INSIGHT October 2021 by Prime Creative Media

INSIGHT OCT

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

27G

Ophthalmologists are at odds with the new Cataract Clinical Care Standard for two reasons.

DRY EYE THERAPIES IN AUSTRALIA The arrival of new treatments is welcome, but Australia has often lagged behind.

CLINICAL STANDARD DRAWS MIXED RESPONSE

LESS INVASIVE MORE PRECISE

WHAT'S NEXT FOR GEORGE & MATILDA? The collective will soon unveil more acquisitions as independents seek security.

Ever thought about relocating to Queensland’s beautiful East Coast? We’re continuing the expansion of our network with new stores opening throughout 2021 and 2022. So why not leave city life behind and aim for a better blend of work and lifestyle, from Brisbane to Cairns and everywhere in between? Talk to us now about the opportunities in one of our new or existing locations. For more information, contact Marie Stewart on 0408 084 134 or email marie.stewart@specsavers.com.

INSIGHT OCT

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

CONTROVERSY OVER AUSTRALIA'S FIRST CATARACT CLINICAL CARE STANDARD

The release of the nation’s first Cataract Clinical Care Standard has been met with mixed reaction, drawing both opposition and support across the ophthalmic sector. Ultimately, it has failed to win the support of the Australian Society of Ophthalmologists (ASO) and RANZCO, with the college citing two major issues. However, proponents of the standard have questioned the interpretation of some aspects. Meanwhile, Optometry Australia has endorsed the final standard, along with Orthoptics Australia, among others. The Australian Commission for Safety and Quality in Health Care (ACSQHC) has spent several years developing the inaugural Cataract Clinical Care Standard, which

determinant for surgical intervention, while 54% dismissed Snellen acuity as an appropriate measure to prioritise patients for surgery.”

was launched in August. Conjoint Professor Anne Duggan, ACSQHC chief medical officer, said it would ensure cataract treatment was appropriate and more efficient, with clear identification of patients more likely to benefit from surgery. In a memo to fellows and trainees, president Professor Nitin Verma said RANZCO won’t endorse the standard because it didn’t agree with the inclusion of 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery. RANZCO applauded the ACSQHC for developing the standard, which it described as “robust”, aside from the two matters it disagreed with. “In particular, our concern regarding Snellen acuity as a

Cataract

Clinical Care Standard August 2021

16/8/21 16/8/2 4:38 4:38pm pm

Australia’s first Cataract Clinical Care Standard has caused division.

prioritisation factor for cataract surgery does not align with any international standard,” Verma said. “The survey of the [RANZCO] fellowship earlier this year showed that over 80% of the respondents advised that a correct acuity of 6/12 is not the most important

Further, RANZCO “strongly disagreed” with the need to routinely discuss same or following day second-eye surgery. Around 96% of respondents to the fellowship survey do not provide such a service. “A similar percentile have views that same day sequential cataract surgery should not be offered as a routine alternative to surgery performed on separate days,” Verma said. Although he acknowledged these were only part of the standards, he said RANZCO continued page 8

NEW WARNING FOR VISITING OPHTHALMOLOGISTS The inability of visiting ophthalmologists to perform sightsaving treatments in cross border communities during lockdowns has re-emerged, prompting industry bodies to step in to rectify the issue. The Macular Disease Foundation Australia (MDFA) recently told Insight that several ophthalmologists from Sydney – where COVID-19 cases have surged since July – had their travel exemptions rejected by ACT Health. This meant they couldn’t attend scheduled Canberra clinics that included a significant number of patients requiring intravitreal injections. A near identical issue

occurred last year when visiting ophthalmologists from South Australia were prevented from attending their regular clinics in the regional Victorian city of Mildura. This was because SA health authorities refused to allow an exemption, meaning they would have had to quarantine for two weeks on return to Adelaide. It meant many Mildura patients were cut off from ophthalmological care for eight months. As a result, ophthalmic organisations prompted calls for state governments to develop a nationally-agreed definition of an essential worker – that included healthcare professionals – as well as a nationally agreed standard for

a COVID-19 hotspot. In the recent NSW-ACT situation, MDFA made representations to the ACT health minister’s office explaining the essential and urgent nature of intravitreal injections. “The previous decision to decline entry was overturned but the advice to visiting ophthalmologists is to specify that travel is to undertake essential and urgent treatment that cannot be provided by other generalist providers,” MDFA CEO Ms Dee Hopkins said. “Like everyone else, visiting specialists also have to adhere to jurisdictional restrictions.” Hopkins has since approached RANZCO and asked the college to continued page 8

IT'S ALL ABOUT THE AQUEOUS FLOW In glaucoma, there's growing evidence to suggest that the ability to re-establish the natural flow of aqueous humour plays a critical role not only in IOP, but in also preserving the health of the corneal endothelium. page 20

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IN THIS ISSUE OCT 2021

EDITORIAL

FEATURES

DRY EYE RIPE FOR INNOVATION For a disease that once existed on the periphery of eyecare, it’s remarkable to consider the evolution of dry eye in Australia. Whether it’s better diagnostics and treatments, the environment, technologydependant lifestyles, or a combination of the above, eyecare practitioners are in little doubt dry eye disease (DED) is on the rise. A pivotal moment for DED came with the publication of the 2017 TFOS DEWS II reports that provided a comprehensive synthesis of state-of-the-art in the field.

THE LATEST IN DRY EYE Update on dry eye treatment in Australia followed by Insight’s inaugural Dry Eye Directory.

EXPANDED SUITE A new player has entered the local dry eye market with two new therapies.

DED's increased prevalence – validated through an evidence-based consensus – has provided an ideal platform for Australian eyecare professionals to launch dry eye services into their practice. In some instances, the business case is strong enough that some are establishing dedicated, standalone clinics. More than 120 of these clinics can be found on pages 28 to 49 within the inaugural Insight Dry Eye Directory. It provides a state-by-state listing of clinics offering comprehensive dry eye services, whom other practitioners can refer to.

STANDARDISED IMAGING Why sharing digital images from multiple devices remains a challenge in the ophthalmic sector.

SECURITY AND GROWTH George & Matilda Eyecare is primed to sign off on several new acquisitions.

EVERY ISSUE 07 UPFRONT

63 MANAGEMENT

09 NEWS THIS MONTH

64 OPTICAL DISPENSING

61 PEOPLE ON THE MOVE

65 CLASSIFIEDS/CALENDAR

62 ORTHOPTICS AUSTRALIA

66 SOAPBOX

The directory also features more than 120 therapies available in Australia, where practitioners can discover the most suitable treatments depending on the severity of the disease. They can also easily decipher available therapies for meibomian gland dysfunction/evaporative dry eye or aqueous deficiency, and whether they are available via the PBS. The final part of the directory features a list of diagnostic devices, with a selection of these innovative gadgets only brought into the country this year. With the ever-evolving nature of dry eye care, we hope this all-in-one resource will prove a valuable tool for local eyecare professionals. We look forward to it becoming an annual fixture in our magazine, with plans to build and expand on it in 2022. MYLES HUME Editor

INSIGHT October 2021 5

Today we help power 450 local rebels. Optometrists turned entrepreneurs, taking on the corporates. Those who put patients and care before bottom lines and sales targets. This is what we’ve been doing for over 30 years. We help make a passion for clinical care a business. From starting-up to selling-up, we are there to make sure they do more than just survive, but thrive. Bolstered by the buying power of hundreds of practices. Empowered to innovate, and guided by the best business coaches in town. Developing systems and campaigns that drive growth. This isn’t a buying group. This is success as a service. The home of eye-care entrepreneurs. Learn more at optom.provision.com.au

UPFRONT Just as Insight went to print, SPECSAVERS unveiled the winners of the respective Doug Perkins and Dame Mary Perkins medals. The company’s store in Hervey Bay Pialba, Queensland, and the Queenstown practice in New Zealand claimed the Doug Perkins Medal, an annual award recognising consistently high standards of clinical excellence and patient care. The Dame Mary Perkins Medal, introduced this year for exceptional acts of patient care, went to Ms Mariella Coluccio, of Specsavers

WEIRD

Bankstown, with her life-saving story of a 3-year-old after being turned away from hospital multiple times. The Kiwi recipient was Ms Celeste Raisbeck, from Specsavers Rotoura, for her outreach work with the Maori community. IN OTHER NEWS, The Australian College of Optometry (ACO) is opening its eighth clinic, Knox Eye Care, in Melbourne’s east. Located in Bayswater, the practice was set to open last month, with Ms Iris Huang appointed the role of site manager and optometrist. It comes after Wyndham Eye Care, located in Hoppers Crossing, opened in June to help meet unmet demand for accessible and affordable eyecare in Melbourne’s west.

FINALLY, with cancelled conferences and travel restrictions, four Australian ophthalmic equipment suppliers are hoping to provide an alternative local opportunity to showcase their range of devices and equipment. The event, O=PEN HOUSE, has brought together BOC Instruments, Device Technologies, Designs For Vision and OptiMed who will offer special sale and showcase events at each of their showrooms in Melbourne during 8-9 October, and in Brisbane 15-16 October. A NSW event will be scheduled when COVID-19 restrictions allow. Due to lockdown requirements, bookings are essential and dates may change.

STAT

WACKY

High profile Brit Piers Morgan has revealed a long list of symptoms after catching COVID-19 at the Euro 2020 finals, including headaches, fatigue and an inability to taste wine. But coughing fits have also caused a posterior vitreous detachment, which has meant he is now seeing floaters.

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WONDERFUL

Vision Australia has thanked the Illawarra community in NSW for its support in helping to raise $851,153 during this year's Seeing Eye Dogs Appeal. The donations collected at Petbarn stores around Australia were enough to fund 17 guide dogs. But the Illawarra community went beyond expectations by contributing $204,539.

Published by:

Publisher Christine Clancy

NSW Minister for Customer Service Mr Victor Dominello has been diagnosed with Bell’s palsy. He only sought medical attention after members of the public raised concerns over his “droopy eye” during a recent media conference. The politician felt pain in his skull, behind his right ear, about 48 hours earlier, before waking up with pins and needles on the right side of his tongue. n

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DEALING WITH DRY EYE It’s estimated around 85% of dry eye sufferers have the evaporative form of the disease. Full report page 23.

WHAT’S ON

Complete calendar page 65

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The Australasian Society of Cataract and Refractive Surgeons' annual conference is going digital due to COVID-19 restrictions. The face-to-face event will return in Noosa next year.

The 52nd congress is expected to be an opportunity to look towards the next 50 years of science, ophthalmology and the college.

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INSIGHT October 2021 7

NEWS

ADDRESSING PRIORITISATION AND EFFICIENCY continued from page 3

resisted parts of the standards being used in isolation by hospitals or private health insurers to determine funding for cataract patients. “We remain disappointed the ACSQHC have not listened to the experts when making a final decision about the standards, as apart from these issues, they are very robust,” Verma said. ASO vice president Dr Peter Sumich said the standard was “a poke in the eye” to ophthalmologists from RANZCO and the ASO who have “universally denounced it”. “Whilst falsely claiming to be consultative, it became clear it was a bureaucratic creation designed to allow manipulation of public hospital waiting lists to suit administrators,” Sumich said. “It is beyond embarrassing for the ACSQHC that their document purporting to represent current standards is out of step with contemporary Australian clinical practice from day one.” PRIORITISATION AND EFFICIENCY Professor Konrad Pesudovs, formerly foundation chair of Optometry and Vision Science at Flinders University, now SHARP Professor at UNSW, supports the standard. He was part of the ACSQHC committee who developed the standard and said it

was the work of a group of stakeholders involved in the cataract patient pathway, not only surgeons. “Surgeons have a very important role in performing operations, but they don’t have a role in public health, primary care or in the community,” he said. “This is important because this is where Australia’s problem with cataract exists. We have 10 times as many people in the age groups that get cataract today than we had 30 years ago, but we don’t do any more public cataract surgery than we did then.” He said three things were required: more public cataract surgery; ensuring the right people – most disabled – get surgery first; and greater efficiencies in service delivery. The standard helps address the final two points – prioritisation and efficiency. Pesudovs, whose opinions are his own and don’t represent any organisation, suggested objections to a visual acuity criterion of 6/12 may be misplaced.

activities.” Pesudovs said this was a wholly appropriate position. “The problem of the right people not getting cataract surgery remains. Therefore, the standard includes a section on the prioritisation for cataract surgery.” "WE REMAIN DISAPPOINTED THE ACSQHC HAVE NOT LISTENED TO THE EXPERTS WHEN MAKING A FINAL DECISION" NITIN VERMA, RANZCO

It includes Pesudovs’ Cataract Impact Model of prioritisation, on page 28. “We take clinical measures of vision, cataract grades and vision-related activity limitation questionnaire data and combine it in a model that ranks people in terms of need for surgery. This type of sophisticated prioritisation model can ensure the right people are directed to hospitals where RANZCO surgeons can do their job and take cataracts out,” Pesudovs said. Regarding bilateral sequential cataract surgery, he said the standard proposed it be used more widely. “This is a safe approach in the era of intracameral antibiotics that eliminates the issue of increased falls, and its associated mortality and morbidity, that occurs between first eye and second eye cataract surgery,” Pesudovs said.

