Insight November 2021 by Prime Creative Media

INSIGHT NOV

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

Concern over who will pay for ophthalmic consumables when they are cut from the list.

HOMEGROWN CRISPR CURES FOR EYE DISEASE New venture in Tasmania aims to take gene editing tech from the lab into the real world.

PROSTHESES LIST REFORM COULD HIT DAY SURGERIES

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INSIGHT NOV

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

PROSTHESES LIST REFORMS TO REMOVE SOME CONSUMABLES COULD IMPACT DAY SURGERIES

There are concerns day surgeries and their ophthalmic patients may bear additional costs under newly proposed reforms of the Prostheses List (PL) that would see the removal of consumables involved in elective surgeries, such as intraocular fluids. The Australian Society of Ophthalmologists (ASO) and other like-minded organisations are also concerned about the potential impact of “bundling” items for surgery, but the private health sector says it’s time to stop disadvantaging patients by cost splitting related items “to maximise revenue”. The comments come in response to The Prostheses List Reforms Consultation Paper No.1: Prostheses List – Purpose

Definitions and Scope, which is part of the Federal Government’s $22 million plan to improve the list over the next four years. The PL was introduced in 1985 and has been reviewed multiple times. It is the way in which hospitals, insurers and device companies know what benefits are payable for listed items, such as intraocular lenses. Insurers are required to pay the governmentmandated price for each listed device, with ophthalmology accounting for around 5% of overall PL payments. Over time, the government hopes PL benefits will better align with prices paid in the public hospital system. To drive this, policymakers are proposing a raft of reforms.

devices, while intraocular dyes and “ophthalmology microcatheters” may also be axed.

Funding for consumables in ophthalmic surgery may be bundled with other items.

A key feature of this is clarifying the PL’s scope by defining which prostheses are eligible for inclusion, and “removing ineligible products”. As a result, ineligible items will instead be funded by “alternative arrangements” between hospitals and insurers. Consumables like intraocular fluids – which costed health funds $14.6 million in 201819 – are set to be removed from the list, among a host of other

ASO vice-president Dr Peter Sumich said it appeared private health insurers had had a lot of influence in the consultation document, and he was not surprised they were attempting to manipulate the process. “Given an inch they try to take a mile. What started as a prostheses review has broadened into a cost cutting exercise including intraoperative fluids and viscoelastics,” he said. “They propose this be funded by ‘alternative means’. The concern is: are they going to pay for it at all continued page 8

CICLOSPORIN TOPICAL TREATMENT NOW PBS-LISTED One of Australia’s newest players to the dry eye disease (DED) market has announced its ciclosporin product Ikervis is now listed on the Pharmaceutical Benefits Scheme (PBS), in a move welcomed by leading eyecare professionals. The ciclosporin 0.1% ophthalmic emulsion is a novel, once-daily treatment for severe keratitis in adults with DED that has not improved with the use of artificial tears. It was listed on the PBS on 1 October. The therapy is in-licensed in Australia by Melbourne-based Seqirus from global ophthalmic company Santen Pharmaceutical Co Ltd. Ikervis marks the company’s second PBS listing of a DED therapy this year after its hydrating and

lubricating emulsion Cationorm was listed on 1 August. According to Seqirus, Ikervis delivers ciclosporin – a calcineurin inhibitor immunosuppressant agent that demonstrates an anti-inflammatory effect by inhibiting the production and/or release of pro-inflammatory cytokines, via an innovative cationic emulsion formulation. The therapy is considered a welltolerated, long-term treatment for severe keratitis, providing sustained relief from DED, with 45% of the patient population experiencing symptom stabilisation after 12 months, in a real-world study. The company says a key feature is its advanced delivery vehicle designed to increase the retention time of the

nano-droplets on the ocular surface, harnessing the electrostatic interaction between the positively charged oil nanodroplets, and the negatively charged ocular surface. Sydney ophthalmologist and clinician scientist Professor Stephanie Watson said affordable access to effective and safe treatments was crucial for optimising patient management. “DED is a serious disorder that can cause keratitis and damage to the ocular surface,” she said. “Contact lens wear increases the risk of DED. In fact, it is four times more likely with contact lens use. Women are also more likely to be affected. In a US study, women were almost threetimes as likely to develop DED than continued page 8

A REFUGEE'S JOURNEY TO OPTOMETRY Cafa Huynh was the youngest Vietnamese refugee pulled off a sinking boat in 1981. Today, he is clinic director of a franchise optometry practice in Hurstville, Sydney. He shares his remarkable story with Insight. page 50

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IN THIS ISSUE NOV 2021

EDITORIAL

FEATURES

CRISPR CURES IN TASSIE The fanfare around ocular gene therapies is heating up. You only need to look as far as our magazine this year to see the increasing number of initiatives to ensure Australia is primed to take hold of the next era of ophthalmic medicine. Just when I thought we had it covered, I learned of an intriguing project bubbling away in Hobart during the past four years, funded via Clinical Professor Brendan Vote’s charitable organisation, the Tasmanian Eye Institute.

PREMIUMISATION PLANS Luxottica’s blueprint to elevate the patient experience in its Australian optical stores.

BETTER BUSINESS Leading eyecare practices offer up their secrets to success, with many surprises.

We cover the story in depth on pages 29-31, but – in short – Vote is building Australia’s first dedicated Ophthalmic Gene Therapy Centre (OGTC) to help Tasmania’s own preeminent ophthalmic genetics expert Professor Alex Hewitt realise his vision of translating CRISPR/Cas gene editing into real world therapies. The project has already cleared major hurdles, including the acquisition and refurbishment of two buildings. What’s more remarkable is the project has been funded entirely through private donations, with no state or government support. Vote and Hewitt should be commended for their vision. Approaches like gene augmentation (Luxturna, approved in 2020) are remarkable in their own right and many Australian researchers are looking into this. But CRISPR/Cas is the future, and once fully harnessed could become the antidote to incurable inherited retinal diseases.

