39 minute read
CHANGING WORKFORCE
THE CHANGING WORKFORCE
In the last decade, the optometry workforce has become more feminised and younger, while in ophthalmology women are demanding greater representation and recognition. RHIANNON BOWMAN meets the women striding forward.
As a graduate, independent New South Wales optometrist Ms Yang Wang never envisaged a career that would allow her to run a successful business with a young family.
But as her career has progressed, she’s come to appreciate the fulfilment she continues to get from her work, while managing perhaps her most important job – motherhood.
“Optometry is an ideal career for raising a family, partly because you can plan work around family. The hours are generally nine to five, no late nights, and it’s relatively stress-free,” Wang, the mother of a two-year-old child, says. “And it’s rewarding, especially when you can establish patient contact for life.”
Today Wang – the owner and principal optometrist at Eyecare Plus Corrimal – can count herself among the majority in an Australian optometry workforce that is increasing in size, becoming more female and younger.
Aged between 30 and 34, she is one of 533 female registered optometrists in Australia, the largest age group, second only to the 25-29 cohort, which has 805
female registered optometrists, according to Optometry Board of Australia (OBA) statistics.
Combined, women in these two age groups make up the largest contingent of a profession that is now 56% female and 44% male, according to OBA data from 1 April 2020 to 30 June 2020.
It was a different picture in 2012 when Wang and her then-boyfriend moved to Australia. Then, the profession was 47% female, 50% male, (with the remaining unspecified).
According to Optometry Australia (OA), in general, younger workforces want more flexible employment, often to fulfil caring responsibilities, and opportunities to continually learn and develop.
This is true for Wang, who grew up in New Zealand and graduated from the University of Auckland (therapeutically endorsed) in 2011, with her now-husband, Mr Roland Mak.
The couple moved to Australia in 2012 due to greater job opportunities. She was attracted to working in a rural setting because she wanted exposure to a variety of ocular pathologies and to practise to her full scope.
As a first-time business owner and parent, she says that timing is important when managing family life with running Eyecare Plus Corrimal with her husband.
Supportive staff, who are also female, have helped and the support of a group such as Eyecare Plus has been invaluable, Wang says. And after taking a brief time out of the business on maternity leave, she eased back into her professional role, working one day a week and slowly building up.
MS YANG WANG PRACTICE OWNER
Balancing parenthood and operating a successful practice, throughout a pandemic and upcoming practice renovations – in the same year – is no small feat. Attributes she didn’t initially appreciate, such as the flexible hours, help make it a rewarding career choice.
“Getting the balance right means utilising and maximising your time at work, and at home, and prioritising what’s important – don’t fuss over the little things,” she says.
“Optometry, as a career, offers an opportunity for work-life balance, and that’s valuable.”
LEADING BY EXAMPLE For ophthalmologist Associate Professor Anne Brooks, the biggest hurdle she has overcome in her career is work-life balance. It’s a challenge she highlighted in an interview with RANZCO to celebrate International Women’s Day in 2018, and one she believes continues to top the list for most ophthalmologists, regardless of gender.
“Life is always a balancing act and ophthalmology is a very involved profession. Beyond the clinical, many of us work in research, run businesses, do administration, teach and serve on committees and advisory boards,” Brooks says. "LIFE IS ALWAYS A BALANCING ACT AND OPHTHALMOLOGY IS A VERY INVOLVED PROFESSION"
A/PROF ANNE BROOKS COLLEGE MEDAL RECIPIENT
“Finding time to balance the myriad of ‘home’ roles in addition to these is difficult. The balancing act has traditionally been one done by women more than men, and while this is still probably the case, many men are now trying to achieve balance too. That is a good thing.”
Highly regarded in ophthalmology and teaching, Brooks has received RANZCO’s award for Excellence in Training eight times and in 2019 became the first female to be awarded the College Medal, RANZCO’s highest honour, following 28 male awardees.
“It is a great honour to have been recognised in this way, and something I had never dreamed of. It has increased the respect of my colleagues,” Brooks, who works in private practice and at the Royal Victorian Eye and Ear Hospital, and specialises in glaucoma and cataract, says.
“I am hopeful that it will inspire more nominations from colleagues that recognise the outstanding work being done by so many other women in the College. We don’t work for recognition, but it is nice to receive it.”
The award was presented by RANZCO’s president Associate Professor Heather Mack, the first female president in the college’s 50-year history who ends her two-year tenure this month.
The achievements of both Brooks and Mack in a traditionally maledominated profession may help to demonstrate how the profession is changing.
However, the figures suggest there is some way to go until ophthalmology reaches parity. Although numbers are trending upwards, Australian Government figures from 2016 show males represented 79.5% of clinicians, and were aged 54 years on average. By contrast, females represented 20.5% of clinicians and were aged 48 years on average, six years younger than their male counterparts.
In 2016, there were 95 male trainees and 51 female. Today, RANZCO boasts 80 female trainees, and 298 female Fellows.