He said it was not a recommended criterion. It reads: ”Visual acuity of 6/12 or worse may provide a useful objective measure of visual impairment but may significantly underestimate function – for example in conditions of high or low light. Glare or contrast sensitivity may be disabling without an impact on visual acuity. Some patients will have higher visual needs, such as occupational

“Bilateral sequential cataract surgery also offers significant efficiencies in terms of public hospital process in clinical appointments and admissions. This would help us to get more surgery done.” n

PATIENTS URGED TO KEEP CRUCIAL APPOINTMENTS continued from page 3

communicate to its fellows and trainees about the importance of being specific when applying for travel exemptions across Australia. RANZCO CEO Dr David Andrews subsequently sent an alert to Australian fellows, which said the issue may have arisen due to authorities not being aware that some services, such as intravitreal injections, were urgent and essential and cannot be provided by a local health professional such as a GP. “We advise making this clear on any applications. Unfortunately, RANZCO cannot intervene for you in this process,” he said to fellows. Meanwhile, the NSW restrictions has 8

INSIGHT October 2021

re-ignited concerns about apprehensive patients missing vital anti-VEGF appointments. The issue was a feature of lockdowns in 2020, when MDFA national research advisor Professor Paul Mitchell grew concerned that thousands of Australians were gambling with their vision. This was exacerbated in July when, in a press conference, NSW chief health officer Dr Kerry Chant used eye checks as an example of something that could be put off during lockdown, if people weren’t experiencing “pain or other issues”. At the time, the MDFA stepped in to clarify the matter and warn patients that any sudden changes in vision – even without pain – could be an eye emergency. It said deferring an eye

appointment in those circumstances could cause irreversible vision loss.

Dee Hopkins, MDFA.

However, the MDFA remained concerned about anecdotal reports of people cancelling eye injection appointments. At one busy Sydney clinic on a particular day in July, only 23 of 43 scheduled patients attended their appointments. “If this is a barometer of what is happening more broadly, the implications are quite concerning,” Hopkins said at the time. “Specialist eye treatments need to continue as scheduled as they are considered to be medically essential. “If you require injections for wet AMD or DMO or other macular conditions, it is essential that you attend your specialist appointment or discuss your treatment options with your ophthalmologist.” n

NEWS XX

WIDELY REVERED ACADEMIC OPTOMETRIST ‘WILL BE MISSED’

The academic community, including the University of California, Berkeley School of Optometry, has paid tribute to well-known Australian expatriate Dr Tony Adams, who passed away recently. “It is with great sadness that we announce the passing of Dr Tony Adams, who died peacefully, with family at his side,” a statement from the school said. “Tony, who served as dean of Berkeley Optometry from 1992 to 2001, was the quintessential academic optometrist; he confronted and removed barriers, won numerous awards, and served selflessly in positions of leadership.” Adams, who died on 16 July, completed his training at the University of Melbourne in 1962, served two years as a faculty member at Indiana University, and was then recruited to join the Berkeley faculty in 1968 at the age of 27, where he rose to prominence in both the school and the profession. He won multiple awards and occupied prominent positions, including within the American Academy of Optometry (AAO) where he was elected to the executive board in 1990 before serving as president from 1998-2000. He also served on the editorial board of Optometry and Vision Science and he was appointed editor-inchief (2004-15). Professor Konrad Pesudovs, formerly foundation chair of Optometry and Vision Science at Flinders University, described Adams as “Australia’s greatest optometrist”. “To me he was a great mentor and greater friend. Tony always had time for people. I would not have achieved one-tenth of what I have without his wise counsel,” he wrote in an online tribute. “The most extraordinary thing is that there are hundreds of people who feel like I do; that Tony was always there for us, had time, cared, didn’t judge and gave sage advice. He was a wonderful influence on many people.” He believed Adams was probably proudest of his leadership: “He was a great leader for the profession of optometry, not just in his leadership roles at Berkeley and the AAO, but in many fora.” In 2016, Pesudovs presented the Tony Adams Medal Lecture at Flinders University’s evidence-based optometry

IN BRIEF

Dr Tony Adams (left) with his colleague, friend, and fellow Australian Dr Ian Bailey.

conference to Adams, the inaugural recipient of the medal. Infamously, Adams was presented with a chocolate frog in lieu of the medal, which arrived a day late. “As always Tony took this hiccup in great humour,” Pesudovs recalled. Adams’ long list of accolades spanning decades include president, AAO (19982000); distinguished practitioner, National Academies of Practice in Optometry (1998); and president, National Board of Examiners in Optometry (1985–87). He also received honorary doctorates from Indiana University (2011), State University of New York (1999) and Pennsylvania College of Optometry (2001); Paul Yarwood Memorial Award (2003); Prentice Medal (2003) and Eminent Service Award (2004), American Academy of Optometry; California Optometry Educator of the Year (2004); National Optometry Hall of Fame (2004); president, American Optometric Foundation (2008); and the American Academy of Optometry Life Fellowship Award (2016). Optometry Australia awarded him Clinical and Experimental Optometry’s H. B. Collin Research Medal in 2012. In 2014 he was inducted into the Berkeley Optometry Hall of Fame, and last year he received the inaugural UC Berkeley School of Optometry Tony Adams Lifetime Achievement Award for his “impressive, important and enduring accomplishments” to the school and the profession. “Tony’s influence was extraordinary. He, along with his life partner Elna, who passed earlier this year, mentored and inspired generations of students, academics, future leaders and change makers. He will be missed,” a statement from Berkeley School of Optometry said. n

DISPENSED MEDICINES

Eyecare professionals who dispense medications are being urged to familiarise themselves with a new national standard about labelling requirements. The National Standard for Labelling Dispensed Medicines has been published by the Australian Commission on Safety and Quality in Health Care and is intended for health professionals who dispense medication. When labels are applied to medicine packaging at the point of dispensing, this is usually performed a pharmacist, but may also be done by pharmacy technicians, nurse practitioners, GPs, optometrists and dentists. The standard, which sought input from Optometry Australia, provides an evidence-based approach to presentation of medicines information, and includes 12 standards.

AVASTIN SHORTAGE

The American Academy of Ophthalmology (AAO) has lamented the behaviour of insurance companies that are pushing ophthalmologists to use new biosimilar drugs as alternatives to Avastin that have never been tested in the eye. The move comes amid an Avastin shortage in the US, with the AAO concerned that pressure to use the biosimilars is essentially making patients “unwitting subjects in a clinical experiment”. “Even the drugs’ manufacturers have advised against injecting the alternative drugs into the eye because there is no scientific proof to support it. This development has alarmed ophthalmologists because one of the drugs may be harmful to corneal tissue,” the AAO stated.

APPLE PATENT

Apple has reportedly won a patent for a direct retinal projector system that provides dynamic focusing for virtual reality (VR). A direct retinal projector system scans images, pixel by pixel, directly onto the wearer's retinas. Dynamic focusing components and techniques may be used in a direct retinal projector system to dynamically and correctly focus each pixel in VR images as the images are being scanned to a subject's eyes. This allows objects and surfaces that are intended to appear at different distances to be projected into the eyes eyes at the correct depths.

INSIGHT October 2021 9

NEWS

HOPES EXPERIMENTAL OCULAR MELANOMA DRUG WILL SAVE PERTH MOTHER’S LIFE A Western Australian mother-of-three who has already lost one eye to ocular melanoma has travelled to New South Wales to receive an experimental treatment that she hopes will save her from the rare form of cancer. Perth woman Ms Stacey Charteris is being treated with immunotherapy drug Tebentafusp as part of a trial at Sydney’s St Vincent’s Hospital. The therapy has been found to improve overall survival rates for patients with metastatic ocular melanoma in clinical trials overseas, with St Vincent’s being the first Australian trial site. To date, international studies have shown a 50% reduction of the risk of deaths in patients with metastasised ocular melanoma, a disease that has had no curative treatment. “It’s the first type of drug we know can help these patients who are otherwise facing a lethal disease,” St Vincent’s head of oncology Professor Anthony Joshua said. In 2016 at the age of 38 and pregnant with her third child, Charteris was diagnosed with ocular melanoma,

Stacey Charteris (centre) is being treated with immunotherapy drug Tebentafusp.

"IT’S THE FIRST TYPE OF DRUG WE KNOW CAN HELP THESE PATIENTS WHO ARE OTHERWISE FACING A LETHAL DISEASE"

site of cancer – were found on her liver.

ANTHONY JOSHUA, ST VINCENT’S HOSPITAL

Until recently, her family said there hadn’t been a known treatment specifically for ocular melanoma. But just as she was finishing the initial trial, she and her medical team became aware of the Tebentafusp trial at St Vincent’s.

a rare cancer that approximately 150 Australians are diagnosed with each year.

According to a Go Fund Me page that has now raised almost $28,000 for her, Charteris commenced an immunotherapy trial in Perth in February, but after several rounds she couldn’t continue because the tumours were not responding, and getting worse.

Adding to her troubles is the necessity to travel to Sydney for treatment, which is amid a strict lockdown. It has also meant she has had to leave her three children and husband behind in WA.

According to the Western Australian, she was concerned about the potential impact of radiation therapy on her unborn child at 20 weeks, so she decided to have surgery to remove the tumour and her eye.

Joshua said Tebentafusp worked by helping immune cells get close enough to cancer cells to attack them.

She was told that the likelihood of it spreading was high. Her son, Phoenix, was born on 17 May 2017 and Charteris went four years cancerfree. But following a six-monthly scan in December 2020, metastasis – the development of secondary malignant growths at a distance from a primary

“It’s like velcro between the tumour and the immune system, such that the immune system is activated to attack the tumour,” he said. St Vincent's Hospital is the only site delivering the treatment in NSW. n

NEW STUDY SHOWS OMEGA-3 EYE DROP IS EFFECTIVE AGAINST EVAPORATIVE FORM OF DRY EYE Australasian drug company AFT Pharmaceuticals has announced results from a post-market study of its licensed dry eye therapy NovaTears + Omega-3, stating it is a significantly effective treatment for the evaporative form of the disease. The eye drop is produced by German firm Novaliq and is said to be the first that combines the tear film stabiliser perfluorohexyloctane with a high quality, vegan-sourced omeg-3 fatty acid. According to AFT, which is licensed to distribute the therapy in Australia and New Zealand, the recent multi-centre, single arm, post-market clinical follow-up study was designed to evaluate the safety and efficacy of NovaTears + Omega-3 (0.2%) eye drops on signs and symptoms of dry eye. It was shown to deliver clinically relevant and statistically significant improvements in dry

INSIGHT October 2021

medicines available to specifically target this form of the disease and relieve symptoms, which include reddened and inflamed eyes and eyelid margins or encrusted eyelids.

eye symptoms in 36 patients over eight weeks, the company reported. “The improvements were evident on a broad range of measures including total corneal staining (NEI scale) and tear film break-up time (TFBUT) over the course of the study,” AFT stated. “Of particular interest was the meibomian gland assessment (MGD) score which improved from an entry level score of 7.1 to 3.0 (p<0.0001) over the course of the study. The latter result supports the hypothesis that the treatment might liquify meibum secretion excreted from the meibomian glands.” According to AFT, the 2020 Vision Index showed 77% of Australians have experienced dry eye, with more than 85% suffering from some form of evaporative dry eye. But there are currently limited

Hartley Atkinson, AFT Pharmaceuticals.

AFT managing director Dr Hartley Atkinson said since launching Novaliq’s NovaTears in 2018 and NovaTears + Omega-3 in 2020, demand for the products has grown rapidly. “In the last year alone, we have moved from the number three to number two position in the lubrication eyecare category in Australia with sales growth from the NovaTears range contributing to our growth,” he said. “This study confirms what our customers already know: NovaTears + Omega-3 and NovaTears are effective treatments that deliver significant improvements in the symptoms of DED. n

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NEWS

WATER EXPOSURE RISK TO CONTACT LENS WEAR BECOMES FOCUS OF AUSTRALIAN CAMPAIGN The UNSW School of Optometry and Vision Science (SOVS) is urging eyecare professionals to better utilise follow-up appointments to re-educate patients on safe contact lens wear. The messaged formed part of the university’s recent campaign called ‘Lens Wear with Care 2021’, which focussed on water exposure and contact lens use. The campaign was developed at the UNSW SOVS’s Dr Nicole Carnt and her final year Masters students Ms Danica Chua and Mr Gerry Wang. It also involved optometrists Mr Adam Samuels and Ms Stephanie Yeo who work with Carnt and their PhDs. They're focusing on developing interventions to help contact lens wearers become more adherent and hygienic, as well as research looking at the effects of contact lens information online. Apart from the use of contact lenses during water sports like surfing and swimming, they said recent evidence had indicated that showering with contact lenses increases risk of microbial keratitis by three to seven times. “In Australia and New Zealand, we generally have good standards of hygiene however when it comes to contact lens

"THE ATTITUDE TOWARDS SAFE LENS WEAR SHOULD BE SIMILAR TO PREVENTATIVE MEDICINE" Studies suggest one in three contact lens wearers are putting their vision at risk.

STEPHANIE YEO, UNSW

hygiene there is still room for improvement. A study done a few years ago showed that in Australia, we have similar contact lens hygiene compliance levels as Germany and Canada. However, most countries could benefit from improved contact lens hygiene,” Yeo said.

Chua who, as part of their research project, observed contact lens wearers during clinics and found many were oblivious to the importance of hand drying and other water exposure behaviours. This lack of awareness is also consistent with research. With the proliferation of contact lens technologies, which include for myopia control lenses and augmented virtual reality lenses that will be available in the not-sodistant future, they believe contact lens use is set to increase. The UNSW team also noted the importance of language. The campaign chose to use the word “adherence” over “compliance”. “Literature suggests that eyecare practitioners are not promoting safe lens wear enough, and as mentioned, promoting healthy contact lens wearing habits is a long-term task that requires a collective effort,” Yeo and Samuels said.

“Contact lens non-adherence rates range between studies and it seems that one in three contact lens wearers are putting their vision at risk. It has also been suggested that eyecare practitioners are not fully utilising follow-up visits to reeducate contact lens wearer. The attitude towards safe lens wear should be similar to preventative medicine – healthy contact lens wear is a long-term task and requires a collective effort.”