VACCINE MANDATES In the absence of public health orders, employers have been left to make the call themselves.

REGAINING CONTROL How Menicon is protecting the interests of Aussie independents with its contact lens portfolio.

EVERY ISSUE 07 UPFRONT

54 MANAGEMENT

09 NEWS THIS MONTH

56 OPTICAL DISPENSING

52 PEOPLE ON THE MOVE

57 CLASSIFIEDS/CALENDAR

53 ORTHOPTICS AUSTRALIA

58 SOAPBOX

CRISPR/Cas brings a new level of sophistication in terms of precision and its potential to be adapted for other diseases without the red tape. And to have sovereign biotechnology infrastructure like this for Australian ophthalmology will be crucial as the technology takes hold. You only need to look to the reliance on overseas manufacturers of mRNA vaccines to realise how vulnerable we are. Although the OGTC still has to satisfy TGA requirements, Australia should count itself lucky for the generosity and vision of Vote and Hewitt. Surely, they have set a strong enough platform for the federal and state governments to chip in. MYLES HUME Editor

INSIGHT November 2021 5

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UPFRONT Just as Insight went to print, GEORGE & MATILDA revealed two Queensland practices have joined its community. Medispecs North Lakes, north of Brisbane, and Atherton Optometrist, in the Queensland Tablelands Region, now join the more than 90 independents who have partnered with G&M. Founder and CEO Mr Chris Beer said more practices were expected. “As we begin to emerge, we are gearing up for our next wave of growth, with many of the country’s best independents now deciding

WEIRD

now is the time to realise the value of their practice and benefit from the security and support we offer.” IN OTHER NEWS, a breakthrough bionic eye that delivers high-fidelity visual and spatial perception for the blind is one of 22 R&D projects to share in $47.1 million from the Federal Government. ARIA Research Pty Ltd has partnered with the University of Sydney, University of Technology Sydney and World Access For The Blind for the project. Valued at $9.6 million, it has been funded under the Cooperative Research Centre Projects initiative and received $2.6 million. If successful, the project could provide new levels of independence for the blind

and vision impaired population nationally (600,000) and globally (over 337 million). FINALLY, new research commissioned by Vision Australia shows more than half of employers have never considered hiring a blind or low vision person. The survey of 1,003 employers – conducted by the firm EY Sweeney – also found many believed blind people would not be productive enough or thought they would be a financial burden. “We often hear from employers how they can’t find candidates who are qualified or committed, yet here we have evidence that employers aren’t even willing to consider a cohort of driven and talented candidates,” Vision Australia CEO Mr Ron Hooton said.

STAT

WACKY

A new study investigating the way people visualise things they have already seen found many adults are resistant to imagining their own vision in 2D – seeing it in its fully processed, knowledge-laden form instead. “The next question to ask is why did these people think in that way? Is it that they could not think in 2D, or that they chose not to?” the authors asked.

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WONDERFUL

Microsoft has launched its Surface Adaptive Kit, a series of sticky labels that make it easier for vision impaired users to identify keys and important components such as USB ports and lightening cables. Even the packaging itself has been designed to be easy to open.

Published by:

Publisher Christine Clancy

Until now, stem cells from mammals, including humans, have been used in organoid research, but Heidelberg University researchers have demonstrated that stem cells from medaka and zebrafish can also form complex retinal tissue that can be cultured in a petri dish. Among other findings, the researchers expect to gain new insights into the basic mechanisms of retinal development. n

insightnews.com.au

michelle.weston@primecreative.com.au

OCULAR TRAUMA Eye injuries led to more than 86,000 emergency department presentations in 2013-15 in Australia and over 51,000 hospitalisations. Image: LEI/Chris Barry. Full report page 45.

WHAT’S ON

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INSIGHT November 2021 7

NEWS

SPLITTING PAYMENTS A 'BLIGHT' ON SYSTEM continued from page 3

and, if so, will they allocate just a small amount of money which is not viable in a business sense? Or are they going to cut out the payment altogether, presumably passing the cost to day surgeries or doctors – none of that we know.” He said private health insurance “would become a joke” if insurers decided to pick apart surgeries and decide which parts to fund. He believed all stakeholders would be better off reviewing each component that determines the funds paid to day surgeries, and setting agreed fees. According to the government, to ensure clinicians and patients still have access to the de-listed items such as intraocular fluids, insurers and hospitals are working together to agree on an alternative funding arrangement. “It is expected that market competition and direct contracting will result in more efficient prices and contracting arrangements. The government has an expectation that for those items removed, insurers and private hospitals will reach an agreement on a market based alternative funding arrangement and one that does not involve out-ofpocket costs for the consumer,” the consultation paper stated. “Some devices that are accessories

intended to be always supplied and used together with an implantable or surgically invasive device will no longer be separately funded through the PL. Instead, it is anticipated their cost will be bundled into the cost of the device they are intended to be used with or funded under a different funding mechanism.” Sumich said the ASO was also against bundling items, which was another example of health funds wrestling control and finding cost savings that could impact the financial viability of day surgeries.

such as intraocular dyes were generally already included in existing banding or bundled payments, and hence should not be included.

"WHAT STARTED AS A PROSTHESIS REVIEW HAS BROADENED INTO A COST CUTTING EXERCISE INCLUDING INTRAOPERATIVE FLUIDS"

“Splitting devices to maximise revenue is a blight on the current system. It disadvantages consumers, who pay more than necessary, and it disadvantages manufacturers who do the right thing. Any future medical device reimbursement system must stamp out this insidious practice,” the organisation stated.