Despite this, female representation is increasing in ophthalmology, coinciding with RANZCO releasing a 2019-2020 Women in Ophthalmology Strategic Plan in late 2018.
Although only indirectly involved, Brooks says one rationale of the strategic plan was to focus the efforts of the Women in Ophthalmology (WIO) Advisory Group.
“The WIO Advisory Group is about 20 Fellows and trainees who have an interest in taking a more hands-on approach to gender issues. Determining what to do, how to start and how to measure success really drove the need for a plan,” she says.
The strategic plan was a communication tool to articulate to members what the WIO want to achieve and how this can occur, and was seen as a way to democratise decision making in terms of deciding focus areas, Brooks says.
“The plan was put together by asking Women in Ophthalmology Luncheon participants at the 2018 annual RANZCO Scientific Congress to identify all areas of concern and then hone these down. All refined ideas were then circulated via a survey, open to all female Fellows and trainees,
and there was a request to rank these. The top three areas became the three pillars of the plan: awareness, recognition and engagement.”
To illustrate the strategic plan in action, Brooks points to the recent accomplishment of a high-achieving colleague.
“Professor Justine Smith, a Matthew Flinders Distinguished Professor at Flinders University, is an internationally recognised expert in the causes, effects and treatment of uveitis. Her work is both clinical and by research,” Brooks says.
“She was recently appointed as the first female editor-in-chief of the RANZCO Journal Clinical and Experimental Ophthalmology and is the first female editor-in-chief of a major ophthalmology journal.”
In her role training the next generation, Brooks says young female ophthalmologists largely aspire to subspecialisation, which usually involves a period of training overseas, but this has currently been affected by COVID-19.
BREAKING THE GLASS CEILING Dr Alina Zeldovich is an anterior segment ophthalmologist, business owner and director at Eye Associates in Macquarie Street, Sydney. She’s also from a refugee family who arrived in Australia without knowing a word of English.
She has overcome many hurdles to become a high-achieving member of the ophthalmic community, which also involves roles within RANZCO. She believes ophthalmology has traditionally been a difficult career to enter because of a lack of government-funded training positions.
“While there have traditionally been obstacles that affected women in particular, this is certainly changing. I think the glass ceiling is gradually being broken and many changes have occurred since I started my training in 2002, which have helped advance the careers’ of women,” she says.
Research on gender differences amongst Australian and New Zealand ophthalmologists’ experiences of the workplace, published in 2019, showed that female ophthalmologists worked fewer hours, mainly in the private sector, to fulfil their greater family commitments.
Female ophthalmologists reported additional obstacles to career advancement and were more likely to report experiencing discrimination in the workplace.
Now, a shift towards increased flexibility, including part time training, and increased participation in College initiatives, is changing dynamics within the profession.
“A lot of work has gone into remodelling the RANZCO training program, this is also better for women. In particular, there has been focus on making the process more transparent by having clear guidelines on training admission requirements and training completion,” Zeldovich says.
“In most training programs part time training is permitted and this has really made things better for those who have a family. There are now larger practices with multiple associates or directors, which makes covering one another easier and this enables women to work sessions with flexible hours. It is always better to be able to spread on-call around more people.”
For Zeldovich, part time training also has other benefits for women.
“Doing exams during training rather than beforehand now means that no one is waiting for a position having invested time and money into passing the exams without being guaranteed one,” Zeldovich says.
“Women are also encouraged to participate on committees and special interest groups within the College. There is a Women in Ophthalmology network that runs in every state in Australia and New Zealand where women can get together to work through issues and provide support and collegiality.”
Under a Board initiative from 2015, RANZCO has encouraged 35% female representation on committees, which has been achieved in most states, Zeldovich says.
“The processes for obtaining training posts, jobs and College positions has become more transparent, so things have changed for the better.
“Having our first female RANZCO president and more female representation at Congress is real evidence of breaking through the glass ceiling. I believe with the right support, women can have a very satisfying career and achieve just as much in ophthalmology as men,” she says.
As previously mentioned, Zeldovich has had to overcome her own obstacles, including immigrating to a foreign country as the daughter of refugees who migrated from the Soviet Union to Australia in the late 1970s when she was pre-school aged.
Wanting to pursue a career that could have a significant impact on people’s lives – and coming from a family of doctors, including three of her four grandparents and both parents, who had to retrain in Australia – Zeldovich chose ophthalmology, where her career aspirations continue to grow.
Outside of her consultation rooms, Zeldovich is an active member of her profession; she was a co-convenor for RANZCO’s annual Congress in Sydney last year and is currently the vice chair of its NSW branch and a federal council member.
DR ALINA ZELDOVICH OPHTHALMOLOGIST
“It was a career highlight to be the co-convenor for the last RANZCO Congress. It was the largest Congress to date and had a female chair of the Scientific Committee, as well as the first female College Medal recipient and female RANZCO president,” she says.
“I aspire to be part of the College’s strategic plan and see its future as an advocacy body, an organisation which unites ophthalmic services and offers both members and the community valuable information on eyecare.”
