collaborative
The ideal method for RD repair should eliminate the cause – the retinal tear –and allow the retina to re-attach itself by physiological mechanisms, including retinal pigment epithelial (RPE) pumping and the oncotic gradient between the vitreous and choroid.6-8 Differences between the conventional surgical approach to retinal detachment and the new retinal thermofusion method.
SOAPBOXANOVEL
METHOD FOR RETINAL DETACHMENT REPAIR
Position: Associate Professor Location: University of Melbourne Years in profession: 40 THE METHODIDEALFOR RD REPAIR MECHANISMS.BYRE-ATTACHTHE–RETINALCAUSEELIMINATESHOULDTHE–THETEARANDALLOWRETINATOITSELFPHYSIOLOGICAL team at the Centre for Eye Research Australia (CERA) and the Department of Optometry and Vision Science at the University of Melbourne (UniMelb) secured those funds and developed a novel method and device. We have now secured additional funding to facilitate translation of the RTF method into clinical care.
58 INSIGHT September 2022
NOTE: References can be found in the online version of this article.
In terms of vitreoretinal surgery, how big of an impact could this new approach have?
An important feature of this water absorbing wavelength is that it initially treats the tear margin at low power evaporating the subretinal fluid and then photocoagulating it at a higher power. Thus, the seal can be created with one device and it is an intuitive method for surgeons already trained to laser retinal tears. The additional time for the dehydration is offset by the elimination of the steps introducing the gas.
Name: A/Prof Wilson Heriot Qualifications: MB BS, FRANZCO Organisation: Centre for Eye Research Australia, Department of Surgery, Ophthalmology, and the Department of Optometry & Vision Sciences
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At OPSM, are obsessed with eye care and offering our customers the confidence in how they see the world. Our advanced technology enables us to look deeper to ensure give the best care to every customer. join OPSM, work with world class technology including the Optos Daytona ultra wide field scanner. have many opportunities for continuing professional development through financially supported industry training, mentoring, graduate induction, peer learning communities and product training. are rewarded with a competitive salary and bonus scheme to recognise your contribution. have career flexibility through our extensive store network. Most importantly, can make a real difference in the way people see the world not only from consulting room but also by participating in OneSight outreach program.
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