AN ‘INSIDIOUS’ PRACTICE

“PHA supports the proposal that devices that are essential and specifically designed as a single-use aid for implanting a prosthesis, or are critical for maintaining ongoing-function of the surgically implanted prosthesis, should be bundled into the price of the device. In many cases, bundling items will involve summing of the current reimbursement, but in many other cases, bundling will in effect remove items and simply change the description of the main device.”

Private Healthcare Australia (PHA) – representing 23 health funds – said the consultation paper did not seek a debate on the merits of items. Instead, it was discussing how these items would be paid for – as part of a government-controlled mandated price list or through market mechanisms. The lobby group said consumables and surgical instruments

“The benefits of reform will be shared by consumers and hospitals. Private health insurers have committed to pass on savings to their customers.” n

“When items are bundled, all they do is combine a couple of items together and cut the cost of both to save money,” he said. “You may choose a certain fluid to go with an IOL due to its properties and fact it suits your technique, but once they start bundling, it is taking control of what you are choosing, which is being determined by what [health funds] are prepared to pay for.”

PETER SUMICH, ASO

PHA stated that consumable items which are removed from the PL from 1 February 2022 would continue to be funded by private health insurance, however it did not state to which degree.

THERAPY A WELCOME ADDITION TO DRY EYE TOOLKIT continued from page 3

men, especially women who were older, and peri- and post-menopausal.” Increased screen time, air conditioning use, and mask associated dry eye (MADE) during the pandemic, will likely increase DED prevalence, Watson added. According to Seqirus, patients with severe keratitis are at heightened risk of infection, vision loss, and impaired quality of life. Tear film instability, and reduced tear production can create a cycle of hyperosmolarity, ocular inflammation (including keratitis), and apoptosis, causing damage to the ocular surface. UNSW clinical scientist and president of the International Society for Contact Lens Research Scientia Professor Fiona Stapleton

INSIGHT November 2021

said ongoing exposure to inflammatory mediators, and a hyperosmolar tear film, resulted in recurring damage to the ocular surface. In most cases, severe symptoms of discomfort and variable vision will significantly impact quality of life. Further, Seqirus stated conventional aqueous solutions are limited to watersoluble molecules. Within two minutes of instillation, more than 80% is eliminated via the nasolacrimal drainage system, limiting residence time on the ocular surface. “A topical formulation that remains longer on the ocular surface, and provides sustained therapeutic concentrations, is a welcome treatment option for those living with severe keratitis associated with DED who have not responded to other treatment options,” Stapleton said.

Prof Stephanie Watson.

“Cationic emulsions with an oily core offer an alternative formulation to deliver lipophilic drug substances with poor water solubility, such as ciclosporin, to the eye. Emulsions provide a high encapsulation rate, enhanced stability of the active ingredient, and improved residence time." Seqirus head of medical affairs for the international region, Dr Jonathan Anderson, said the company was excited about introducing its second PBS listed eyecare product this year. “Seqirus is committed to broadening access to eyecare products to help address unmet clinical needs,” he said. “The PBS listing of Ikervis for severe keratitis in adults with DED, will give Australians access to affordable treatment options that have long been available overseas.” n

NEWS XX

OPTOMETRISTS TO JOIN NATIONAL COVID-19 SURGE WORKFORCE

Optometrists are among 12 regulated health professions that authorities have recently approved to expand the nation's COVID-19 response workforce, which includes administering vaccines. On 22 September, the Australian Health Practitioner Regulation Agency (Ahpra) the National Boards established a new pandemic response sub-register for 2021 (the 2021 sub-register) for up to 12 months. Nearly 29,000 practitioners are now eligible, with the sub register identifying practitioners whose clinical skills and training give them appropriate qualifications to provide clinical and non-clinical support for the COVID-19 health response. The 2021 pandemic response subregister was established in response to the changing needs of Australia’s health system due to the COVID-19 pandemic. It includes 12 regulated health professions who can work to the full scope of their registration. On the 2021 sub-register are key professions identified by governments in their pandemic response planning. These include medical practitioners, nurses, midwives, pharmacists along with dental practitioners, diagnostic radiographers, occupational therapists, optometrists, physiotherapists, podiatrists and psychologists. Eligible Aboriginal and Torres Strait Islander Health Practitioners are being added to the 2021 sub-register if they choose to opt in. The extra health practitioners on the 2021 sub-register join 26,000 practitioners who are on the 2020 pandemic response sub-register first established in April 2020. Practitioners on the 2020 sub-register have registration limited to practise in areas supporting the COVID-19 response, such as administering the COVID-19 vaccination or backfilling furloughed staff. Practitioners on both sub-registers can opt out at any time and don’t need to explain why. Optometry Australia (OA) reported that Ahpra confirmed it would commence contacting optometrists, along with other health practitioners included in the subregistry, to notify them of this decision. "It further confirmed that there is no requirement for any optometrist to participate in the COVID-19 surge workforce but it potentially provided employment opportunities to optometrists who may be unemployed, or who have had their work hours significantly reduced, as a result of on-

IN BRIEF

The measure allows optometrists to administer vaccines.

going lockdowns and restrictions,” OA stated. "Optometrists who have let their registration lapse will also be contacted by Ahpra, and will need to opt out should they not wish to join the surge workforce. Ahpra verified that its decision enables state governments to appoint health practitioners on the two sub-registers to be included as part of their surge workforce but, due to differing state legislation, the decision to do this rested with each jurisdiction’s government.” OA national president Mr Darrell Baker said the announcement was a major development for the profession, recognising the clinical skills, experience and training of optometrists as primary healthcare workers and major contributors to community health. ‘We are delighted as this recognition could help to unlock further scope-of-practice advancements that could otherwise, take years to come to fruition,” Baker said. He said OA was hopeful that other state and territory governments will follow the precedence set by the Victorian Government on 2 September, to include optometrists in their COVID-19 vaccination health response team. ‘Optometry Australia will support our state divisions’ efforts in lobbying their governments in relation to today’s announcement,” Baker said. Ahpra CEO Mr Martin Fletcher said the organisation was working with governments to help support Australia’s health system response to the pandemic. ‘Health service needs are constantly changing across Australia. The 2021 subregister is a tool to help health authorities meet current workforce needs and those that might arise in the next 12 months,” he said. ‘Our focus has been on ensuring that practitioners available as a potential surge health workforce are properly qualified, competent and suitable to be on the sub-registers." n