A lecturer with the University of Sydney’s Faculty of Medicine and completing an MBA at UNSW Business School, Zeldovich hopes to gain business knowledge to help run organisations and promote eye health.
In addition to this, she has co-founded a business called Beamers that produces children’s sunglasses. It was established due to concerns that 80% of UV damage occurs before age 18, and is currently working with the World Society of Paediatric Ophthalmology and Strabismus on a consensus statement to be released later this year.
As her career to date demonstrates, Zeldovich credits ophthalmology for the range of options it presents.
“The most challenging part is the many years of training and exams, however after this there are many career options, from working in the public system to working in private or a combination of both. There is also the flexibility of working full time or part time, in one or several practices, and the ability to participate in research, work as a surgeon or not operate at all, be involved in RANZCO, or teach and mentor peers. There are many paths for women in ophthalmology that are not necessarily available in other surgical specialties.”
MS SOPHIE KOH PROSESSIONAL SERVICES ADVISOR
FOCUS ON FLEXIBILITY AND EQUALITY According to a study published in Clinical and Experimental Optometry in August, the number of registered optometrists in Australia has increased by 30.1% during the past decade, a rate that is greater than the population growth of the country (12.1%).
The study also found that new entrants to the optometry profession could be generalised as graduates of an Australian optometry program, female, aged in their early to mid 20s and qualified for therapeutic practice.
OA CEO Ms Lyn Brodie says the growing optometry workforce is favouring flexible employment.
“Over the last decade we have seen increasing feminisation of the optometry workforce, and an increase in the proportion of the workforce that is made up of younger cohorts. ‘Female optometrists’ and ‘young optometrists’ are, of course, not homogenous groups. However, as it is common across many professions, there appears to be a particular demand from women, and increasingly men, for more flexible employment conditions, often in order to enable them to fulfil caring responsibilities,” she says.
OA has been working to create a more open discussion across the sector on what is needed to create more flexible work conditions that work for optometrists and their employers.
“In the recent past we have worked with FlexAgility to provide advice, case studies and an education session addressing rights with regard to flexible work requests and examples of optometrists working outside typical full-time, standard practice hours arrangements. We also continue to support members one-on-one in their negotiations for flexible working arrangements,” Brodie says.
“There are promising examples across the sector of more flexible approaches being taken to employment arrangements. As the profession continues to evolve, we feel it will need to do better in accommodating flexible work, but also that changing technologies and practice hours may support ever-more flexible arrangements.”
In conjunction with the optometry workforce tipping to a female majority, so too is OA’s membership, albeit only marginally, Brodie says. The organisation is responding by providing women-centric advice on its website and through its member support services.
Brodie acknowledges the strong female leadership across the profession in academia, clinical practice, management and leadership roles in larger service providers and within the governance of entities that support optometrists, such as OA.
“We recognise the need to continue to support women to pursue fulfilling careers and leadership roles within optometry. The Women in Optometry section on our website has been created to support women’s career development. We offer support via advice available to all our members on our website, and one-on-one guidance and support via our Member Support team, around progressing a career in optometry, negotiating working arrangements and pursuing leadership in the sector.”
One of the people providing that support is national professional services advisor and optometrist Ms Sophie Koh.
She says the topics that younger female optometrists contact OA for advice about are broad.
“It ranges from career and contract advice to everyday professional, clinical, or legal issues with patients or their workplace. Generally, there are no major gender differences across the broad topics our membership reach out to us for,” Koh says.
MS LYN BRODIE OPTOMETRY AUSTRALIA
“However, as women in Australia still take on the lion’s share of care responsibilities in the family, whether that is looking after aging parents or children, almost all queries Optometry Australia receives regarding the topic of taking extended leave or a career break as result of caregiving and/or parental responsibilities, are from female optometrists.”
For a new parent, Koh says, the immediate questions are regarding the logistics of maintaining AHPRA registration, keeping up with CPD requirements and clinical hours to stay registered, while on an extended break.
“We also have a number of female members living overseas whilst being the main carer for young children, so upkeeping registration requirements can be complex.”
Koh says members returning to the workforce after several years contact OA for advice on returning to the sector; others have questions regarding working as a locum.
“There are also everyday HR and workplace flexibility questions that may arise due to maternity leave or returning to work. We help both employees and employers needing such advice,” Koh says. n
LOW VISION SERVICES AND BORDER RESTRICTIONS
THE LOGISTICAL HEADACHES ASSOCIATED WITH COVID-19 RESTRICTIONS ARE MOST PRONOUNCED IN BORDER COMMUNITIES. ORTHOPTIST MEAGAN ANDERSON DISCUSSES THE IMPACT IT IS HAVING ON LOW VISION CLIENTS AND CLINICIANS.
MEAGAN ANDERSON
"A NUMBER OF CLIENTS HAVE REFUSED OUR SERVICES PURELY BECAUSE WE ARE FROM THE 'BORDER BUBBLE'" A s an orthoptist working on the New South Wales and Victorian border, I can only describe this as being a case of doing what you can, while you can.