“Compliance is a more passive behaviour that suggests a more ‘doctor-centred’ model, whereas adherence is a more positive, proactive behaviour that is more patient-centric. The emphasis needs to be on understanding how to overcome the barriers instead of emphasis on a provider’s judgment.” n

The campaign was designed by Wang and

HEALTH FUND MEMBERS CAN NOW CLAIM BY TAPPING THEIR IPHONE OR APPLE WATCH AT HICAPS TERMINALS Optometrists that use the HICAPS claims and payment system can now accept digital health insurance membership cards via the Apple Wallet platform. NAB, which owns HICAPS (Health Industry Claims and Payments Service), announced from 27 July that health fund members of Medibank, Bupa, nib, and GU Health can download their digital membership card from their health fund app and add it to their digital wallet on Apple devices. The move allows customers to make a health insurance claim by holding their iPhone or Apple Watch near any HICAPS terminal in Australia, rather than swiping a plastic membership card. Customers can also pay for gap payments using Apple Pay.

INSIGHT October 2021

NAB executive for business everyday banking Ms Tania Motton said the bank was excited to offer health practitioners, including optometrists, dentists and physiotherapists, the ability to accept digital health insurance membership cards. “Digital technology is rapidly changing the way merchants receive payments – with more customers choosing contactless over cash. This is an exciting enhancement that will further support those who prefer a more digital experience,” she said. “Claims made using this method help reduce the time spent on manual processing for practitioners due to forgotten plastic cards, while putting money back in customers’ bank accounts quicker.”

When patients use their digital health fund card, they receive real-time notifications about their claim within their health fund’s app.

Four health funds have subscribed.

According to NAB, when customers add a health insurance membership card to Apple Wallet, the customer identifier number is encrypted during transmission to the terminal. It is then only decrypted by HICAPS and then passed on to the customer’s health insurer. Apple doesn’t receive information about the health insurance claim as there is a direct, encrypted connection between the user’s device and the HICAPS terminal. Formed in June 1998, HICAPS is part of NAB Health. More than 89,000 health practitioners use the system that is available in more than 25,000 health practices Australia-wide. n

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NEWS

SURVEY SEEKS NEW DATA ON EYECARE NURSE WORKFORCE

INFRARED LIGHT COULD REPLACE INJECTIONS TO TREAT MACULAR OEDEMA A clinical trial at Sydney Eye Hospital is evaluating the safety and efficacy of using infrared light to treat macular oedema from retinal vein occlusions, instead of the current standard treatment of eye injections. Near infrared light treatment is thought to work by stimulating cellular metabolism and repair. Known as NIRVO (near infrared light for the treatment of macular oedema from retinal vein occlusions), the study is being led by the Save Sight Institute (SSI) Macular Research Group (MRG) at the University of Sydney. The project, which received support from the Ophthalmic Research Institute of Australia, recently enrolled its third participant. According to the researchers, retinal vein occlusions typically occur in patients aged over 50 with cardiovascular risk factors such as hypertension, diabetes, high cholesterol, obesity and smoking. They said eye injections work well but most patients need to continue them for years to maintain their vision. The institute believes a less invasive treatment may have many advantages and be better tolerated. The MRG recently published results from a pilot study in Diabetologia, the official journal of the European Association for the Study of Diabetes, demonstrating that near infrared light was effective and safe when treating macular oedema due to diabetic retinopathy.

"WE HOPE THE DATA COLLECTED IN THIS SURVEY WILL CONTRIBUTE TO POLICY DISCUSSIONS ABOUT THE FUTURE OF EYE HEALTH SERVICES" HEATHER MACHIN, CERA

Australia’s nurses are at the centre of a research survey that will create a snapshot of the eyecare nurse workforce and shape discussion about their future involvement in the sector.

of data about eyecare professionals, but there was no data on nurses, despite being the largest healthcare provider group, and their critical role in many settings.

Researcher and registered nurse Ms Heather Machin is leading the survey, the first of its kind in Australia, with Associate Researcher Professor Mark Daniell, both from Centre for Eye Research Australia (CERA). The survey, titled ‘Workforce survey of Australian nurses involved in eyecare’, is supported by the Australia Ophthalmic Nurses Association.

“We know that eyecare nurses work in specialist hospitals like the Eye and Ear here in Melbourne – but we are also keen to get a fuller picture of those working in other settings like private ophthalmology practices, domiciliary care, community or Indigenous health settings, who may or may not identify as an eyecare nurse, yet they are providing care to eyecare patients,” she said.

Machin said the study would gather key information about the types of settings nurses work in when caring for people with eyecare needs, their location and the different roles performed.

The survey also wants to hear nurses’ views on issues such as training, their role in eyecare and what the profession can do to attract and retain nurses with specialist eyecare skills, Machin said.

“We hope the data collected in this survey will contribute to policy discussions about the future of eye health services in Australia and the role of nurses in how they are delivered,’’ she said.

“We hope the information gathered from this survey will form an important part of the discussion about the provision of eyecare services in Australia – and help develop new strategies to attract and retain more nurses to eyecare.’’ n

Machin said there was currently a wealth

NANODRUG MACULAR TREATMENT YIELDS ‘IMPRESSIVE RESULTS’ A leading researcher in Queensland has lauded the efficacy of a pioneering treatment for ocular neovascular disease recently trialled in animals.

According to results, 12 90-second treatment sessions with infrared light reduced the patients’ macular oedema and the subsequent requirement for eye injections.

Professor Di Yu of the University of Queensland Diamantina Institute collaborated with scientists from the Chinese Academy of Sciences and Beijing Chaoyang Hospital to challenge the current standard of treatment for agerelated macular degeneration (AMD) and diabetic retinopathy – anti-VEGF injections.

The US Diabetic Retinopathy Research Collaboration is currently recruiting for a larger study with near infrared light which may or may not confirm MRG’s findings.

They are pioneering a more complex nanodrug which not only delivers an antibody, but simultaneously combats inflammation and identified side effects.

Dr Yong Tao, chief ophthalmologist at Beijing Chaoyang Hospital, is a senior author in the study.

In their study of the novel treatment in animals, published in the journal Nature Biomedical Engineering, volumes of lesions were reduced by 95%.

“The NIRVO study may provide proof of principle for a definitive placebo controlled clinical trial which would be required before the treatment could be widely adopted,” the SSI said.

“The efficacy was superb. The new design allows the nanodrug to concentrate on lesions and deliver lasting benefits," Yu said.

“We are very excited to see what we will learn from this new potential treatment.” n

“With the impressive results, further developments are now under way to translate it into a new therapy.

INSIGHT October 2021

Fluorescein angiography showing the large area of hyperfluorescence of choroidal neovascularization.

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NEWS

OSCAR WYLEE OPENS 100TH STORE, ENTERS CANADA

ECP TO WIN A CAR IN TRANSITIONS OPTICAL COMPETITION

Australian eyewear retailer Oscar Wylee is expanding into the Canadian market, with its first store opening in Alberta at the end of August.

a chance to win. The competition can be entered online at www.XTRActive.com. au, which features more information and the terms and conditions. Additionally, to celebrate the newly launched Transitions XTRActive new generation and Transitions XTRActive Polarized technologies, eyecare professionals receive three entries when ordering a pair of these products. For all other Transitions technologies, they receive one.

The announcement follows the opening of its 100th retail store in Australia and New Zealand recently, with 27 of those locations added to its network this year alone. In Canada, the company is also planning to establish itself at four further locations in Halifax, Calgary and Toronto. With a focus on employee benefits, it has promised to provide its Canadian optometrists with generous daily minimums, uncapped earning potential and qualified support staff. Additionally, each new store will be fitted with top quality equipment. The franchise’s 100th ANZ practice was in the Auckland suburb of Albany. Other recent locations include; Mornington (Victoria), Orange, (New South Wales), Fremantle, (Western Australia) and Launceston (Tasmania). The local Australian optometry chain said it had hired more than 170 employees since the beginning of 2021 for its new stores and support office team. “We anticipate that our continued growth will create over 400 new jobs over the year and contribute to the recovering economy and job market,” Mr Kane Ford, director of retail operations at Oscar Wylee, said. “We are always looking for new location opportunities to expand access to eyecare across Australia and New Zealand.” Oscar Wylee has grown rapidly since brothers Mr Jack Teoh and Mr Bob Teoh purchased the company with their investment firm and began to expand its operations. At the time, it was a small e-commerce operation delivering glasses over the internet with no brick-and-mortar store. It opened its first physical store in 2015. n

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INSIGHT October 2021

According to the company, Transitions XTRActive Polarized features dynamic polarisation. The lens is clear and unpolarised indoors. In bright light outdoors it quickly darkens and also becomes polarised. Transitions XTRActive new generation is 35% faster to fade back than the previous generation. It is the darkest clear to dark photochromic lens on the market. “While many of us may not know what summer will look like this year, there is one thing we know we can do: get out and active during the warmer months,” Mr Adam McMahon, Transitions Optical key account manager for Australia and New Zealand, said. “We chose prizes we felt could be used and enjoyed during these strange times.” n

HEALTHIA EXPANDS PORTFOLIO Australian allied health group Healthia has continued its expansion into the optical market with the acquisition of John Holme Optometrist, a two-store business in North Queensland. The ASX-listed company – which entered the optical arena in December 2020 with the acquisition of The Optical Company’s 41-store business in a $43 million agreement – confirmed the deal on 16 August. Since its public listing in September 2018, Healthia has grown its portfolio of owned allied health businesses from 104 to 217, representing portfolio growth of 109%.

The company opened its first physical store in 2015.

The two new Transitions technologies feature in the clear to extra dark lens range which also work in the car.

John Holme Optometrist, located in Mareeba and Malanda, is joining its Eyes and Ears division, which now comprises 45 optometry stores and a wholesale eyewear frame distribution business trading as AED.

Healthia now owns 217 allied health businesses.

“Our key target sectors of Bodies and Minds, Feet and Ankles, and Eyes and Ears have a collective addressable market of $9.8 billion,” Healthia managing director Wesley Coote said. “We have a proven management team and a clinician and patient first culture and are excited to have these businesses joining our growing allied health network.” n

CMY

AUSTRALIA'S SECOND NATIONAL EYE HEALTH SURVEY TO INCLUDE EAR HEALTH ELEMENT A second National Eye Health Survey has been announced – this time with an added ear health component – and will examine close to 5,000 Aboriginal and Torres Strait Islander peoples and nonAboriginal Australians over two years. The Centre for Vision Research at The Westmead Institute for Medical Research (WIMR) and partners, including the University of New South Wales, The George Institute for Global Health, the Brien Holden Foundation and Macquarie University, have been awarded the tender to conduct the nationwide survey, called the Australian Eye and Ear Health Survey. It comes five years after the 2016 National Eye Health Survey, which was the first nationwide survey to determine the prevalence and major causes of vision impairment and blindness in Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians NOVA EYE MEDICAL_INSIGHT-PRINT.pdf

27/7/21

in city, regional and remote areas. The Australian Government Department of Health has sponsored the call to conduct a second national eye health survey in view of increased prevalence of diabetes since the 2016 survey and the critical eye complications that may follow. Professor Paul Mitchell, director of WIMR’s Centre for Vision Research who will lead the study, said having a thorough and accurate understanding of the prevalence of eye disease and hearing loss in Australia is essential. “It allows us to anticipate and plan prevention and treatment approaches that address the issues of vision and hearing loss now, and well into the future,” Mitchell said. “Our study will use new, non-invasive imaging technologies to help improve eye disease detection rates. Importantly, it will assess a broad representation of

people from across Australia. We will also look to assess potential links between eye disease/vision and hearing loss and critical health and/or social outcomes.”

Prof Paul Mitchell, WIMR.

Macquarie University has provided support to ensure ear health assessment occurs at the same time as collection of data on eye and general health measures in the survey. Professor Bamini Gopinath, Cochlear Chair in Hearing and Health at Macquarie University Hearing, will lead the survey’s ear health component. “We have a unique opportunity to expand the scope of the Second National Eye Health Survey to also establish prevalence, risk factors and impacts of hearing loss in Australia,” Gopinath said. “This will not only help to determine the current state of hearing health in Australia, but it will provide vital information to the government to assist in its policy development. n

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Unlike other MIGS which create artificial flow, iTrack™ is a stent-free, tissue-sparing MIGS procedure that treats 360° of the outflow pathway to re-establish natural aqueous flow. A B-IN TERNO CANAL O P L A S TY

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RESEARCH

LONG COVID LINK TO CORNEAL NERVE DAMAGE Nerve fibre loss and an increase in key immune cells on the cornea may be an identifying feature of 'long COVID', suggests a small study published in the British Journal of Ophthalmology. These changes – identified through corneal confocal microscopy (CCM) – were particularly evident among those with neurological symptoms, such as loss of taste and smell, headache, dizziness, numbness, and neuropathic pain, following COVID-19 infection, the findings show. The study was conducted by researchers from Necmettin Erbakan University Meram Medical Faculty Hospital in Turkey and Weill Cornell Medicine-Qatar in Doha. "To the best of our knowledge, this is the first study reporting corneal nerve loss and an increase in [dendritic cell] density in patients who have recovered from COVID-19, especially in subjects with persisting symptoms consistent with long COVID,” the researchers said. "We show that patients with long COVID have evidence of small nerve fibre damage which relates to the severity of long COVID and neuropathic as well as musculoskeletal symptoms.

"Corneal confocal microscopy may have clinical utility as a rapid objective ophthalmic test to evaluate patients with long COVID."

These cells have a key role in the primary immune system response by capturing and presenting antigens from invading organisms.

According to the study, long COVID is characterised by several potentially debilitating symptoms that continue for more than four weeks after the acute phase of the infection has passed and aren't explained by an alternative diagnosis. Around one in 10 of all infected people will develop long COVID, and it has been suggested that small nerve fibre damage may underlie its development.