MYOPIA LENS

Johnson & Johnson (J&J) Vision has received approval from Canadian health authorities for Acuvue Abiliti 1-Day contact lenses for myopia control. The company says the lenses are a new daily wear, single-use option for children aged seven to 12 at the start of treatment. It said Abiliti 1-Day were not traditional concentric ring presbyopic design lenses, and have been shown to reduce axial elongation by 0.105mm on average over a six-month period. “The approval … marks another major step forward in our collaborative efforts with parents and eyecare professionals to reshape the future of myopia,” Dr Xiao-Yu Song, J&J Vision's global head of R&D, said.

BEIRUT BLAST

A review of the ophthalmic injuries sustained by survivors of the Port of Beirut blast in August 2020 showed a predominance of shrapnel-based injuries, many of which had a delayed presentation owing to the strained health system. The study involved 48 eyes of 39 patients. Twenty-one (53.8%) required surgical intervention, more than half of which were urgently requested. Most injuries were caused by shattered glass leading to surface injury (26) eyelid lacerations (20), orbital fractures (14) brow lacerations (10), hyphema (nine), open globe injuries (10), and other global injuries. Seven (14.5%) had a final best-corrected visual acuity of less than 20/200, including four open globe injuries with primary no light perception (8.3%) requiring enucleation or evisceration.

MATERNAL DIABETES

New research has found maternal diabetes before or during pregnancy is linked to a 39% greater risk the child would go on to develop high refractive error (RE). The researchers, from Nanjing Medical University in China and Aarhus University in Denmark, said: “We observed that children born to mothers with either pre-gestational or gestational diabetes were at an increased risk of developing high RE in general, as well as specific types of high RE, persisting from the neonatal period to early adulthood. Children born to mothers with diabetic complications had the highest risk of high RE. Although the 39% increased risk is a relatively low effect size, from a public health perspective, any tiny improvement in this low-risk preventable factor will contribute to a huge reduction in absolute numbers of these eye conditions.”

INSIGHT November 2021 9

NEWS

EMPLOYERS URGED TO AVOID LAST-DITCH RUSH FOR DISPENSING WAGE SUBSIDY One of Australia’s largest optical dispensing training providers is urging employers to capitalise on a trainee wage subsidy by February – before it lapses – which could double as a key recruitment tool as demand for staff ramps up at the end of the year. Mr James Gibbins, director and senior trainer at the Australasian College of Optical Dispensing (ACOD), says optical dispensing is experiencing a “renaissance” since the Federal Government introduced the Boosting Apprenticeship Commencements (BAC) scheme as part of its COVID-19 recovery plan in October 2020. The initiative – which has been extended multiple times and is now uncapped – involves a wage subsidy of up to $28,000 for new or existing employees enrolled into appropriate courses, which include the Certificate IV in Optical Dispensing. This means optical businesses that enrol eligible employees, such as unqualified optical assistants, before 31 March 2022 can receive a 50% wage subsidy for a full 12-month period from the date of commencement, to a maximum of $7,000 per quarter. Gibbins said ACOD had experienced a huge increase in enrolments through the program during the past year. Although it’s open to both new and existing staff, he said new employees would receive extra training support: $4,000 for fulltime employees enrolled within the first three months of commencing employment, and $1,500 for part-timers enrolled within the first 12 months of employment. The scheme is expected to end on 31 March 2022. However, paperwork delays could mean late applications don’t make the cut, so ACOD is urging employers to enrol eligible staff by February. With NSW and Victoria set to ease lockdown restrictions from November, Gibbins expects there to be surging demand for optical staff. “I can feel it, and I am hearing it: there is going to be a mad employment period, and people are probably going to find there are no qualified or experienced staff available,” he said. “Even though inducting new people to our industry can be slow and difficult, we

INSIGHT November 2021

"WHEN YOU INTERVIEW FOR STAFF BE SURE TO TELL THEM THAT THIS ISN’T JUST A JOB, IT’S A CAREER WITH FULLY FUNDED TRAINING FOR A RECOGNISED QUALIFICATION"

ACOD has experienced a major surge in enrolments due to the wage subsidy scheme.

are encouraging businesses to bite the bullet, and when you interview for staff be sure to tell them that this isn’t just a job, it’s a career with fully funded training for a recognised qualification. “That means those just looking for a short-term job will drop out of the applications process because they won’t want to do the training, but you will ultimately attract genuine career seekers as well as those who are now seriously considering a job in optical dispensing because it comes with training.” Gibbins said various employers from corporates to single store independents

KEY POINTS n

50% wage subsidy for a 12-month period from the date of commencement, to a maximum of $7,000 per quarter. Open to both new and existing staff in optical practices. Must be employed in a part time or full time capacity – not casual.

n M ust

be an Australian citizen or permanent resident, or New Zealand citizen.

No limit on the number of employees enrolled per business.

n B oosting

Apprenticeship Commencements scheme set to end on 31 March 2022.

Source: Australasian College of Optical Dispensing.