The border community sees itself as one, albeit with separate driving laws and constant competition for which side has the best coffee; and the health impacts are starting to become more apparent with increasing restrictions and heightened anxiety to follow the rules and exercise common sense as much as we can.
The sometimes vaguely-worded border permits for both clients and clinicians – and increased travel times for local and surrounding areas attempting to access essential health services (which are usually only present on one side of the border) – have led many community members to effectively become “hermits”.
They are avoiding health services because it is proving just too difficult to access. The associated risks of developing further eye and general health complications are high and have been reported elsewhere.
As a low vision orthoptist, my role incorporates functional vision assessments, strategy and equipment recommendations, and counselling through vision loss. The rates of depression and anxiety skyrocket with any form of vision loss, more so in this current COVID-19 climate.
Trialling magnifiers and other reading devices is not appropriate via telehealth; for both the client’s (and clinician’s) peace of mind, a physical trial is required, particularly for funded equipment via the Department of Veteran’s Affairs or the NDIS.
The delivery, repairs and trial of devices, and the personal protective equipment (PPE) and increased time required to ensure our equipment and personnel do not inadvertently spread the virus, has become even more of a logistical nightmare in recent months.
Home visits are traditionally utilised because they provide better context of the client’s home and lighting environment and communication is easier when demonstrating strategies; for example, when watching television, and how to find and cut up food when the chopping board is in a dark corner of the kitchen. This is especially useful for our more rural clients, as our region covers a 200km radius (100,000km2 area), and access to equipment is otherwise extremely limited. In a single comprehensive session we will often assess, set up and provide training on equipment.
The travel restrictions, and particularly the inability to physically attend agedcare facilities, has restricted our efficiency in this area, and a number of clients have refused our services purely because we are from the “border bubble”.
Telehealth has been utilised as much as possible, but only works when the person on the other end has enough vision to see how to use their phone and/or computer in the first place. Additionally, “black holes” in internet coverage still exist in many areas, with some relying on just a crackly landline phone.
Joint telehealth and shorter face-to-face appointments have been utilised to some effect. Telehealth sessions provide time to counsel on the medical and functional aspects of vision loss, providing an opportunity to discuss and encourage ongoing reviews with clients who may have been otherwise told “there was nothing more they could do” and had refused to have another check-up for several years. Telehealth sessions have also provided an opportunity for clearer communication, strategies and training, ensuring they are as well supported as possible.
There have been other unexpected benefits via telehealth: one client in a particularly inaccessible area had a joint session via HealthDirect using the local nursing district; by explaining her inability to see her medication and daily glucose levels we were able to brainstorm strategies to ensure she would be supported as much as possible in both ocular and general health within her home environment.
The pandemic has created new challenges for the low vision sector.
The increased collaboration between our local low vision services, family members and friends (living locally and/or across the country), external health providers (especially hospital rehabilitation services and occupational therapists), and optometrists and ophthalmology clinics both during and outside appointments has become the largest benefit, from my point of view.
Many services previously unaware of the recent technological updates have had a crash course in equipment and software, particularly with clients with a visual and/or cognitive inability to read and are now stuck at home with nothing else to do.
It has been a hard few months, and will continue to be, but this period is making us all into more efficient clinicians. n
ABOUT THE AUTHOR: MEAGAN ANDERSON is the Vision Australia Orthoptist in Albury (NSW) and Shepparton (VIC). She has a Bachelor of Health Sciences/Master of Clinical Vision Sciences degree (University of Sydney).
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
MATCHING LENS AND FRAME CURVES
POOR LENS CURVE AND FRAME COMBINATIONS CAN LEAD TO DISSATISFIED CUSTOMERS AND TIME-WASTING REMAKES IN THE LABORATORY. MURRAY O’BRIEN DETAILS SOME OF THE MOST IMPORTANT CONSIDERATIONS IN THIS AREA.
MURRAY O’BRIEN
"THE ACTUAL PROFILE OF THE LENS MAKES A HUGE DIFFERENCE TO HOW ACCOMMODATING A FRAME WILL BE TO A RANGE OF LENS CURVES" F ront curve selection to ensure the best solution for each frame and lens combination is crucial to successful optical dispensing. Making the wrong choice or, more commonly, not making a choice at all can cause heartache, cost money and lose customers.
It can also assist your laboratory in saving costly and time-wasting remakes.
In this article I hope to offer some practical advice on front curve selection. But to understand the issue, it’s important to note some of the problems that arise from poor lens curve and frame combinations: 1. Flat lenses into a frame with a high eye wire curve makes the temple ends too wide (loose fit on the head). 2. Highly curved lenses into a frame with a flattish eye wire curve makes the temple ends too close (tight fit on the head). 3. Spectacles become unattractive or optically inappropriate. This is due to the extreme adjustment required because the frame is being distorted by inappropriate lenses. 4. Poor lens fitting results where the lenses are too highly curved for the frame design and tend to ‘pop’ along the upper eye wire. 5. Uncomfortable visual effects from inappropriate curves or inappropriate or extreme forced adjustment.