The corneal scans were compared with those of 30 healthy people who hadn't had COVID-19 infection.

Symptoms correlated strongly with corneal nerve fibre loss.

To explore this further, the researchers used a real time CCM to identify nerve damage in the cornea. Forty people who had recovered from confirmed COVID-19 infection between one and six months earlier completed a National Institute of Health and Clinical Excellence (NICE) questionnaire.

Twenty-two (55%) of the 40 COVID-19 patients had no clinical signs of pneumonia; 11 (28%) had clinical signs of pneumonia not requiring oxygen therapy; four (10%) had been admitted to hospital with pneumonia and received oxygen therapy; and three (8%) with pneumonia had been admitted to the intensive care. The corneal scans revealed that patients with neurological symptoms four weeks after they had recovered from acute COVID-19 had greater corneal nerve fibre damage and loss, with higher numbers of dendritic cells, than those who hadn't been infected. Those without neurological symptoms had comparable numbers of corneal nerve fibres as those who hadn't been infected with COVID-19, but higher numbers of dendritic cells.

Neurological symptoms were present at four and 12 weeks in 22 out of 40 (55%) and 13 out of 29 (45%) patients, respectively. Participants' corneas were then scanned using CCM to look for small nerve fibre damage and the density of dendritic cells.

The questionnaire responses indicative of long COVID symptoms correlated strongly with corneal nerve fibre loss. n

CLINIC WITH OPTOMAP IMAGING CUTS VISITS BY A THIRD A study conducted at a prominent research university has found patient visits were 28 minutes shorter on average after systemic changes to its workflow, including decentralised optomap imaging. The company behind the technology, Optos, recently released the findings as part of a clinical summary. It was based on new research out of Stanford University in the US that sought to reduce visit times for retina patients in an affiliated academic ophthalmology department. In an article published in Retina, the researchers identified photography as a major bottleneck in patient movement and clinic efficiency. To address this, it trained ophthalmic technicians to perform optomap imaging in addition to OCT. It also better aligned staff and doctor schedules. To support the new workflow, the clinic also procured three additional

INSIGHT October 2021

Optos widefield retinal photography units, taking its total number to four. It aimed to decentralise usage by moving devices outside of the photography suite to be adjacent with exam rooms. Ophthalmic technicians were trained to perform optomap imaging in exam lanes, bypassing the need for patients to go to the photography suite. According to the study, prior to these changes, the average patient visit duration was 87 minutes. Four weeks after, this was reduced to 58.5, a reduction of 28.5 minutes or 33%. From a financial perspective, the clinic reached a breakeven point on each Optos device after one year, using the instrument at least eight times per workday, which was readily exceed by its high-volume retina practice. The authors also noted other benefits including, increased patient satisfaction scores, less downtime for patients and fewer staff handoffs, and minimised

patient movement throughout the clinic.

An optomap image of a retinal detachment. Image: Optos

“This study has shown that improving clinic efficiency can be accomplished by reducing bottlenecks in clinic workflow,” the authors said. “Reallocation of resources, including reorganising equipment and training clinic personnel for new responsibilities, is a more cost-effective solution than only focusing on capital purchases or hiring additional personnel.” The authors also noted that the relative ease of implementation and the program benefits show similar changes can be applied to other clinics, with similar results expected. According to Optos, a previous study in 2017 in US Ophthalmic Review found similar results. In the first year after integrating ultrawidefield (UWF) retinal imaging, the authors said 220 more patients were seen, an increase of 4.4% over the pre-UWF period, which was an average of 1.5 additional patient encounters per day. n

NEW STUDY LENDS WEIGHT TO LINK BETWEEN PANDEMIC AND MYOPIA A Hong Kong study highlighting a significant decrease in the time schoolchildren have been able to spend outdoors and a sharp increase in screen time is the latest to join mounting evidence that a rise in childhood myopia may be linked to the coronavirus pandemic. The research published online in the British Journal of Ophthalmology follows a similar Chinese study published last year in JAMA Ophthalmology that found myopia prevalence was three times higher in sixyear-olds during the COVID-19 pandemic, giving rise to the term “quarantine myopia”. Despite the Hong Kong study being an observational study with certain limitations, the researchers warned that their initial results show an alarming myopia progression that warrants appropriate remedial action. “Our results serve to warn eyecare professionals, and also policymakers,

Researchers studied the eyes of 1,793 children.

educators and parents, that collective efforts are needed to prevent childhood myopia—a potential public health crisis as a result of COVID-19,” they concluded. In what is arguably one of the world’s most densely populated cities, the researchers studied the eyes of 1,793 children, all part of the Hong Kong Children Eye Study (HKCES) – an ongoing population-based study of eye conditions among six- to eight-year-olds. Nearly

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"COLLECTIVE EFFORTS ARE NEEDED TO PREVENT CHILDHOOD MYOPIA—A POTENTIAL PUBLIC HEALTH CRISIS AS A RESULT OF COVID-19" STUDY AUTHORS

two-thirds (1,084 children) had entered the study before the start of the pandemic and had been monitored for around three years; 709 children were recruited to the study at the start of the pandemic (December 2019 to January 2020) and were monitored for around eight months. Around one in five children in the COVID-19 group developed myopia between January and August 2020, compared with around one in three (37%) of those in the pre-COVID-19 group over a period of three years. The researchers found the numbers of new cases of myopia were higher among children in the COVID-19 group. The estimated one-year myopia incidence was 28%, 27%, and 26%, respectively, for six-, seven- and eight-year-olds in the COVID-19 group, compared with 17%, 16%, and 15%, for six-, seven-, and eightyear-olds in the pre-COVID-19 group. n

GLAUCOMA

IT’S ALL ABOUT THE

(aqueous) flow

When it comes to the treatment of glaucoma, there is growing evidence to suggest that the ability to re-establish the natural flow of aqueous humour plays a critical role not only in reducing IOP, but also in preserving the health of the corneal endothelium, says US ophthalmologist DR DAVID LUBECK.

n a healthy eye, most aqueous humour drains through the conventional outflow pathway, flowing from the anterior chamber through progressively smaller channels of the trabecular meshwork into Schlemm’s canal. From the canal, circuitous channels, known as collector channels, connect to the episcleral vasculature, which drains into the venous system. The flow of aqueous throughout the conventional outflow pathway is dynamic and is determined by intraocular pressure (IOP), outflow resistance or facility and episcleral venous pressure, and can be described as natural aqueous flow.

the loss in ECD following glaucoma treatment. “It is well accepted that more invasive glaucoma surgeries such as trabeculectomy and tube shunts are associated with a more significant loss of ECD,” he said.

Blockages can occur along several points of the conventional outflow pathway, including the trabecular meshwork, Schlemm’s canal and the collector channels, disrupting the natural aqueous flow and resulting in elevated IOP. It also has the consequence of depriving the eye of the nutrientrich flow of aqueous throughout the full 360 degrees of the conventional outflow pathway, thereby contributing to the pathogenesis of glaucoma. While all MIGS devices aim to overcome the reduced outflow facility associated with glaucoma, their respective mechanisms of action are very different. Considering each of the MIGS devices, they are often categorised based on whether they require the use of a stent or implant. These microtrabecular bypass stents commonly include iStent (Glaukos) and Hydrus (Ivantis). There are also MIGS designed to remove or manipulate the trabecular meshwork tissue, referred to as goniotomy (KDB, New World Medical) or ab-interno trabeculotomy (OMNI, Sight Sciences). The results of a prospective study presented at the 2021 meeting of the American Society of Cataract and Refractive Surgery (ASCRS) would posit another criterion for the categorisation of MIGS and glaucoma treatments: the re-establishment of natural aqueous flow, as compared to the creation of artificial flow. Presented by doctors David M. Lubeck, MD, ABO and Robert J. Noecker, MD, MBA, ABO and awarded best paper in the session “Minimally Invasive Glaucoma Surgery (MIGS) II”, the 12-month data reported a mean change in endothelial cell density (ECD) of 3.2% (SD ±9.0%) following ab-interno canaloplasty (iTrack, Nova Eye Medical) performed in conjunction with cataract surgery – and represents one of the lowest reported rates of endothelial cell loss (ECL) of all the MIGS procedures. Refer to Table 1. At the ASCRS meeting, Lubeck asked the question of whether it is the change in aqueous currents which is responsible for much of

INSIGHT October 2021

Dr David Lubeck, Arbor Centers for Eye Care, Illinois.

“In the case of tube shunts, much of this loss is thought to result from the mechanical disruption caused by the shunt itself. Studies estimate ECL at between 8.0% and 18.6% at two years for tube shunt surgery and between 9.5% and 28.0% at one year for trabeculectomy.”

Examining the various MIGS procedures and their impact on the corneal endothelium, the reported rates of ECL are much lower than that of traditional glaucoma surgeries.

“Micro-trabecular bypass stents, when correctly implanted in the angle, should not negatively impact on the health of the corneal endothelium,” Lubeck said. “Further, migration of these stents is uncommon. They do create artificial flow, however, and the impact of this on the corneal endothelium may warrant further consideration. With MIGS procedures such as goniotomy, there is the additional drawback of post-operative inflammation that may disrupt the delicate environment of the corneal endothelium.” He added: “In contrast, ab-interno canaloplasty re-establishes natural aqueous flow throughout the entire 360 degrees of the conventional outflow pathway without the use of an implant, and without the removal or damage of tissue. Theoretically it may safeguard against the risk of excessive damage to the corneal endothelium." During the ab-interno canaloplasty procedure, 360-degree catheterization and viscodilation dilates the canal and separates the compressed tissue planes of the trabecular meshwork. It also acts

Table 1: Comparison of ECL rates between different MIGS procedures MIGS device/procedure

Follow-up

Mean % ECL

Samuelson T. et al (1)

505

24 months

13.1% (12.3% control)

Arriola-Villalobos et al (2)

12 months

13.2%

Gillman et al (3)

12 months

14.6%

Hydrus Microstent in conjunction with cataract surgery

Samuelson T. et al (4)

556

24 months

14.0% (10.0% control)

36 months

15.0% (11.0% control)

iTrack ab-interno canaloplasty in conjunction with cataract surgery

Lubeck et al (5)

12 months

3.2%

OMNI

Not reported

Kahook Dual Blade (KDB)

Not reported

Conventional Outflow Pathway iStent inject in conjunction with cataract surgery

TABLE 1 REFERENCES 1. Samuelson, T. W., Sarkisian, S. R., Jr, Lubeck, D. M., Stiles, M. C., Duh, Y. J., Romo, E. A., Giamporcaro, J. E., Hornbeak, D. M., Katz, L. J., & iStent inject Study Group (2019). Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary OpenAngle Glaucoma and Cataract: Two-Year Results. Ophthalmology, 126(6), 811–821https://doi.org/10.1016/j.ophtha.2019.03.006 2. Arriola-Villalobos, P., Martínez-de-la-Casa, J. M., Díaz-Valle, D., García-Vidal, S. E., Fernández-Pérez, C., García-Sánchez, J., & García-Feijoó, J. (2013). Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. British Journal of Ophthalmology, 97(10), 1250-1255. 3. Gillmann K, Mansouri K, Ambresin A, Bravetti GE, Mermoud A. A Prospective Analysis of iStent Inject Microstent Implantation: Surgical Outcomes, Endothelial Cell Density, and Device Position at 12 Months. J Glaucoma. 2020 Aug;29(8):639-647. 4. Samuelson, T. W., Chang, D. F., Marquis, R., Flowers, B., Lim, K. S., Ahmed, I. I. K., & Pfeiffer, N. (2019). A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: the HORIZON study. Ophthalmology, 126(1), 29-37.

Subconjunctival XEN Gel Implant in combination with cataract surgery

Oddone et al (6)

6 months

11.3%

XEN Gel Implant as standalone procedure

Oddone et al (6)

6 months

5.6%

Source: Nova Eye Medical.

downstream on the collector channel ostia, pushing out herniations of trabecular meshwork tissue, which have been shown to block up to 90% of collector channels in glaucomatous eyes. “There is no denying the improved safety profile afforded by MIGS. I would encourage my peers to consider the impact of MIGS on natural aqueous flow, and how this relates to the health of the corneal endothelium.”

5. D.M. Lubeck, MD, and R.J. Noecker, MD, unpublished data, 2021; accepted for presentation at ASCRS 2021). 6. Oddone, F., Roberti, G., Posarelli, C., Agnifili, L., Mastropasqua, L., Carnevale, C., ... & Figus, M. (2021). Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR). Journal of Glaucoma, 30(7), 559-565.

NOTE: This article was submitted by Nova Eye Medical. Further references are available in the online version of this article at www.insightnews.com.au. Dr David Lubeck is Assistant Clinical Professor of Ophthalmology, UIC Eye Center, Chicago; director of advanced anterior segment surgery, Arbor Centers for Eye Care, Homewood, Illinois. Financial disclosures: consultant/speaker (Alcon, Glaukos, Nova Eye Medical). n

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DRY EYE

e y e dry s t n e m t a tre ACCESS TO

IN AUSTRALIA

New eye drop formulations are making dry eye treatment more affordable and accessible, especially for more severe sufferers. But Australia has often played catch up, as RHIANNON BOWMAN reports.

n one of Insight’s popular Soapbox column’s last year, Dr Brendan Cronin from the Queensland Eye Institute, expressed his views on whether enough was being done for dry eye patients in Australia.