JAMES GIBBINS, ACOD

had enrolled staff through the BAC scheme, but he was keen to stress there was neither a cap on the number of trainees per employer, nor was there an upper age limit. “Many employers misunderstand the parameters which are extremely broad, and they are: you must be an Australian citizen or permanent resident or New Zealand citizen, you must be an employee and not a director, and finally, you must be part or full time employed and not casual – but importantly casuals can be scaled up to part time, and this isn’t gaming the system because it is exactly what the government is trying to incentivise.” Gibbins said with some employers opting to enrol multiple staff, it meant trainees were progressing their studies together. “It’s great to see them helping each other out, keeping each other accountable and attending various workshops – they don’t all have to attend the same workshop to try spread the load for the store – that is a lovely thing that we have never seen before,” he said. “Ultimately, this is a renaissance for dispensing that will supercharge our industry – there will be a huge increase in the number of qualified dispensers which will improve the quality of dispensing and ordering from the lab.” Optical Superstore national training manager Ms Lesley Stephenson said the firm had only recently enrolled staff for the first time. “The biggest impact I have noticed is how excited and motivated the staff are when they return to work after completing the block release. I hear time and again about the new skills they have acquired and are eager to share with their work colleagues,” she said. “As an employer, one of the benefits has been the wonderful support from all the team at ACOD, the response to any emails and phone calls has been immediate. The communication regarding our staff's progress has been very useful, we feel valued and supported, and so do our staff enrolled on the course. We look forward to having even more skilled and qualified optical dispensers in our stores.” n

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NEWS

COMPLAINTS OVER COMPOUNDED ATROPINE EYE DROPS IN NEW SOUTH WALES The Pharmacy Council of New South Wales has reported a rise in complaints over compounded atropine eye drops, with one patient lodging their grievance with Ahpra after becoming aware the formulation was not prepared under sterile conditions. The council – which manages pharmacyrelated complaints about the conduct, performance and health of registered practitioners and students in NSW – reported that it had noticed an increase in complaints in community pharmacies and highlighted two recent incidents. In the first case (Case 1), a patient submitted a complaint to the Australian Health Practitioner Regulation Agency (Ahpra) complaining of blurred vision, dilated pupils, light sensitivity and eye pain. According to the Pharmacy Council of NSW, the symptoms occurred the morning after using one dose of newly prescribed, low-dose atropine (0.02%) eye drops that had been compounded at a local pharmacy.

The compounded eye drops were prepared by dilution of commercially available 1% atropine.

"THE DROPS WERE NOT FILTERED OR STERILISED, AND THE FINAL CONTAINER WAS NOT STERILE"

available lubricant/artificial tears preparation. The pharmacy gave a 30-day expiry to the compounded preparation as this was consistent with the expiry of the commercially available products. No compounding documentation was available in the pharmacy.

PHARMACY COUNCIL OF NSW

The council said these cases highlighted the need to ensure pharmacists involved in compounding practices were suitably trained and aware of their professional responsibilities. “In both these cases, the compounded eye drops had been prepared by dilution of commercially available eye drops. The stability of the final product, including the concentration of preservative and the potential effect on the pH, as the commercially available drops were in a buffered solution, were potentially affected by dilution,” the organisation stated.

that the drops had been diluted from a commercially available preparation and not prepared under sterile conditions prompting the lodgement of the complaint.” In the second case, a complaint was lodged with the Pharmacy Council of NSW identifying several concerns about compounding practices in a pharmacy.

“The patient’s specialist advised to stop the use of the drops immediately, however the dilated pupils and headaches remained for several days,” the council reported.

One of the issues was the compounding of eye drops in a non-sterile environment. The compounding area in the pharmacy was situated behind the dispensary area but was not equipped with facilities or equipment for complex compounding or for preparing sterile products, the council reported.

“In discussing the symptoms with other health professionals and with the pharmacist that had prepared the eye drops, the patient became aware

The pharmacy confirmed atropine 0.1% eye drops were prepared on the bench by diluting commercially available atropine 1% eye drops, with a commercially

“The drops were not filtered or sterilised, and the final container was not sterile. The expiry date had not been assessed, and the preservative (to which some patients are sensitive) was not identified on the label. “Case 1 also highlights the expectations of the public that a pharmacist should take particular care to ensure that supply of any medicine is carried out according to legislation and professional guidelines to minimise the risk of any adverse outcome.”

HOYA UNVEILS NEW LENS COATING TECHNOLOGIES Hoya Vision Care Australia & New Zealand has launched two new lens coating technologies, focusing on anti-bacterial properties and UV protection.

coating uses Kohkin, an anti-bacterial process that can inhibit growth for a long period, unlike sterilisation or disinfection which temporarily kill and eliminate bacteria.

The first of these innovations – the Hi-Vision Anti-Bacterial lens coating – is proven to reduce bacterial growth on the surface of a lens by 99.9%, the company stated, which can help reduce the chance of eye infections while meeting the increased consumer demand for safer, more hygienic products brought about by the COVID-19 pandemic.

The lens coating is certified for its quality and effectiveness by ISO and The Society of International Sustaining Growth for Antimicrobial Articles (SIAA), with the company being the first eyeglass lens manufacturer to be registered with SIAA.