WHEN SHOULD I THINK ABOUT IT? When the frame rep comes to your practice and lays out the new and exciting stock, what are the range of prescriptions you think these frames will take? The major considerations are:
Frame shape: The actual profile of the lens makes a huge difference to how accommodating a frame will be to a range of lens curves. Perfectly round is the easiest shape of all.
The closer any of the edges of the shape are to being straight, the less accommodating the frame will be to getting a good lens fit with the widest range of prescriptions. The very shallow, oblong shapes of 15 or so years ago were by far the most troublesome frames for optical mechanics to fit from a shape basis.
Frame material: Make sure the frame material being offered in the frame is easily adjustable. Cellulose acetate, monel and stainless steel are frame materials that are generally very easy to manipulate.
Some thinner titanium frames tend to be very springy and adding extra curve in the frame with the frame benders can be very difficult. Some injection moulded plastics are impossible to adjust and cast titanium can be so stiff and brittle that they are unadjustable. If the frames are not easily adjustable, give them a miss, even if they look great, they will cause you heartache and grief in the end.
Frame construction: Before purchasing frames, have a good look at the construction. If the frame is very flat, will you be able to add some curve to the eye wires and then be able to adjust the temples out?
Sometimes if you come across a new design ask the rep if you can test the adjustability. It’s better to be safe than sorry being stuck with a frame that can’t be adjusted appropriately and easily.
THE PRESCRIPTION The dispenser must be fully aware of the patient prescription before becoming too involved in looking at frames. If the prescription is at the higher end of the range, let’s say over three dioptres, we may have to give serious thought to the front curve.
As the customer tries on each frame, have a look at the frame closely and think about the practicalities of getting their lenses into the frame and what refractive index or design lens we may need to use for the best fit.
Use a lens clock and measure the shape of the insert lens. That will give an idea of the ideal front curve that will
Correct front curve selection can prevent remakes in the lab.
give a nice fit without much adjustment being required.
How far will the customer’s new lenses stray from the insert curve if we make them from 1.5 index? Will we need to specify a four base rather than the normal six base? Will we need to do 1.6 index and use an aspheric design lens to make it even flatter?
In some cases with minus lenses we may need to stay away from aspheric designs as they will be too flat for a given frame and render the sides too wide.
In conclusion, all we can do in such a brief article is to encourage you to think. Look at the frame, look at the Rx. Use your experience to consider how the lab will make the lenses then think about if you need to ensure some extra specifications to make the completed spectacles as good as they can be. n
MURRAY O’BRIEN owns Designed Eyes in Rosebud, Victoria, where he works in full retail optics. He is also past president of the Australian Dispensing Opticians Association (Vic) and has previously worked in lens fitting work, specialising in rimless.
INFORMED MEDICAL CONSENT
INFORMED CONSENT CAN BE A COMPLEX AREA OF MEDICINE, ESPECIALLY WHEN THE PATIENT IS INCAPABLE OF DOING SO THEMSELVES. KAREN CROUCH SAYS PRACTITIONERS NEED TO UNDERSTAND THEIR RIGHTS AND RESPONSIBILITIES.
KAREN CROUCH
"FAILURE TO OBTAIN AN INFORMED CONSENT PRIOR TO TREATMENT COULD LEAD TO A CLAIM OF ASSAULT AGAINST THE PRACTITIONER" It is imperative to obtain consent – or permission to proceed – from a patient prior to providing medical treatment.
It is of greater importance that the permission to proceed with the recommended treatment is an “informed consent”. A patient must understand all of the issues associated with the treatment before they can make a proper and informed decision to proceed.
Issues that should be discussed with a patient include the nature and consequence of treatment, risks involved, alternatives available and the possible impact of not receiving the treatment at all.
Failure to obtain an informed consent prior to treatment could lead to a claim of assault against the practitioner.
However, there are certain instances where the patient is unable to consent. In such situations, it is important to understand whether consent is necessary in the particular circumstance and from whom an alternative form of consent could or should be obtained.
Where immediate treatment is necessary to save a person’s life or to prevent serious injury, and that person is incapable of giving consent (for example, a patient is rushed into the emergency ward with serious head injuries and is not sufficiently lucid as a result), the practitioner may proceed with medical treatment without consent.
This is assuming that the treatment administered is, in the opinion of the practitioner, the most appropriate to apply.
However, despite the dire situation described herein, the presence of an unequivocal written direction not to treat in the manner required may prevent the practitioner from proceeding.
This is a complex area of the law and practitioners may need to obtain further advice before proceeding in these circumstances.
When it is not a life-threatening situation and there is reasonable time to identify and contact the ‘person responsible’ for
Practitioners are required to discuss the nature and consequences of treatment with patients.
the patient, the following rules apply:
The following person/s or authority are responsible for:
A minor: • Where the minor has a parent or guardian – the parent or guardian. • Where the minor is in the care of the state – Department of Community
Services.
A person over 16 years (In accordance with the Guardianship Act 1987 hierarchy): • Guardian. • Appointed Guardian. • Spouse or de facto. • Carer. • Close relative or friend.