As an example, he pointed out that while first-generation ciclosporin compounds have been available in the rest of the world for more than a decade, the first Therapeutic Goods Administration (TGA)-approved ciclosporin in Australia (Cequa) only became available last year. Although Ikervis (another ciclosporin) and Xiidra (lifitegrast) have since expanded the suite of products available locally, Cronin pointed out that the cost of obtaining TGA approval for new medications means a small market like Australia is often overlooked by pharmaceutical companies due to the high cost of gaining an approval. While several therapies are accessible via the Pharmaceutical Benefits Scheme (PBS), he noted Medicare has not yet adopted any procedural treatment for dry eye in the MBS schedule, meaning expenses are borne by patients. His comments struck a chord; the column attracting thousands of views from Australian eyecare professionals. This month, Insight invited eyecare professionals with a strong clinical presence in dry eye to weigh-in about the current dry eye treatment options and discuss what is happening to address issues around the cost of treatment.

SUPPLY NOT KEEPING UP WITH DEMAND Clinical optometrist Mr Jason Holland practises at two locations in Brisbane, The Optical Superstore and The Eye Health Centre. At the latter, he operates a co-management clinic with ophthalmologist Dr Andrew Apel to manage and review patients with diabetes, glaucoma and ongoing conditions including dry eye. Holland says more specific treatment options are emerging. “For many practitioners, over-the-counter lubricant eye drops have been their go-to treatment for dry eye disease for many years, and for mild cases, the DEWS II report supports this approach is appropriate,” he says. “Initially we had a plethora of lubricants to support the aqueous layer, however, for many patients it is the lipid layer which is deficient. In recent years there have been a number of new lipid containing products released in Australia, so I feel that we are being supported by industry in regard to innovation.” While lubricants are good at managing symptoms, Holland says patients with more severe disease are looking for treatments to improve the underlying conditions. “We have been lucky to have access to many devices to treat dry eye in Australia, however, there is no rebate for these procedures so the

INSIGHT October 2021 23

DRY EYE

but are accessible via the Special Access Scheme (SAS). Holland says a lot of research is being carried out into potential dry eye treatments, predominantly eye drops, with new and existing players in the ophthalmic industry vying for market share. This is particularly exciting for more severe disease sufferers who may not respond to the multitude of other eye drop therapies available, currently dominated by therapies for aqueous deficiency. One of those is pharmaceutical company Seqirus, a subsidiary of the Melbourne-based biotechnology company CSL, which is behind two novel treatments. This includes the aforementioned Ikervis (ciclosporin 0.1% ophthalmic emulsion), which is a treatment for severe keratitis in adult patients with dry eye disease when artificial tears are insufficient. The other product, Cationorm (cationic nanoemulsion), listed on the Pharmaceutical Benefits Scheme from 1 August, is a hydrating and lubricating emulsion that protects the eye surface and relieves irritation due to persistent dry eyes.

Some believe a Medicare rebate for basic imaging like meibography could have a significant impact.

"WE HAD A PLETHORA OF LUBRICANTS TO SUPPORT THE AQUEOUS LAYER, HOWEVER, FOR MANY IT IS THE LIPID LAYER WHICH IS DEFICIENT"

JASON HOLLAND THE EYE HEALTH CENTRE

cost of therapy can be a limiting factor despite a growing demand from the community,” he says.

“Seqirus is a new company to enter the dry eye market that virtually no one has heard of before. Their mineral oil emulsion for evaporative dry eye – Cationorm – has TGA approval, and while I’ve got product samples, I want more,” Holland says. “Ikervis is certainly going to be utilised in my practice. Having a preservative-free alternative will be wonderful for many of my patients and the once-a-day dosing is a bonus. Like most ciclosporin products, patients will need to wait 90 days to assess its effectiveness.” Holland says there are also other major companies, which traditionally target treatments for the posterior of the eye, getting further into dry eye treatments, and directly marketing to optometrists. One of those is Novartis, which acquired dry eye drug Xiidra (lifitegrast ophthalmic solution) in a $7.5 billion deal in 2019. It was included on the Australian Register of Therapeutics Goods (ARTG) the same year. It is a prescription treatment indicated for moderate to severe dry eye in adults for whom prior use of artificial tears has not been sufficient. “Xiidra is designed to manage inflammation. Although the government is not restricting access to this unique product, there is a challenge in prescribing it as optometrists need to get SAS approval for every script, as per TGA rules,” Holland says.

Holland believes the TGA is not delaying access to dry eye treatments – but COVID is.

For more severe dry eye sufferers, Holland says it’s encouraging to see the rollout of novel eye drop therapies in Australia because they allow any registered optometrist with therapeutic endorsement access to treatment, without needing to outlay thousands of dollars in specialist treatment devices.

This is particularly the case for Cequa, Australia’s first approved ciclosporin eye drop. The TGA approved the prescription-only immunosuppressant, indicated to increase tear production in patients with moderate-to-severe dry eye, in February 2020.

“Eye drops like Cequa, Xiidra and now Cationorm take away the cost barrier to treatment for patients. Eye drops are not cost prohibitive, compared to other treatments, like LipiFlow or intense pulsed light (IPL) that some patients simply can’t afford.”

“Research has shown Cequa is a promising medicine – and it’s preservative-free, and TGA-approved, but since COVID hit, we can’t get stock. Patients are desperate to get more. It’s a challenge because Australia is a small market, globally,” Holland says.

Despite the prohibitive cost of some treatment options, Holland suspects that seeking a new Medicare item number for treating dry eye could be a bridge too far.

“Many of my patients have had incredible success with Cequa so I was forced to find an alternative when stock from America became limited. Initially I sourced compounded ciclosporin with an aqueous base from a local hospital, however, I am now keen to assess the effectiveness of [new drug] Ikervis as an alternative.” He says local practitioners also hope to soon have access to Alcon’s iLux MGD treatment device for dry eye, which debuted at SECO International in 2019. “iLux is a device which practitioners can use in their clinics. It is unique in that it heats the meibomian glands from the inside like the Lipiflow device. The device then simultaneously expresses the meibomian glands,” Holland says. Other treatments, such as the ciclosporincontaining Restasis (AbbVie/Allergan), have not met with TGA approval

INSIGHT October 2021

“In 2015, when an MBS item number for removal of foreign body was introduced, it was a different environment politically. We need critical mass in order for a dry eye therapy to be MBS-listed, but at the moment, there might only be about 20% of optometrists who are actively treating dry eye,” Holland says. “We might have more luck with private health funds to contribute towards the cost of procedural aspects of dry eye treatment.” FEES AFFECT PROFIT MARGIN Ophthalmologist Dr Kenneth Ooi, from the University of Sydney’s Save Sight Institute, says Australia has experienced a slow uptake in accessing the world’s leading dry eye therapies – and there are many reasons for this. Ooi himself is hoping to address a major unmet need by repurposing a

common cholesterol-lowering drug into a topical ocular therapy for dry eye and blepharitis, called Atorvastatin. Along with Professor Stephanie Watson, they have shown promising results in a pilot study and believe their therapy has the potential to treat both evaporative and aqueous deficient forms of the disease.

"WE’RE DEPENDENT SOMEWHAT ON PHARMACEUTICAL COMPANIES WHO WANT TO TAKE UP A LICENSE TO DISTRIBUTE IN AUSTRALIA"

Generally, Ooi says one of the main barriers to Australia accessing the most innovative therapies include licensing policies of global pharmaceutical companies, which can impact, or delay therapies being brought into Australia a lot of the time. “We’re dependent somewhat on pharmaceutical companies who want to take up a license to distribute in Australia. Where do they see something that differentiates the potential new dry eye product? It’s a crowded market, so a new product has to have a hook,” Ooi says. “An innovative, novel product would therefore have an increased price point and likely need a reimbursement capability. It needs to be shown to be costeffective compared to currently reimbursed therapies, so eligibility criteria, as designated by Pharmaceutical Benefits Advisory Committee (PBAC), may limit uptake of the drug to smaller patient groups via the PBS. For example, limiting reimbursed treatment to patients with an Ocular Surface Disease Index (OSDI) score greater than 30.” Ooi says in Australia there are a limited number of companies willing to bring in a new drug. “From an innovating company perspective, they need to recoup investment and failed products investment. It can be to the order of a 20% reinvestment strategy into new research, and $2 billion, on average, to bring a new drug to the global market,” he says. In a smaller market like Australia, which has two-thirds the population

Quarterly rebates paid back to your practice. Non-optical supplier deals to help improve your profitability, including insurance, IT, security and more. Marketing services utilising proven strategies to attract, engage and retain patients Continued education, business improvement initiatives and resources to support you and your practice.

From a PBAC perspective, any new product brought to market must have already been reviewed and approved for Australia by the TGA and has to be cost-effective, he says. “It’s a balance. The patient population with the eye health condition has to be large enough for the licenser, but to achieve the desired price point, the PBAC may mandate additional criteria to limit its use so that it remains cost-effective.” Ooi says the PBAC has a remit to allow reimbursed access to alternative, cost-effective treatments. PBAC cost-effectiveness (health economics) determines the amount of reimbursement.

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“For example, if a treatment is approved for PBS reimbursement, a

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DRY EYE

"IT’S GROWING AND BECOMING MORE ACCEPTED, BUT IT SEEMS THERE IS A TWO-TIERED MODEL OF DRY EYE PRACTICE EVOLVING" DR JENNIFER RAYNER ALLEVE EYE CLINIC

But once a new therapy is introduced, Ooi says the profession has enough respected advocates in ophthalmology and optometry. “Australia has a combination of well-trained ophthalmic and optometric eyecare providers; education on therapeutic prescribing rights takes place now at an undergraduate level in optometry; there is a lot of interest in dry eye in optometry, and where access to ophthalmology in country areas is difficult, optometrists fill this need.” Ooi says it may be feasible to use compounding chemists to get around a lack of access to some leading products but only if the products are TGA-approved and included on the ARTG but not commercially available in Australia, or unavailable via the SAS. “For example, preservative-free formulations that are out of stock in Australia can be compounded. A drug can also be prescribed off-license/ label, but it has to be formulated and made by a compounding pharmacy that approves of its use,” he explains. “Individual Schedule 5 TGA exemptions allow for specific individual patient drug needs but products cannot be commercialised or produced in large-scale quantities.” TIP OF THE ICEBERG The cost of treatment is an aspect of dry eye that optometrist and co-owner of Alleve Eye Clinic in Adelaide, Dr Jennifer Rayner, knows well. With a background in both independent and corporate optometry, she initially owned and operated a regular optometry and concurrent dry eye practice for two years, then broke away to open a clinic where she could devote her time and resources to only dry eye patients. As a result, she established South Australia's only dedicated dry eye clinic.

It's estimated about 20% of optometrists are actively treating dry eye in Australia.

pensioner pays $6 for the product, and the government makes up the shortfall of $34, for a product that costs $40 from the licensor. If a product is not reimbursed via the PBS, then it may only be available for ‘private sale’, so the patient must pay the full price, including dispensing fees, which may be prohibitive,” he says.

“I don’t refract, or fit contact lenses – I purely diagnose and treat dry eye,” Rayner says. “Dry eye is a growing clinical field, still being recognised and, at times, dismissed. It’s a huge problem, more than people realise.” Alleve Eye Clinic opened in 2016 and has taken a few years to get off the ground, Rayner says. Her patient referrals come from a wide variety of sources, including GPs, optometrists, ophthalmologists, rheumatologists, dermatologists, pharmacists – and Google “because patients don’t need an official referral to see me – people are looking for a solution”.

Regulatory fees can also affect profit margin and are a consideration when deciding whether to bring a product to Australia.

“Dry eye takes time. It can be notoriously hard to treat. Diagnosis is relatively straight forward but managing patients and testing treatment options takes time. Some patients have been suffering for 15 to 20 years. There is no one solution that works for everyone. Fortunately, the Tear Film and Ocular Surface Society (TFOS) have established treatment protocols (DEWS I and II) but it still involves trial and error for each patient,” she says.

“The parent pharmaceutical company sets in-licensing fees and negotiates fees for the licensing company purchasing the product. Then there are registration fees with the TGA and PBAC, and ongoing fees maintaining registration,” Ooi says.

Despite the inherent difficulty in finding successful solutions, Rayner says treatment options have come a long way in the last five years, with products like Optimel Manuka eye drops and gel, which feature highly in her practice’s arsenal.

He says the TGA assesses products for efficacy, safety, and whether manufacturing processes and facilities are appropriate, which results in fees being incurred.

However, she laments that even though dry eye is a growing area, practitioners don’t have an official body where they can exchange information and insight about dry eye treatments, new products, or equipment, she says.

“When reimbursing therapies via the PBS, the government is deciding how to divide money from a pool of a set size with other medications in place which already are reimbursed and work.”

“For a European approved drug, European Medicines Agency (EMA) registration paperwork and pharmacovigilance assessment is similar to Australia. For a US approved drug, FDA re-writing costs needs to be incurred. Additional safety data may be requested from regulatory authorities which add to ongoing costs.”

“It’s growing and becoming more accepted, but it seems there is a twotiered model of dry eye practice evolving. There are those offering dry eye treatment at an entry level, like myopia, and there are those who are taking the next step, like myself, with a dedicated clinic backed by an elevated knowledge of this disease.”

Ooi says Australian eyecare practitioners’ uptake of innovative treatments is generally slow, compared to their global counterparts, given that dry eye drug development is not usually done in Australia.

Rayner’s practice model assesses each patient’s dry eye disease – and financial position to afford treatment – on a case-by-case basis.

“And we tend to be conservative preferring to be presented with randomised controlled trial/real-world data and using wellestablished products,” he says.