The coating – applied to front and back of the lens surfaces – contains silver ions known as AG+ which penetrate bacteria and change the intracellular enzyme within the bacteria, stopping its function. The

INSIGHT November 2021

“The launch of Hi-Vision Anti-Bacterial coating in turn creates a ‘Full Control’ four-in-one combination that will provide Australians and New Zealanders with the ultimate in eye protection,” Mr Ulli Hentschel, national training & development manager for Hoya ANZ, said. “Full Control is a combination of Hoya’s four signature

Hi-Vision AntiBacterial lens coating.

lens coatings, namely, Diamond Finish, UV Control, BlueControl and new Hi-Vision Anti-Bacterial. The benefits of the four-in-one combination directly address four current eyecare consumer concerns: hygiene, digital eye strain, UV protection and lens scratch resistance.” Meanwhile, Hoya has launched the HiVision SUN Pro lens coating which provides double-sided UV protection. In addition to preventing UV transmission, the back surface coating reduces UV rays from being reflected into the eyes when facing away from the sun. The lens is scratch resistant for enhanced durability during outdoor activities and is water, grease and dirt repellent. It is available in Hoya’s tinted and polarised lenses. n

NEWS

RANZCO PREPARES FOR CPD OVERHAUL AFFECTING OPHTHALMOLOGISTS AND OTHER DOCTORS RANZCO is supportive of a new CPD framework affecting all Australian medical professionals and is working to ensure it is ready to implement the changes when they come into effect in January 2023. The Medical Board of Australia (MBA) recently announced changes to the continuing professional development (CPD) registration standard, approved by Australia’s health ministers. The three core changes are the introduction of CPD Homes and Professional Development Plans (PDPs) for all doctors, and requiring them to do different types of CPD to improve the value of their professional development.

The college wants to ensure the Professional Development Plan is well understood.

RANZCO’s CPD Committee had been working consistently over the past year to ensure the college was ready to implement the changes.

RANZCO CPD Committee chair Dr Lawrence Lee confirmed to Insight this “significant change to the CPD framework” will affect ophthalmologists.

“This has included a review of how our framework is structured, points are awarded, the content available to ophthalmologists and changes to our ReD (CPD Diary) functionality,” he said.

“RANZCO is supportive of the changes as they will contribute to relevant, effective and evidence-based learning practices,” he said.

MBA chair Dr Anne Tonkin said the changes would assure that doctors are engaging in learning that is relevant, effective and evidence-based.

“In particular, RANZCO is keen to ensure the proposed Professional Development Plan is well understood and utilised so there is a considered approach to learning, which positively affects real-world practice.” Lee said

“The goal is to make sure that the time doctors spend on CPD is useful and helps keep them practising at their best throughout their working lives,” Tonkin said.

"RANZCO IS SUPPORTIVE OF THE CHANGES AS THEY WILL CONTRIBUTE TO RELEVANT, EFFECTIVE AND EVIDENCEBASED LEARNING PRACTICES" LAWRENCE LEE, RANZCO

RANZCO) have been moving their CPD programs towards these changes over recent years, because they reflect contemporary best practice and make CPD more valuable to doctors and their patients. Under the changes, doctors will do 50 hours of CPD each year, made up of: • 2 5 hours active CPD – reviewing performance and measuring outcomes (doctors decide the best mix for these activities to suit their practice, with five hours minimum of each type). • 1 2.5 hours traditional learning or educational activities – reading, lectures, conferences. • 1 2.5 hours – doctors choose across the three types of CPD. The MBA believes introducing accredited CPD Homes for all doctors will improve consistency in learning, structure, standards and educational value. They will provide a framework to foster safe practice and support doctors by coordinating programs, ensuring quality activities and keeping track of hours. They will be accredited by the Australian Medical Council. All doctors will need to make a PDP each year that targets their professional development to their learning goals and strengthens their practice. n

She said existing CPD providers (specialist medical colleges such as

ACO ANNOUNCES EIGHTH CLINIC FOR MELBOURNE'S EAST The Australian College of Optometry (ACO) is opening its eighth clinic, Knox Eye Care, in Melbourne’s east. The ACO, which has been operational for more than 50 years, provides affordable, vital eyecare and optometry services to individuals and families across Australia. The Victorian Government has made funds available for the establishment of these services to support improved access to the Victoria Eyecare Service (VES).

patients with complex ocular history,” she said. “Our focus on eye health education, regular eye check promotion, optometry teaching and collaboration with other professionals and hospitals will allow patients living in the far east to have more options accessing high standard and affordable eyecare.” Meanwhile, Wyndham Eye Care, located in Hoppers Crossing, opened in June to address unmet demand for accessible and affordable eyecare in Melbourne’s west.

Located in Bayswater, Knox Eye Care was scheduled to open in September. Ms Iris Huang will be the site manager and optometrist.

The clinic is staffed by clinical receptionist King Lay as well as site manager and optometrist Mr Michael Yen.

“The new Knox clinic will improve access to our service for VES patients as well as

“Patients love the convenience of our new location. They appreciated the eye care

INSIGHT November 2021

services the ACO provides and the affordable spectacle range but for many in the west, Carlton was too far to travel,” Yen said.

Iris Huang, Knox Eye Care.

ACO director of clinical services Mr Neville Turner said both new clinics were located in areas of identified need to support access to the VES. He said the Wyndham clinic was situated in one of the largest growing communities with a culturally diverse population, while the Knox service was accessible to the Yarra Ranges, Knox and Maroondah populations. “With state-of-the-art equipment and our focus on excellence in patient care, the aim of these clinics is to improve access to eyecare for the local community and to support people who may not have been accessing care in the past,” Turner said. n

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NEWS

PROF ROBYN GUYMER ‘THRILLED’ BY PHASE 3 RESULTS OF PEGCETACOPLAN FOR DRY AMD Prominent Melbourne retinal disease researcher Professor Robyn Guymer is encouraged by the Phase 3 results of a trial she’s been involved in, investigating a new therapy she says is the only intervention shown to significantly slow the growth of lesions in dry AMD. The Centre for Eye Research Australia (CERA) deputy director and head of macular research is on the advisory board of Apellis Pharmaceuticals, a US-based company that is developing therapies for several debilitating diseases by controlling complement, part of the body’s immune system. On 9 September, the company reported top-line results from the Phase 3 DERBY and OAKS studies evaluating intravitreal pegcetacoplan, an investigational targeted C3 therapy, in 1,258 adults with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). The drug works to regulate excessive activation of the complement cascade. In the OAKS trial, monthly and everyother-month treatment with pegcetacoplan met the primary endpoint, significantly reducing GA lesion growth by 22% and 16%, respectively, compared to pooled sham at 12 months. DERBY did not meet

Prof Robyn Guymer was CERA's principal investigator for DERBY. Image: Anna Carlile.

the primary endpoint, showing a reduction in GA lesion growth of 12% and 11% with monthly and every-other-month treatment, respectively, compared to pooled sham at 12 months.