When obtaining consent from the person responsible it is important to provide him/her with the same information that would be provided to the patient so that the person responsible can make an informed decision on behalf of the patient.
There is no obligation to accept the position of ‘person responsible’ and a person may decline in writing to take on this role.
A practitioner is also entitled to certify, in writing, that a particular person is incapable of assuming the role of ‘person responsible’ where they feel that person is unsuitable to perform the role. A supporting reason for the certification is recommended to address any subsequent challenge to the opinion.
In the case of minor treatment, and where the person responsible cannot be found, a medical practitioner may make the decision to go ahead with treatment as long as it is necessary, appropriate (for example they would clearly qualify as a ‘minor’ treatment), and there is no objection from the patient.
It is important for medical practitioners to understand their rights and responsibilities in relation to medical consent.
This can be a very complex area of medicine/law and you should contact your medical defence organisation, otherwise known as MDO, when encountering a situation you are unsure of. n
KAREN CROUCH is Managing Director of Health Practice Creations, a company that assists with practice set ups, administrative, legal and financial management. Contact Karen on 0433 233 478, by email kcrouch@hpcnsw.com.au or visit www. hpcgroup.com.au
SPECSAVERS – YOUR CAREER, NO LIMITS VISIT SPECTRUM-ANZ.COM SO LET’S TALK! In a few short years, Specsavers has achieved market SRS – Optical Assistants and Dispensers available across Australia At Specsavers, our vision is to passionately provide the best value eye care to everyone, simply, clearly and affordably, exceeding customer expectations every time. We are currently seeking dedicated and experienced All Specsavers stores now with OCT optical assistants and dispensers to join our Specsavers family. We have full and part-time opportunities leadership in Australia and New Zealand with more available across Australia. We will provide you with a fantastic working environment with a supportive team and the people choosing to have their eyes tested and buy opportunity to deliver optimal patient care. their prescription eyewear from Specsavers than any Full/Part-time and fixed-term Optometrists, multiple locations across QLD/NT other optometrist. To learn more about these roles, 2020 has certainly brought some challenges, but now we are seeing the light at the end of the tunnel. Our stores are busier or to put your hand up for other roles as they emerge, than they have ever been, and we are looking for passionate and patient-focused optometrists to join our Specsavers please contact us today: family to help us continue to deliver quality and cost effective eyecare to our communities across regional QLD and the NT. Joint Venture Partnership (JVP) enquiries: Specsavers can offer an excellent work environment, market leading equipment – including OCT in every store, experienced Maria Savva – Partner Recruitment Manager retail support teams and a host of professional development opportunities. There are a range of full-time, part-time and maria.savva@specsavers.com or 0401 353 587 fixed-term positions available. NSW/ACT, SA & WA enquiries: Graduate Optometrists – Darwin, NT Madeleine Curran – Recruitment Consultant The Specsavers Graduate Recruitment team is currently recruiting two graduate optometrists to join their teams in Darwin. madeleine.curran@specsavers.com or 0437 840 749 If you are looking to make a difference in a smaller community, for a new challenge, or perhaps a fresh start – a move to QLD/NT & VIC/TAS enquiries: Darwin could be the opportunity for you! If you want to make a genuine impact, and deliver patient-centric, evidence-based Marie Stewart – Recruitment Consultant preventative eye care and work collaboratively to manage health outcomes, then we urge you to talk to us about how marie.stewart@specsavers.com or 0408 084 134 you can join the mission to transform eye health. Also, if you relocate with a friend, you will avail of our ‘Go with a Friend’ Locum employment enquiries: incentive. Cindy Marshall – Locum Team Leader Optometrist JVP Opportunity – Hobart, TAS: cindy.marshall@specsavers.com or 0450 609 872 An incredible opportunity to become a Joint Venture Partner in our Hobart store! Specsavers Hobart is located within The New Zealand employment enquiries: Cat and Fiddle Arcade, which houses over 70 specialty stores including H&M, Target and Myer. The store itself is 164 sqm in Chris Rickard – Recruitment Consultant size, and boasts eight dispense desks, four test-rooms and three pre-test rooms, with over 1,160 frames on display. chris.rickard@specsavers.com or 0275 795 499 Specsavers Recruitment Services – Locums across Australia and New Zealand: Specsavers Recruitment Services (SRS) is the in-house recruitment support to Specsavers 400+ stores across ANZ. The team is made up of seven experienced recruiters who act as the liaison between you and our stores to secure you the greatest opportunity to work in locations that suit your needs best, in either a full, part-time, casual or locum roles. The team will manage every stage of the recruitment and placement process. They’ll work with you to find suitable matches – ensuring opportunities with Specsavers are always at your fingertips. To find out more about our services please contact us today.
Graduate employment enquiries: apac.graduateteam@specsavers.com
* Careers at EyecarePlus® Optometrists
EYECARE PLUS OPTOMETRISTS
Eyecare Plus provides business support and marketing services to over 150 clinically focused independent full scope optometry practices throughout Australia. Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment. Eyecare Plus offers three membership options; branded, co-branded and unbranded. Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training.