“We clinically assess patients as part of an initial consultation under Medicare guidelines if they are eligible. We don’t bulk bill. In my experience, patients are so desperate to resolve their dry eye that they will pay out-of-

INSIGHT October 2021

"WE ARE SEEING THE ESTABLISHMENT OF DRY EYE CLINICS THROUGHOUT AUSTRALIA TO ASSIST PATIENTS MANAGE THIS CONDITION"

LUKE ARUNDEL OPTOMETRY AUSTRALIA

pocket, but they often say, ‘I wish my health fund would cover this’. I initially spoke to one major health fund about covering dry eye, but it was not considered big enough to cover,” Rayner says. “Some people can’t afford the gap. We take an individual approach to cost and payment. It would be fabulous to see a Medicare rebate for basic imaging like meibography (infrared imaging of meibomian glands). Medicare should be covering meibography, much like Medicare covers a bone x-ray. But it’s not covered.” EMPHASIS ON EDUCATION Optometry Australia (OA)’s chief clinical officer Mr Luke Arundel says the organisation recognises that the incidence of dry eye is high with most people experiencing this condition at some time.

“The rise in dry eye is creating a need within the population for more specialised treatment, hence we are seeing the establishment of dry eye clinics throughout Australia to assist patients manage this condition. We are highly supportive of the establishment of practices dedicated to specific eye conditions and diseases,” he says. Given the prevalence of dry eye, OA is continuing to provide education and professional development resources for its members. In July, the US inventor of the IPL procedure, Dr Rolando Toyos, facilitated a dry eye webcast, outlining the basic concept and mechanism of IPL therapy and how it can be incorporated into dry eye treatment, and reviewing existing and new therapeutic dry eye management options available to practitioners. Simultaneously, Arundel says OA is continually lobbying for the expansion of the MBS schedule. The organisation has a member-based Medicare Services Advisory Group to assist in this area and its policy team is in regular communication with the numerous divisions within Medicare. But as Arundel points out, lobbying for items to be added to the MBS can be an expensive enterprise. “Addition of procedural items to the MBS involves a large amount of effort and resources, with the first of these (item 10944: foreign body removal) successfully added to the list after eight years of lobbying from Optometry Australia.” Arundel confirmed the organisation is not actively advocating for a procedural item for dry eye to be added to the MBS. “Currently no modifications or additions to our MBS list are being considered until the results of the MBS review for our tranche are handed down. After numerous delays (exacerbated by COVID-19) this is now anticipated to be as late as 2022.” n

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

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

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

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

INSIGHT

Dry Eye Directory

Welcome to the inaugural Insight Dry Eye Directory, an all-in-one resource featuring clinics offering dry eye services across Australia, as well as a list of therapies and diagnostics from the country’s leading suppliers.

Banner 470x70.pdf

Disclaimer: The Insight Dry Eye Directory is compiled of opt-in participants. Information has been provided by clinics and suppliers themselves. If you missed out or need to update your details for next year’s directory, email myles.hume@primecreative.com.au 31/8/21 6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY NEW SOUTH WALES / ACT 1001 OPTICAL EASTGARDENS Shop 245 Westfield Pagewood, Pagewood, NSW 2022 Frank Zhang P (02) 9314 3331 W 1001optical.com.au Lubricants, meibomian gland management, co-management with ophthalmology.

ATKINS OPTOMETRIST EP GORDON 12 St Johns Ave, Gordon, NSW 2072 Sally Atkins P (02) 9498 8383

CARINA EYE CARE 40 Neich Pde, Burwood, NSW 2134 Carina Trinh P 0423 590 959 W carinaeyecare.com.au

DR OLIVER WOO OPTOMETRIST

Entry level dry eye treatment with products that range from quality lubricants, tea-tree oil based lid wipes, preservative-free hypochlorous acid eyelid cleanser (Avenova), Optimel Manuka honey gel, premium thermal eye masks, eye gel and ointment, 7eye and Ziena moisture chamber glasses and sunglasses with silicone/ foam shield, in-office lid debridement and lid expression, bulk-packs of preservative-free lubricant Hylo-Forte.

1/201-203 Rowe St, Eastwood, NSW 2122

W atkinsoptometrist.com.au We offer a range of dry eye products including preservative-free lubricants and Omega 3 supplements. We also offer in house Blephex treatments and take home lid therapy including heat masks and lid wipes and foam and Optimel drops for the treatment of blepharitis.

BONDI EYE DOCTORS Suite 2002, Level 20, Westfield Tower 1, 520 Oxford St Bondi Junction, NSW 2022 Prof Stephanie Watson P (02) 9389 0666 W bondieyedoctors.com.au Comprehensive dry eye treatments and clinical research into dry eye.

manage and treat advanced dry eye. We use the latest clinical evidence including accurate diagnosis and monitoring using a range of eye drops, as well as eyelid hygiene, steam treatments and gland expression.

CHATSWOOD OPTICAL SERVICE 2 Lindel Pl, Lindfield, NSW 2070 H. G. Roberts P 0414 941 661 W henrob22@tpg.com.au Eye drops for patients.

CONCORD EYE CARE 161 Concord Rd, North Strathfield, NSW 2137 Jenny Livanos

Dr Oliver Woo P 0412 388 166 W N/A IPL, Blephsteam, Blephex, Medmont and K5.

EASTERN SUBURBS EYE SPECIALISTS Suite 901/3 Waverley St, Bondi Junction, NSW 2022 Dr Matthew Wells P (02) 9389 4840 W eseyespecialists.com.au The latest technology in diagnostic equipment and treatments for dry eye disease including TearLab osmolarity, tear function testing, Lipiscan, punctal plugs, anti-inflammatory treatment, Blephex and Lipiflow.

EXPERT EYECARE

P (02) 8765 9600

Shop 3, 11 Mashman Ave, Kingsgrove, NSW 2208

W concordeyecare.com.au

Elias Harb

Comprehensive dry eye assessment, treatment (including IPL) and range of dry eye products available.

P (02) 8014 8933

CAPITAL EYE Suite 3B 3 Sydney Ave, Barton, ACT 2600

CUSTOM EYECARE

Dr Jack Guan

158 Darby St, Newcastle, NSW 2300

P (02) 6273 7458

Wes Butler

W capitaleye.com.au

P (02) 4927 0500

E-Light IPL, Blephasteam, MGD expression, BlephEx, punctal plugs, therapeutic eye drops.

W customeyecare.com.au

W eyecareplus.com.au/kingsgrove Dry eye disease diagnosis (Ocular Surface Analyser), phenol red thread testing, TBUT, NIBUT, meibography, Blephadex, hypochlorous acid, Optimel, Blephasteam, IPL.

EYECARE PLUS BATEAU BAY Shop 20 Bateau Bay Sq, Bateau Bay, NSW 2261

A range of services to thoroughly diagnose,

... not a dry eye in sight

CLINICS Adam Li

W Eyecareplus.com.au/toronto

P (02) 4332 0032

Advice and therapeutic prescriptions for dry eyes. Tear film analysis and meibomian gland assessment, plus IPL treatment, meibomian cleansing and expression.

W rolfeoptometrists.com.au We run a full dry eye clinic including an IPL machine. Please phone us to arrange a dry eye assessment appointment.

EYECARE PLUS FORSTER

ICON EYEWEAR 28/2A Cross St, Hurstville, NSW 2220 Michael Mihailidis/Maria Dimitratos P (02) 9580 5766

EYECARE PLUS MERRYLANDS

1/12 Wharf St, Forster, NSW 2428

W iconeyewear.com.au

3 Memorial Ave, Merrylands, NSW 2160

Cana Xu

Thu & Thao Le

P (02) 6554 7817

P (02) 2963 75047

W rolfeoptometrists.com.au

W eyecareplus.com.au/merrylands

A complete dry eye clinic including an IPL machine. Please call us to arrange a dry eye assessment appointment.

Assess and diagnose dry eye as an extension of a comprehensive eye examination. We use the Oculus Keratograph as part of this assessment. Treatment options include Lipiflow, Rexon-eye and Lumenis.

Diagnostic equipment with K5M. Treatments available: therapeutic, Blephasteam, IPL.

EYECARE PLUS TAREE

EYERYS I CARE

181 Victoria St, Taree, NSW 2430

Shop 16 Westside Plaza, Broken Hill, NSW 2880

Peter McKay P (02) 6552 5044 W eyecareplus.com.au/taree Non-invasive tear assessment, meibography, IPL, meibomian gland expression, nutrition advice, lifestyle advice.

EYECARE PLUS THE JUNCTION 198 Union St, The Junction, NSW 2291

P (08) 8087 8099

Comprehensive ocular surface assessments using keratography and tear osmolarity. Time is spent on patient education and practical demonstrations. In-room treatments include eyelid margin debridement, warm compresses, lid massage, lid hygiene and meibomian gland expression.

W eyerysicare.com.au MGD expression, punctal plugs, manuka honey (Optimel), tear duct irrigation, omega-3 products, dry eye forte, Lacritec, fish oil supplements. In-office eyelid treatments, Blephadex foam, Blephadex wipes, topography. Therapeutic oral and topical medications.

EYES IN DESIGN

W rolfeoptometrists.com.au

832 Military Rd, Mosman, NSW 2088

We have a complete dry eye clinic including an IPL machine. Please call us to arrange a dry eye assessment appointment.

Gary Rodney

Nasen Udayan P (02) 4959 9222 Banner 470x70.pdf

31/8/21

P (02) 9635 7077 W marsdeneye.com.au

P (02) 4969 5458

Suites 3-5, 108 The Boulevarde, Toronto, NSW 2283

Lara Greig (orthoptist)

Siri Tang

Daniel Cao

EYECARE PLUS TORONTO

MARSDEN EYE SPECIALISTS 152 Marsden St, Parramatta, NSW 2150

P (02) 9969 1600 W smartvisionoptometry.com.au Tear film analysis. Corneal health analysis. Meibomium gland analysis. All forms of dry eye testing and diagnosis and treatment. Blephasteam and meibomian gland expression. micorexfoliation of eye lid margins. All forms of blepharitis treatment.

MENAI EYE CARE 8/62-70 Allison Cres, Menai, NSW 2234 Dianne Andrews P (02) 9543 1166 W menaieyecare.com.au Practice has therapeutically endorsed optometrist with access to a BlephEx pen, and an IPL machine for more severe dry eye, especially associated with ocular rosacea. Don’t have meibomian gland imaging yet, but are purchasing a Medmont corneal topographer for tearfilm and meibomian gland visualisation.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

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Apply NovaTears®

Spreads quickly and easily on the lipid layer

STREAMLINED AUTHORITY CODE 6172 – NovaTears® only PBS Information: Authority Required (STREAMLINED): Severe dry eye syndrome in patients who are sensitive to preservatives in multi-dose eye drops. 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.

For more information:

1800 2387 4276

www.aftpharm.com

mydryeyes.com.au

CLINICS MOSMAN EYE CENTRE

Dr. Nick Papadopoulos

W rjkoptometry.com.au

1A Effingham St, Mosman, NSW 2088

P (02) 9891 2020

Comprehensive dry eye clinic including IPL and advanced diagnostic techniques.

Dr Tanya Trinh

Dry eye assessment; patient counselling; inhouse and at-home treatment.

W optometristparramatta.com.au

P (02) 9969 1333

TANILBA BAY OPTOMETRIST

W mosmaneye.com.au Intense Pulsed Light (IPL): Therapy for dry eye patients, particularly those who suffer from symptoms mainly due to the meibomian gland dysfunction.

MT CORONEO PTY LTD 2 St Pauls St, Randwick, NSW 2031 Prof Minas Coroneo P (02) 9399 9211

PAUL HARVEY OPTOMETRY Shop 20 Shoppingworld, Tamworth, NSW 2340

5/77 President Wilson Walk, Tanilba Bay, NSW 2319 Neil Kearns

Paul Harvey

P 0421 027 186

P (02) 6765 2912

W tanilbabayoptometrist.com.au

W harveyoptometry.com.au

Comprehensive assessment of dry eye dysfunction including meibomian gland photography. Various low cost in-office and at home treatment options including Blephex and gland expression.

Comprehensive dry eye treatment including meibography, therapeutic care, BlephEx debridement and IPL.

W N/A Comprehensive dry eye assessment and management.

PETER D'ARCY OPTOMETRIST PO BOX 115, Bega, NSW 2550 Peter D'Arcy

NEXUS EYE CARE

P 0419 248 731

130D Main St, Blacktown, NSW 2148

W peterdarcy.com.au

Dr Chameen Samarawickrama

Evaluation and treatment using OCULUS Keratograph 5M,blephex,manuka honey, blephasteam, MG.

P (02) 9672 3055 W nexuseyecare.com.au

R AND B'S OPTOMETRIST

OPTICS

B. H. Kurtz

Mi Ja (“Midge”) Choi W Optics25@bigpond.net.au Keratograph; Blepharosteam; BlephEx; meibomian gland expression.

OPTOMETRIST PARRAMATTA Shop 9A, 103 George St, Parramatta, NSW 2150 Banner 470x70.pdf

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Banora Shopping Village, Banora Point, NSW 2486 P 0418 432 834

Emma Furniss (optometrist), A/Prof Chandra Bala (ophthalmologist), Dr Freny Kalapesi (ophthalmologist), Anna Siu (optometrist) P (02) 8319 0555 A comprehensive assessment and treatment clinic, offering the most advanced and innovative treatment modalities for all types of dry eyes including PRGF drops, Lipiflow, IPL and several options tailored to a patient's individual needs.

W tweedcityoptometrist.com Dry eye assessment and individual treatment program implemented.

P (02) 9477 5216

Level 2, 33 York St, Sydney, NSW 2000

W dryeyeinstitute.com.au

Comprehensive and specialised dry eye management from drops through to more complex treatments.

1, 14 Hunter St, Hornsby, NSW 2077

THE DRY EYE INSTITUTE

RJK OPTOMETRY

THE EYE PRACTICE 50 York St, Level 3, Sydney, NSW 2000 Dr Jim Kokkinakis P (02) 9290 1899

14 Arthur St, Coffs Harbour, NSW 2450

W theeyepractice.com.au/dry-eyes

Michael Jones

All diagnostic and therapeutic options currently available in Australia. Includes LipiView, Oculus

P (02) 6651 1139

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

Keratograph, TearView, LipiFlow, IPL, RexonEye, MG debridement and expression are just a few.