"PEGCETACOPLAN IS CURRENTLY THE ONLY INTERVENTION THAT HAS SHOWN SIGNIFICANT SLOWING OF THE GROWTH OF LESION IN DRY AMD" ROBYN GUYMER, CERA

Phase 2 trial,” Guymer said. “Pegcetacoplan is currently the only intervention that has shown significant slowing of the growth of lesion in dry AMD. This is exciting news for all those patients that have been diagnosed with AMD. Apellis added: "We plan to discuss the results with regulatory authorities worldwide, including the Therapeutic Goods Administration (TGA) in Australia. Our goal is to bring pegcetacoplan to patients with GA as quickly as possible.” In other results, a prespecified analysis of the primary endpoint showed pegcetacoplan had a greater effect in patients with extrafoveal lesions at baseline. Patients with GA typically present first with extrafoveal lesions, which then progress toward the fovea where central vision is impacted. In the combined studies, monthly and every-other-month treatment with pegcetacoplan decreased GA lesion growth by 26% and 23%, respectively, in patients with extrafoveal lesions compared to pooled sham at 12 months.

CERA was one of the recruiting sites for the trials, which recruited four patients into DERBY. Guymer was the principal investigator on the CERA trial but during a sabbatical in 2020 Dr Sanjeewa Wickremasinghe took over this role Overall, there were 45 patients from Australia and New Zealand recruited into DERBY (nine) and OAKS (36).

Based on results, Apellis plans to submit a New Drug Application for pegcetacoplan for GA to the US Food and Drug Administration (FDA) in the first half of 2022. n

“I was thrilled to see that the DERBY and OAKS 12 month results produced the results that were anticipated from the

LATEST AIHW REPORT SHOWS INDIGENOUS EYE HEALTH TRENDING IN RIGHT DIRECTION The Australian Institute for Health and Welfare (AIHW) has launched its Indigenous eye health measures 2021 report which shows measurable progress towards improving the eye health of Aboriginal and Torres Strait Islander people. The report features data from the 2019-20 year, which included the first four months of the COVID-19 pandemic in Australia. Despite the pandemic's impact, the report highlights that the number of Aboriginal and Torres Strait Islander people having an eye examination by an optometrist or ophthalmologist continued to increase, reaching 104,300 in 2019-20 (compared to 100,700 in 2018-19). However, it also highlights some of

INSIGHT November 2021

the continuing challenges Aboriginal and Torres Strait Islander people face in accessing the eyecare. For example, Aboriginal and Torres Strait Islander people continue to wait substantially longer for cataract surgery (a median number of 124 days) than other Australians (82 days). According to Vision 2020 Australia, there are practical solutions to address these challenges, which are laid out in the national plan for Aboriginal and Torres Strait Islander eye health and vision, Strong eyes, Strong Communities – A five year plan for Aboriginal and Torres Strait Islander eye health and vision, 2019-2024. “Investing in public provision of priority

DR screening rose to 34% in 2019–20.

treatments (such as cataract surgery and treatments for diabetic eye disease), supporting development of community led models and building local case management that can help Aboriginal and Torres Strait Islander people connect to, and remain engaged with, treatment are all critical,” the peak body for the eye health and vision care sector stated. Vision 2020 Australia interim CEO Ms Maureen O'Keefe said the positive results, despite the impact of the COVID-19 pandemic, demonstrated the progress Vision 2020 Australia members have been making for several years in tackling avoidable blindness and ensuring access to timely eyecare services for Aboriginal and Torres Strait Islander people. n

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NEWS

CYLITE CONTINUES TO GROW AND LAUNCHES NEW WEBSITE

RANZCO PUSHES CONGRESS OUT TO FEBRUARY 2022

Australian HP-OCT manufacturer Cylite continues to grow with an everexpanding workforce and the launch of its new website.

RANZCO has decided to postpone its 52nd Annual Scientific Congress until February 2022, as it aims to give Brisbane Convention ophthalmologists and other attendees & Exhibition Centre. the best chance to meeting at a face-to-face event.

With the imminent release of the HPOCT, the company has been ramping up production and increasing its staff. During the past six months, the operations team alone has grown from seven to 20 people, with 10 more positions to be filled within the next nine months. “Due to the complexity involved with manufacturing each HP-OCT, our production team is highly skilled and Cylite invests heavily in staff training to enable the business to scale-up,” Cylite vice president of operations Mr Simon Davis said.

The congress, which is taking place is Brisbane Convention & Exhibition Centre, was originally scheduled for 1923 November, but COVID-19 lockdowns across the country prompted the RANZCO Board to meet on 3 September to formulate a new plan.

“With production capacity tripling this financial year it is an exciting time to be involved in Cylite’s growth.”

The event will now run 25 February to 1 March 2022. The official 2022 congress booked for 3-8 November in Perth will go ahead as planned.

The overall workforce has similarly expanded, now numbering well over 50 employees, primarily based in the manufacturing site in Melbourne. The production and workforce has expanded to such a degree that the company plans to move premises early next calendar year. The move will not only allow for future growth in employees but also enable the expansion of the company’s high-tech “clean room” space to cater for the expected ramp-up of ongoing global production from the Melbourne.