We also actively assist Optometrists and Dispensers who are looking to establish their own practice. If you are looking to buy, or sell, an optometry practice, please contact us.
For more information call Philip Rose: 0416 807 546 or email: Philip.rose@eyecareplus.com.au.
OPTOMETRIST – GAWLER, SA
Eyecare Plus Gawler is currently seeking an optometrist to join the practice with very flexible working hours available. Enjoy professional autonomy in a full scope practice with all the latest equipment and support from an experienced team. To apply please contact Chris via phone on (08) 8522 7611 or via email; gawler@eyecareplus.com.au
OPTOMETRIST – GOLD COAST
The practice is located in the Miami One Centre, a short distance from the beach, and has a very good level of equipment and excellent support staff. A broad base of patients makes for an interesting clinical profile, and a high level of autonomy, with patient care being the primary focus. There is a full range of clinical optometry services offered to patients, including Orthokeratology and other forms of contact lenses. This is a very effective small team and a great opportunity to make your mark in a friendly and professional practice. To Apply: Please apply with your CV and cover letter to Mark Overton, Ideology Consulting. mark@ideologyconsulting.com.au
PRACTICE RETIREMENT – NSW REGIONAL HUB, INLAND MID-NORTH COAST LOCATION
The practice has been established for 40 years. The owner, who has operated this clinically driven practice from its foundation, is now looking to pass the practice into the hands of a new community minded owner. With a turnover well above $600k, this practice is now available on very favourable terms. If desired, the premises can also be acquired, or a long term lease will be offered.
The practice has an excellent local reputation with a loyal patient base and exceptional relationships with local General Practitioners and Ophthalmologists, receiving a consistent level of referrals. This regional administrative centre has great infrastructure with an airport and large higher education facilities. Easy access to the coast and Sydney makes this an attractive location.
Contact Philip Rose: philip.rose@eyecareplus.com.au or 0416 807 546
CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/ OPTOMETRIST: Miami, QLD. Gawler, SA. Practice Retirement, NSW.
20/21 CALENDAR
OCTOBER 2020
20TH EURETINA VIRTUAL CONGRESS Amsterdam, Netherlands, 2 – 4 October euretina.org
38TH CONGRESS OF THE ESCRS (VIRTUAL) Amsterdam, Netherlands 2 – 4 October escrs.org
AMERICAN ACADEMY OF OPTOMETRY MEETING (VIRTUAL) Nashville, USA 7 – 22 October academymeeting.org
118TH CONFERENCE OF THE GERMAN SOCIETY OF OPHTHALMOLOGY Berlin, Germany 8 – 11 October dog.org
RANZCO COUNCIL MEETING Australia 9 October ranzco.edu
INTERNATIONAL OPTICAL FAIR Tokyo, Japan 27 – 29 October ioft.jp
NOVEMBER 2020
OPTOMETRY NSW/ACT CANBERRA CONFERENCE Canberra, Australia 8 November optometry.org.au
OA ONLINE WEEK Australia 14 – 15 November orthoptics.org.au AAO ANNUAL MEETING Las Vegas, USA 14 – 17 November aao.org
OV/SA BLUE SKY CONGRESS 2020 Adelaide, Australia 20 – 21 November optometry.org
SILMO BANGKOK Bangkok, Thailand 25 – 27 November silmobangkok.com
DECEMBER 2020
14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS Brussels, Belgium 14 – 16 December egs2020.org
JANUARY 2021
OPTI 2021 Stuttgart, Germany 8 – 10 January opti.de
GLOBAL SPECIALTY LENS SYMPOSIUM Las Vegas, USA 20 – 23 January na.eventscloud.com/
100% OPTICAL London, UK 23 – 25 January 100percentoptical.com
CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: ASIAAUSTRALIA Bangkok, Thailand 29 – 30 January cophyaa.comtecmed.com EUROPEAN MEETING OF YOUNG OPHTHALMOLOGISTS Brussels, Belgium 30 – 31 January emyo2020@seauton-international
FEBRUARY 2021
MIDO EYEWEAR SHOW Milan, Italy 6 – 8 February mido.com
silmobangkok.com MARCH 2021
OA VIC BRANCH JULY SCIENTIFIC MEETING Victoria, Australia 27 March orthoptics.org.au
AUSTRALIAN VISION CONVENTION 2021 Gold Coast, Australia 27 – 28 March optometryqldnt.org.au
silmobangkok.com APRIL 2021
BARCELONA SPECS Barcelona, Spain 10 – 11 April barcelonaspecs.com
JULY 2021
APOTS MEETING Bali, Indonesia 1 – 4 July apots2020.com
apots2020.com AUGUST 2021
OPHTHALMOLOGY UPDATES! Sydney, Australia 28 – 29 August ophthalmologyupdates.com
To list an event in our calendar email: myles.hume@primecreative.com.au
5TH ASIA-PACIFIC GLAUCOMA CONGRESS Kuala Lumpur, Malaysia 13 – 15 August apgc2020.org
SEPTEMBER 2021
O=MEGA21 Melbourne, Australia 2 – 4 September omega21.com.au
SILMO PARIS Paris, France 24 – 27 September en.silmoparis.com
EUROPEAN ASSOCIATION FOR VISION AND EYE RESEARCH CONGRESS Nice, France 30 September – 2 October ever2020.org
OCTOBER 2021
AUSCRS 2021 Noosa, Australia 20 – 23 October www.auscrs.org.au
NOVEMBER 2021
RANZCO ANNUAL SCIENTIFIC CONGRESS Brisbane, Australia 19 – 23 November ranzco.edu
DECEMBER 2021
14TH ASIA-PACIFIC VITREORETINA SOCIETY (APVRS) CONGRESS Chinese Taipei 10 – 12 December 2021.apvrs.org
SOAPBOX
ADDRESSING BLINK INEFFICIENCY
Although blink efficiency is an essential part of the lacrimal functional unit, it has too frequently not received enough attention from clinicians who are focused on remediating other tear dysfunctions.1
However, researchers have been increasingly interested in blink performance with multiple studies showing how anomalies, such as an abnormally high ratio of incomplete blinks, can detract significantly from blink efficiency and efforts to reduce dry eye or dry contact lens symptoms.