Dr Nikhil L Kumar FRANZCO P (02) 9222 9188 W visionclinicsydney.com.au

THE SPECTACLE PLACE 34 Railway Pde, Burwood, NSW 2134 Michael Warnock P (02) 9745 4497 W thespectacleplace.com.au We provide a bulk billed diagnostic consultation where the Schirmer tear test is performed. The test will indicate whether treatment from the E-Eye IRPL will be beneficial.

Comprehensive cornea subspecialist evaluation and management of dry eye syndrome, including the use of new and emerging therapeutic technologies.

3/241 Oxford St, Bondi Junction, NSW 2022 Daniel Tracton P (02) 9188 9288

WESTMEAD EYES OPTOMETRISTS T204A Westmead Hospital, Westmead, NSW 2145 Dr Kevin Trac P (02) 9635 8464 Artificial eye drops and ointments, manuka honey, hot compresses, lid scrubs, hypochlorous acid, meibomian gland expression and blephasteam, topical steroids and oral antibiotics, vitamin supplements, dietary changes, punctal plugs.

W tractonoptometrists.com.au Therapeutically-endorsed optometrist trained at UNSW. Offering the full range of dry eye treatments from over-the-counter treatments to PBS prescribed ophthalmic preparations and PBS prescriptions.

UNSW DRY EYE CLINIC Gate 14, Barker St, UNSW, NSW 2052 Kathleen Watt P (02) 9385 4624 W optometry.unsw.edu.au/ optometry-clinic/dry-eye-clinic A referral centre for the diagnosis, imaging and evidence-based management of dry eye disease. We require a referral from your eyecare practitioner or from within our own clinic.

VISION CLINIC SYDNEY Suite 605, Level 6, 229 Macquarie St, Sydney, NSW 2000

20/20 SIGHT'N'STYLE 161 Main St, Mornington, VIC 3931 George Sahely P (03) 5973 5520 W sightandstyle.com.au

W westmeadeyes.com.au

TRACTON OPTOMETRISTS

VICTORIA

Offering comprehensive dry eye testing (Oculus K5, Korb MGE, osmolarity, meibomography) and an extensive range of treatments, including Lipiflow, IPL, Blephex and therapeutics.

DIAMOND VALLEY OPTICAL Shop 15/72 Main Hurstbridge Rd, Diamond Creek, VIC 3089 Asela Senanayake P (03) 9438 3286 W diamondvalleyoptical.com.au We provide many suitable eye drops, ointments, Blephasteam, Blephex, heat masks and full IPL.

WISE EYES OPTICAL 2-4 Kenny St, Wollongong, NSW 2500

DRY EYE CENTRE

Andrew Reveley P (02) 4227 3330

142 Canterbury Rd, Heathmont, VIC 3135

W wiseeyes.com.au

Dr Nicholas Young

Dry eye assessment of MGD using antares in dedicated treatment room. We also offer Blephasteam, Blephadex and IRPL.

P (03) 9729 4077

WOONONA EYECARE 391 Princess Highway Woonona, NSW 2517 Ashleigh Peters P (02) 4284 1344 W woononaeyecare.com.au Bulk billed dry eye assessment using slit lam camera and meibography, Lumenis IPL with meibomian gland expressions, in office BlephEx treatment, in office products such as Blephadex foam, Lacritec/dry eye forte supplements.

W dryeyecentre.com.au Diagnostics: including infra-red tear metrics and osmolarity. Treatments: Intense Pulsed Light (Lumenis M22), Lipiflow, amniotic membranes, autologous serum, compounded eyedrops, lid hygiene/tear supplements, co-management for systemic diseases.

DRY EYE SPECIALISTS 467 Toorak Rd, Toorak, VIC 3142 Lucille Gergis P (03) 9826 0740 W dryeyespecialists.com.au

... not a dry eye in sight

CLINICS Comprehensive dry eye assessment using K5, Blephex treatment, Lumenis IPL, autologous serum and all dry eye drops ointment and wipes.

DRY EYE VICTORIA Level 1, 242 Hoppers Lane, Werribee, VIC 3030

P (03) 9819 7695 W eyecareconcepts.com.au Comprehensive dry eye assessment with the Oculus Keratograph 5 and Medmont Meridia, in-room dry eye treatments including IPL, and scleral lenses for severe dry eye patients.

Ophthalmologist

EYECARE PLUS BUNDOORA

P 1300 150 806

Shop 5 University Hill Town Centre, Bundoora, VIC 3083

W australianeyespecialists.com An initial full ophthalmic consultation; Oculus Keratograph to assess tear film, lid margin and ocular surface. Investigation of relevant muscle and nerve function. Therapy options: moist heat therapies, lid wash formulations and suitable topical lubricants; direct meibomian gland expression, low level light therapy and intense pulse light therapy.

Shop 2/2-20 Koornang Rd, Carnegie, VIC 3163 Khang Ta

Intense Pulse Laser (IPL) for severe dry eye. Blephasteam, an in-store spa treatment. Range of home remedies for mild-moderate cases and ongoing maintenance.

512 Plenty Rd, Mill Park, VIC 3082 Giorgio Campanella

37 Church St, Brighton, VIC 3186 Vicky Chang P (03) 9592 4800 W eyesonbrighton.com.au or www.dryeyegroup.com.au Full scope dry eye service, including diagnostic imaging, ocular surface disease management/ maintenance. Advanced dry eye treatments on offer include: specialty CL options for dry eyes, meibomium gland expression, Optima IPL and Lipiflow.

GRAHAM HILL EYECARE 98 Maude St, Shepparton, VIC 3630 Mark DePaola P (03) 5821 2811 W hilleyecare.com K5 mebography and dry eye assessment, IPL, blephasteam, over the counter drops, tablets and heat packs, prescription eye drops.

W eyecareplus.com.au

W evergreenoptical.com.au Comprehensive dry eye and ocular surface assessment. A range of in-practice treatments.

EYE DESIGN 538 Malvern Rd, Prahran, VIC 3181 Beverley Sacho P (03) 9533 2000

Comprehensive assessment including meibography. Treatment options discussed including numerous eye drops, eye ointments, oral supplements and treatments including heat, intense pulse light and meibomian gland expression.

IN2EYES

EYECARE PLUS MULGRAVE

Full scope dry eye service, including diagnostic imaging, ocular surface disease management/ maintenance. Advanced dry eye treatments on offer include: specialty contact lens options for dry eyes, Rexon Eye, Optima IPL and Lipiflow.

431 Police Rd, Mulgrave, VIC 3170

W eye-design.com.au Blephasteam treatment with meibomian gland expression. Eye drops, lid care products, nutritional supplements, heat packs.

Glenn Vessey P 0414 747 171

EYECARE CONCEPTS

Dr Philip Cheng 6:07 pm

511 Whitehorse Rd, Surrey Hills, VIC 3127 Jason Teh P (03) 9836 6883 W www.in2eyes.com.au or www.dryeyegroup. com.au

W eyecareplus.com.au/mulgrave Full dry eye assessment and treatments. Including Antares dry eye and meibomian gland assessments as well as eEye IPL, Blephasteam and Blephadex treatments.

Suite 14, 828 High St, Kew East, VIC 3102 31/8/21

W eyecareplus.com.au/bundoora

P (03) 9436 9644

P 0403 575 625

P (03) 9467 7580

EYECARE PLUS MILL PARK

EVERGREEN OPTICAL

Banner 470x70.pdf

Prerna Bhatia and Jean Walters

EYES ON BRIGHTON

KIDDIES EYE CARE 1/167 Hyde St, Yarraville, VIC 3013 Nicky Kiparissis P (03) 9448 8933 W kiddieseyecare.com.au

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

SEE THE DIFFERENCE A POSITIVE EMULSION CAN MAKE TO DRY EYES

NEW Cationorm®

more than relief.

NOW PBS LISTED

+ REPAIRS

+ RESTORES

+ HEALS

the lipid layer to reduce evaporation, lubricate and stabilise the tear film1,2

the balance of moisture in the muco-aqueous layer of the tear film1,2

the ocular surface, providing long-lasting protection1-3

PBS Information: Authority required (STREAMLINED). Refer to PBS Schedule for full authority information. ALWAYS READ THE LABEL AND INSTRUCTIONS FOR USE. IF SYMPTOMS PERSIST, TALK TO YOUR HEALTH PROFESSIONAL. 1. Lallemand F et al. J Drug Deliv 2012:604204. 2. Daull P, et al. J Pharm Pharmacol 2014;66(4):531–41. 3. Robert P et al. Eur J Ophthalmol 2016;26(6):546–55. Seqirus (Australia) Pty Ltd Melbourne, Victoria | Ph: 1800 642 865. Seqirus is a trademark of Seqirus UK Limited or its affiliates. Cationorm is a registered trademark of Santen S.A.S. and distributed by Seqirus (Australia) Pty Ltd under license from Santen Pharmaceutical Asia Pte Ltd. Date of Preparation: July 2021. ANZ-Cati-21-0021.

CLINICS With the recent purchase of the Myah machine we can look at the tear later, measure tear film meniscus and measure meibomian gland loss. Offering Blephasteam, Bruder masks and dry eye advice.

OTWAY OPTICAL 143 Murray St, Colac, VIC 3250 Leigh Plowman P (03) 5231 4075

KOSMAC & CLEMENS OPTOMETRISTS

W otwayoptical.com.au

Shop 48C Strath Village Shopping Centre, 134 Condon St, Bendigo, VIC 3550 Ian Clemens

We take a holistic approach to dry eye treatment. We also offer Blephasteam and IPL.

PORTLAND EYECARE

P (03) 5441 8841

including meibography, Optimel Manuka drops, Silicon sleep shields, I-Lid'N Lash plus wipes, Blephadex wipes, Lactritec oral supplements.

64A Percy St, Portland, VIC 3305

THE OPTOMETRIST TOORONGA Shop 04, Tooronga Village, 766 Toorak Rd, Glen Iris VIC 3146 Teresa Antonios P (03) 8560 0560 W theoptometristtooronga.com.au

Diagnosis, Blephasteam expression, lacrimal lavage.

Full scope dry eye service, including diagnostic imaging, ocular surface disease management/maintenance. Advanced dry eye treatments on offer include: specialty contact lens options for dry eyes, meibomium gland expression, Optima IPL and Lipiflow.

200 Berkeley St, Ground Floor, Carlton, VIC 3053

RASHELLE COHEN OPTOMETRY

WARRNAMBOOL EYECARE

Dr Andrew Huhtanen (Clinic Director)

263 Glen Eira Rd, Caulfield North, VIC 3161

152 Liebig St, Warrnambool, VIC 3280

P (03) 9035 6666

Rashelle Cohen

Matthew Buckis

W healthsciences.unimelb.edu.au/eyecareclinic/home

P 0421 281 910

P (03) 5562 2244

W cfmp.com.au/rashelle-cohen-optometry

Comprehensive services for the assessment and treatment of dry eye disease and MGD, including tear film analysis (LipiView), punctal plugs, eyelid hygiene, and in-office meibomian gland expression (LipiFlow).

Oculus Keratograph dry eye assesment, Blephasteam and MG expression, Nulid treatment, range of lubricants, Optimel ointment.

W portlandandwarrnambooleyecare. com.au

W kosmacandclemens.com.au Comprehensive assessment. Oculus K5, Schirmer testing, punctal plugs, IPL treatment, anterior eye photography.

MELBOURNE EYECARE CLINIC

MYOPIA CONTROL ORTHO-K CENTRE Suite 12, 456 St Kilda Rd, Melbourne, VIC 3004

Matthew Buckis P (03) 5523 1189 W portlandandwarrnambooleyecare.com.au

SANCTUARY LAKES EYECARE Shop 18, Sanctuary Lakes Shopping Centre, Point Cook, VIC 3030 Jenkin Yau

Jimmy Huang

P (03) 9395 7530

P (03) 7036 6788

W eyecarepoint.com.au

W myopiacontrolcentre.com.au

Lumenis M22 Optima IPL, Blephex lid treatment, meibomian gland expression, tear osmolarity testing, ocular keratograph dye eye Jenvis assessment

Diagnosis of dry eye, in house treatment with Nulid, meibomian lid expression lid. Banner 470x70.pdf

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Comprehensive diagnosis with K5, Blephasteam expression, lacrimal lavage.

WODONGA EYECARE 203 Beechworth Rd, Wodonga, VIC 3690 Kelly Gibbons P (02) 6056 4000 W wodongaeyecare.com.au Digital dry eye analysis using IDRA OSA. Lid margin debridement. BlephEx, digital heat therapy and meibomian gland expression. Punctal plugs. Lacrimal lavage. IPL Therapy using Lumenis M22.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DON’T LET DRY EYES HOLD YOU BACK STAY FOCUSED with the Systane ® family of products

NEW

2 DROPS, 1 FOCUSED YOU 1

CLINICS QUEENSLAND

where this restricts or prevents the use of contact lenses.

A+ EYECARE 30 Boyanda St, Wishart, QLD 4122 Optometrist P 0403 354 212 W eyecareplus.com.au/inala Blephasteam, E Eye Laser, supplements and eye drops.

APHRODITE LIVANES OPTOMETRISTS 71 Cambridge Dr Alexandra Hills Shopping Centre, Alexandra Hills, QLD 4161 Optometrists P (07) 3824 1878 W livanes.com.au Dry eye assessment, IPL treatments, Blephasteam treatments, debriding eyelids with BlephEx, dry eye solutions – eye drops, Eyeseal goggles.