Incomplete blinks increase ocular surface exposure and impair meibomian gland secretion. Because complaints of discomfort and dryness are very common, blink efficiency exercises have great potential for helping many patients. However, to achieve good outcomes, the action of giving patients a handout with detailed instructions for improving blink efficiency, most definitely needs to be supported by an explanation of the importance of efficient blinking in the maintenance of tear functions by the practitioner involved.
Guidance as to how exercises can be performed appropriately is also required. Consulting room time can be saved if support staff are trained to competently demonstrate an efficient blink practice session so that patients can go home having learnt how to perform blink efficiency exercises as specified in their handout (complete,
soft, brief and natural looking).
Having multiple descriptors for these specifications helps. For example, if a patient’s initial efforts are not soft enough (too much hard squeeze force involved) then describing the desired soft complete blink as light, relaxed and gentle can improve their understanding of what is required. It can help to add the comment that while their initial squeeze blink effort for ‘completeness’ was good for completeness, such hard squeeze blinks take too long as well as looking unnatural when compared to complete, soft, brief and natural looking blinks.
In addition, it can be worth noting that hard squeeze blinks can attract the wrong kind of attention from work colleagues or family members who observe a blink practice session.
Tim Ho recently had a patient who asked for a letter which explained why he was practising squeeze blink closures. The patient’s lawyer is defending the patient against a sexual harassment claim made by one of the patient’s co-workers.
Nevertheless, there are many adherents to prescribing blink exercises which involve frequent sessions of voluntary prolonged ‘squeeze’ or ‘forced’ blinks and this approach has been supported by a very recent study (Kim et al. Therapeutic benefits etc. Cont Lens Ant Eye 2020). However, squeeze blink exercises involve intraocular pressure elevations of as much as 90mmHg (Coleman and Trokel. Direct-recorded IOP etc. Arch Ophthalmol 1969) and so are adverse for patients with or at risk for developing a baropathic disease such as glaucoma, axial and degenerative myopia, as well as keratoconus and other ectatic diseases.
Squeezed blinks have been shown to increase lipid secretion in unselected subjects but for patients with obstructed meibomian glands that outcome is less likely. Squeeze blinks may actually have an adverse overall effect with initial increased lipid flow from some unobstructed glands being the limit of benefit. The lipid reservoir in glands can be too easily depleted because gland recovery to normal lipid reservoir levels for optimally functioning glands which have been emptied has been found to take over two hours. Consequently, ‘squeezed’ lipid flow appears likely to be followed by a relapse to an absence or major reduction of flow during a very extended gland recovery period.
Practising blinks which are complete, brief, soft and natural looking has the potential to be immediately therapeutic because complete blinks increase tear layer thickness, help to distribute mucin over a desiccated epithelium, and improve lipid flow according to the normal capacity for complete blinks to promote secretion. In addition, they promote the establishment of a motor memory of efficient blinking which helps to compensate for low blink rates that occur during periods involving reading and screen-based activities. Unfortunately, squeeze blinking practice sessions have the potential to destroy that kind of motor memory.
Copies of the updated Blink Efficiency Exercises handout are available from: c.mcmonnies@unsw.edu.au. n
1. McMonnies CW. Diagnosis and remediation of blink inefficiency. Cont Lens Ant Eye; Published ahead of print May 2020.
Name: Charles McMonnies Qualifications: DSC Workplace: School of Optometry and Vision Science, University of New South Wales Position: Honorary Professor Location: Sydney Years In The Profession: 58 BECAUSE COMPLAINTS OF DISCOMFORT AND DRYNESS ARE VERY COMMON, BLINK EFFICIENCY EXERCISES HAVE GREAT POTENTIAL FOR HELPING MANY PATIENTS
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