CAIRNS EYE SURGERY 77 Woodward St, Edge Hill, QLD 4870 Dr Brian Todd P (07) 4081 3000 W cairnseyesurgery.com.au For assessment, education and treatment with IPL, Blephasteam.

DAVID STEPHENSEN OPTOMETRIST 197 Beaudesert Rd, Moorooka, QLD 4105 David Stephensen P (07) 3848 8979 W dsoptom.com.au We provide well established experience in the therapeutic care of dry eye, particularly Banner 470x70.pdf

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treatments, such as the Rexon-Eye and IPL dry eye treatment.

ENVISION OPTICAL

EYECARE PLUS WILSONTON

19/7 Classic Way, Burleigh Waters, QLD 4220

407 Bridge St, Toowoomba, QLD 4350

Andrew Bowden

Justin Durkin

P (07) 5593 7844

P (07) 4633 0274

W envisionoptical.com.au

W eyecareplustoowoomba.com.au

Digital diagnosis including interferometry and meibography imaging. In-office treatment with IPL and Lipiflow.

Dry eye workshop with an Antares to provide degree of dry eye and IPL and Blephasteam treatments.

EYEBIZ OPTOMETRY CARRARA

EYEMAN.COM.AU

Shop 5 54 Manchester Rd, Carrara, QLD 4211

Shop 1, 3 Byres St, Newstead, QLD 4006

Brett Partridge

Optometrist

P (07) 5573 7630

P (07) 3216 1926 or 0408 069 075

W eyebiz.net.au

W eyeman.com.au

Full range of diagnostic procedures and treatment options.

Full scope dry eye management for persons of all ages.

EYECARE EYEWEAR

H2 VISION CENTRES

Shop 21 17-67 Cunningham St, Dalby QLD 4405

7/11-19 Chancellor Village Boulevard, Sippy Downs, QLD 4556

Tom Roger

Dr Eloise Thomas

P (07) 4669 7072

P (07) 5353 5080

W ecew.com.au

W h2visioncentres.com.au

Blephasteam, debridement, MG expression, lacrimal probing and lavage, plugs, schirmer and phenol red cotton thread, Optimel. In office treatments.

Tear film analysis, treatments inclusive of heat related compressions and expressions of the mybomian glands. Lid scrubs and Intense Pulse Light (IPL) treatments.

EYECARE PLUS MERMAID BEACH

HARRYS OPTOMETRIST

Shop 3A, 2431 Gold Coast Highway, Mermaid Beach, QLD 4218

132 Beaudesert Rd, Moorooka, QLD 4105

Jackson Yip

Harry Melides

P (07) 5526 1400

P (07) 3848 6673

W eyecareplusmermaidbeach.com.au

W harrysoptometrist.com.au

We offer leading dry eye solutions and

General dry and red eye services.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

HERON EYECARE

MYRIAM GOLDMAN OPTOMETRIST

SIGHT SPECIALISTS

147 Russell St, Toowoomba, QLD, 4350

Level 2, 95 Nerang St, Southport, QLD 4215

Hugh Bradshaw

1/970 Logan Rd, Holland Park, QLD 4103

P (07) 4639 2378

Myriam Goldman

P (07) 5647 5777

W heroneyecare.com.au

P (07) 3394 2412

W sightspecialists.com.au

Lumenis M22 IPL, Rexon Eye QMR, BlephEx, Blephasteam, puntal plugs, therapeutic contact lenses, scleral contact lenses.

W myriamgoldman.com

Comprehensive dry eye diagnostics, Blephex, Intense Pulsed Light, manual meibomian gland expression, and prescription pharmaceutical treatments.

ISIGHT SPECIALISTS TOWNSVILLE

Drops and advice.

OPTOMETRY@COOROY 62 Maple St, Cooroy, QLD, 4563

13-15 Martinez Ave, West End, QLD 4810

Jennifer Currie

Dr William Talbot

P (07) 5442 5555

P (07) 4775 1633

W optometryatcooroy.com.au

W isighttownsville.com.au

We will consider the symptoms and causes of dry eye syndrome to determine how the condition is treated. We may evaluate using video tear film quality testing with a corneal topographer, flurorescein and lissamine green staining and the schirmer test of tear production.

Osmolarity testing, E-Eye dry eye treatment.

JUDI COEY OPTOMETRY 1/13 Bunya St, Maleny, QLD, 4552 Judi Coey P (07) 5494 2877 W judicoeyoptometry

R AND B'S OPTOMETRIST

Extensive range of ocular lubricants including natural and preservative-free.

122 Pacific Pde, Bilinga QLD 4225

LOOKING SMART OPTOMETRISTS 2/44 Pelican Waters Blvd, Pelican Waters, QLD 4551

Dr Nick Andrew

SPECSAVERS RUNAWAY BAY Shop 74, 10-12 Lae Dr, Runaway Bay, QLD, 4216 Simon Kelly P 0434 939 293 W specsavers.com.au/book runawaybay Bulk-billing, qualified and caring therapeutically endorsed optometry services seven days a week, including biomicroscopy, OCT and corneal topography. Retail of related dry eye products and extensive range of comfortable contact lenses, including orthokeratology.

B. H. Kurtz P 0418 432 834

THE EYE HEALTH CENTRE

W tweedcityoptometrist.com

44 South Station Rd, Booval, QLD 4304

Dry eye assessment and individual treatment program implemented.

David O’Neill

Phuc Q. Ngo P (07) 7328 24396

P (07) 5439 7844 W LookingSmartOptometrists.com.au Full range of dry eye treatments, including Blephsteam, prescription (PBS) prescribing, dry eye workshops. We can also advise on IPL and work in conjunction with a local eye specialist who specialises in dry eye.

ROSSER OPTOMETRY

W theeyehealthcentre.com.au

6 New St, Nerang, QLD 4211

Comprehensive diagnostic and management from mild to complex cases. Can triage with ophthalmologist to improve ocular surfaces before and after cataracts/ refractive surgery. In-room treatments including KG5 scans, Blephsteam, IPL and serum tears.

Sophia Gerritsma P (07) 5578 4611 W rosseroptometry.com.au Eye ointment and drops, heat packs and lid massage, in-office lid meibomian gland expression, steroidal eye drops.

... not a dry eye in sight

CLINICS THE EYE HEALTH CENTRE

THE EYEWEAR SHOP

BAROSSA EYE CLINIC

Level 11, 87 Wickham Tce, Brisbane, QLD, 4000

15G, 25 Samuel St, Camp Hill, QLD 4152

23 High St Gawler, Adelaide, SA, 5118

Minh Nguyen

Dr Deric De Wit

Jason Holland

P (07) 3395 4105

P (08) 8250 6107

P (07) 3831 8606

W theeyewearshop.com.au

W barossaeyeclinic.com

W theeyehealthcentre.com.au

Comprehensive assessment including Schirmer tear volume testing, fluorescein tear assessment, and slit lamp biomicroscope tear and eyelid assessment of conditions like Sjogren's syndrome and blepharitis. Demodex treatments such as in-clinic tea tree oil and lid cleanse, Blephasteam and expression for blepharitis/ MGD. All optometrists therapeutically endorsed.

Comprehensive dry eye assessment, Lipiview meibography scanning and lipid layer analysis. Lipiflow, Blephex treatments.

Comprehensive dry eye diagnostic services including the Keratograph 5, Tear Lab and anterior eye imaging. Optima IPL, Rexon Eye, BlephEX, punctal plugs, serum tears and Blephasteam. Also offer high quality products for at-home management.

THE EYE HEALTH CENTRE (ASPLEY) 7/1344 Gympie Rd, Aspley, QLD 4034 Andy McCormack P (07) 3863 1097

VISION OPTICS 95 Vulture St, West End, QLD 4101 Andrew Angeli

W theeyehealthcentre.com.au Dry eye clinic with IPL and Blephasteam. Full range of therapeutic options to treat and manage dry eye in conjunction with Dr John Hogden.

THE EYE HEALTH CENTRE (WYNNUM) 93 Clara St, Wynnum, QLD, 4178

P (07) 3844 1556 W visionoptics.com.au IPL, Blephex, prescription and over the counter eye drops, omega-3 tablets, eyes masks and gland extractions.

SOUTH AUSTRALIA

Lily Luong

ALLEVE EYE CLINIC

P (07) 3026 2600

49a Stephen Tce, St Peters, SA 5069

W theeyehealthcentre.com.au

Jennifer Rayner

After learning more about your dry eye symptoms and identifying the contributing factors, we can recommend one or more of: artificial tears and medicated eye drops, punctal plugs, Blephasteam, autologous serum tears, Intense Pulsed Light.

P (08) 7225 9798 W alleveeyeclinic.com.au Diagnosis and treatment of dry eye with a holistic approach using all evidencebased tools available including IPL, topical ciclosporin, punctal plugs and manuka honey to manage the condition.

EYES & VISION MUNNO PARA 20 Munno Para Shopping City, Munno Para, SA 5115 Naima Bammann P (08) 8284 1445 W eyesandvision.com.au Diagnosis of the type of dry eye, ocular lubricant and topical medications, lid scrubs, Blephasteam and meibomian gland expression. Other locations: • Eyes & Vision Burnside, 431 Portrush Rd, Toorak Gardens, SA 5065 – (08) 8338 5311 • Eyes & Vision Colonnades, 75 Colonnades, Noarlunga, SA 5168 – (08) 8384 6211 • Eyes & Vision Goolwa, 7 Railway Tce, Goolwa, SA, 5214 – (08) 8555 2151 • Eyes & Vision Hallett Cove, 20 Hallett Cove Shopping Centre, Hallett Cove, SA 5158 – (08) 8387 7388 • Eyes & Vision Unley, 50 Unley Shopping Centre, Unley, SA, 5061 – (08) 8271 6020

GOGGLEMAN 5A Yachtsman St, Seaford, SA 5169 David Aulert P (08) 8298 1462 W goggleman.com.au

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6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

An extensive range of dry eye eyewear designed to minimise the symptoms of dry eye conditions.

DRY EYE WA

FOR EYES OPTOMETRIST 158 High St Fremantle, WA 6160

RIVERSIDE EYE CARE

Suite 18 Riseley Corporate Centre, 135 Riseley St, Booragoon WA 6154 Marilyn Stern

P (08) 9335 3433

P (08) 6468 5296

W foreyes.com.au

W dryeyewa.com.au

Comprehensive dry eye diagnosis including osmolarity measurements. Most patients suffering from dry eye have meibomian gland dysfunction. We use the advanced Lumenis M22 IPL system in the treatment of MGD.

Unit 8/84 Onkaparinga Valley Rd, Balhannah Shopping Centre, Blahannah SA 5242 Christopher Kawecki P (08) 8389 9176 W riverside-eye-care.com Pharmaceuticals, temporary nasolacrimal plugs, permanent plugs, Blephasteam, stain analysis.

WESTERN AUSTRALIA SPECIALEYES OPTICAL 43 Rokeby Rd, Subiaco, WA, 6008 Philip Hofan P (08) 9380 4577 W specialeyesoptical.info Full scope optometry inclusive of dry eye assessment and treatment. Therapeutic eye drops and endorsed for prescription drops when required. Intense Pulsed Light (IPL), particularly useful for acne rosacea suffers who typically undiagnosed prior to treatment.

Anterior surface and lid examination including meibography and tear film analysis, Blephex for blepharitis, Blephasteam, IPL, Rexon Eye, My Mask LED light for MGD and ocular rosacea, moisture chamber spectacles, cleansers, drops, heat packs.

E EYE PLACE Shop 9/6 Calypso Pde, North Coogee, WA 6163

TASMANIA TOTAL EYECARE 99 Macquarie St, Hobart, TAS 7000 Andrew Koch

Stephanie Yeo and Annie Hwong

P (03) 6234 5709

P (08) 6191 0344

W totaleyecare.com.au

W eeyeplace.com.au

Comprehensive assessment of dry eye and blepharitis, with a broad range of treatment options including nutrition, topical treatments and Rexon-eye medical treatment to improve both evaporative dry eye and tear film insufficiency.

Equipped to provide comprehensive dry eye assessment using the Oculus K5 Jenvis report and treatment options such as Blephasteam, and stock a wide range of specialty dry eyes products.

EYECARE PLUS GLEN FORREST

ANGELO STREET OPTICAL

U4 5 Hardey Rd, Glen Forrest, WA 6071

4/53 Angelo St, South Perth, WA 6151

Dr Kristin Larson

Wayne McCarthy

P (08) 8929 89992

P (08) 9474 4653

W eyecareplus.com.au/glenforrest

W angelostoptical.com.au

A full range of ocular surface care including evaluation, daily self-care information and products and in-office treatment including the Rexon-Eye, a durable, non-invasive treatment for all forms of dry eye.

Diagnosis and treatment of evaporative (meibomian gland dysfunction) and aqueous dry eye disease aided by objective keratograph testing.

Adrian Rossiter

MARTIN’S EYECARE 1/359 Main Rd Glenorchy, TAS 7010 Martin Robinson P (03) 6272 8423 W martinseyecare.com.au Keratograph diagnostics, Lumenis IPL, Blephasteam, Blephex, wide range of pharmaceuticals.

... not a dry eye in sight

Severe

Mild

NAME

Moderate

GRADE OF DRY EYE Company

EYE DROPS EYE DROPS

THERAPIES

Nova Tears 3ml

AFT Pharmaceuticals/Good Optical Services

•

Nova Tears Omega-3 3ml

AFT Pharmaceuticals/Good Optical Services

•

Hylo-Fresh

AFT Pharmaceuticals/Good Optical Services

Hylo Forte 10ml

AFT Pharmaceuticals/Good Optical Services

•

VitaPos Ointment 5gm

AFT Pharmaceuticals/Good Optical Services

•

Systane Hydration UD Lubricant Eye Drops (30 x 0.7mL)