“We hope you will agree that this is a pragmatic move that gives everyone the best shot at a face-to-face event and to attend a congress in the format that you all know and love,” RANZCO stated in a communique to members. “We very much hope that the majority of members will be able to attend the congress in-person, and of course, there will be the option to attend virtually.”

Cylite plans to continue this growth despite the challenges of the pandemic and currently has positions advertised in

Renowned local and international invited speakers include: Professor Alex Hewitt (Dame Ida Mann Memorial Lecture); Professor Graham Barrett (Sir Norman Gregg Lecture), Dr Catherine Green (Fred Hollows Lecture); Dr Clare Fraser (Council Lecture); Dr Lynn Gordon (Neuro-ophthalmology Update Lecture); Mr David Lockington (Cataract Update Lecture); Dr Anita Agarwal (Retina Update Lecture); Dr Pradeep Ramulu (Glaucoma Update Lecture); and Dr Damien Gatinel (Refractive Update Lecture). This is the second time the college has postponed the congress, which was originally slated for October 2020 before being pushed out to the now ill-fated November 2021 date. Complementing the invited speakers will be a range of concurrent symposia, courses, papers, posters, films and rapid-fire sessions. The congress will also include its usual social program. n

INSIGHT November 2021

Cylite is manufacturing its HP-OCT at its Melbourne production site.

the ‘Careers’ section of its new website, which was launched in September. “Already generating multiple daily inquiries from interested clinicians, the new website aims to inform interested parties about the technology behind the HP-OCT and to keep readers up to date with news and events,” the company stated. To fulfil the first aim, the site’s ‘Resources’ section includes informative descriptions under such titles as ‘The Hyperparallel Difference’, ‘Understanding Beamlets’ and ‘How Volume Capture Works’, and a descriptive video aims to give the viewer an intuitive understanding of the capabilities of the system. “We hope that our new website not only helps readers to understand the technology behind HP-OCT, but also to get to know us a little better too.” n

BRISBANE PRACTICES JOIN NATIONAL OPTICAL CARE National Optical Care (NOC) has welcomed another new practice to its expanding portfolio.

National Optical Care CEO Jason Gowie.

The company recently welcomed Dickens and Herd Optometrist, in the Brisbane suburb of Chermside, to its growing community of optical practices. In late August, Hawken Eyes, St Lucia also joined NOC and merged into its larger nearby practice Insight Optometrists, Indooroopilly. During the past 10 months, NOC has grown its portfolio of practices to 15 locations.

It has also completed new fitouts and expansions of two of its largest practices to improve the eyecare experience for patients and working environment for team members. “In a short period of time and in an unpredictable COVID environment we have been able to establish a business that is delivering on our promise of respecting the legacy of the businesses we purchase by retaining the local brands and teams and supporting the practices to further grow and prosper,” NOC CEO Mr Jason Gowie said. n

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An RNA-Targeted Approach for Adults with Geographic Atrophy Phase 2 clinical trial investigates new antisense oligonucleotide therapy delivered by a monthly subcutaneous injection Sponsored by Ionis Pharmaceuticals

Geographic Atrophy, Quality of Life and Australia’s Ageing Population Dry age-related macular degeneration (AMD) affects 90 percent of the 170 million people living with AMD worldwide.1,2 Age-related macular degeneration is a historical definition, however, the macula is not “wearing out” from the ravages of time specifically. We now understand that there is a strong association with part of the body’s own immune system called the “complement system”, which is strongly associated with the development of a variety of complement-mediated diseases throughout the body, including dry AMD. This anomaly allows the complement system to damage host cells – in this case, the retina, retinal pigment epithelium (RPE) and choriocapillaris - because the cell’s protective coating (Complement Factor H or CFH) that signals “self” or “host” is faulty or cannot overcome complement overactivity. This damage is cumulative so that the greatest predictive risk factor in vulnerable people is age. 3 In Australia approximately one in seven adults over 50 has the early signs of AMD.4 Therefore, worsening vision threatens to take a toll on a growing number of older patients, potentially leading to suffering, disability, loss of productivity and other quality of life challenges. 5 Geographic atrophy (GA) in AMD is characterised by the formation of islands of photoreceptor and RPE loss that rapidly enlarge and encircle the fovea until the central vision is lost.6 The early stages of GA are visually silent and the signs can be subtle – although more obvious on OCT imaging. There are currently no proven treatment options to arrest or reverse GA, however, there is some evidence that diet or lifestyle changes (i.e., quit smoking) may slow the progression.7 But these are not targeting the underlying problem.

Fortunately, the role of complement factor anomalies in the causation of AMD has been identified, giving hope that complement targeted therapy could address the underlying cause and give patients with advanced cases of dry AMD a better chance to preserve one of the most important senses for navigating daily life.

An Investigational Treatment Targeting the Root Cause of Dry AMD While RNA-based viruses and vaccines have recently received worldwide attention for its role in COVID-19, the potential of targeting RNA-based therapy to treat and prevent a variety of disease has long been recognised by some scientists. For more than 30 years, Ionis Pharmaceuticals has been the leading innovator in RNA-targeted therapeutics, pioneering new markets and changing standards of care with its novel antisense technology. The biotechnology company is currently enrolling Australian patients in the GOLDEN Study, a Phase 2 clinical trial investigating the safety and effectiveness of IONIS-FB-LRX , an RNA-targeted therapy for geographic atrophy.

IONIS-FB-LRX leverages antisense medicine to modulate the over-activity of the complement system. Specifically, IONIS-FB-LRX seeks out, binds to and destroys the specific messenger RNA (mRNA) in the liver to reduce the production of complement factor B protein that is found in the blood and eyes, and directly addresses the root cause of the disease. The RNA-targeted investigational therapeutic is delivered by a single monthly subcutaneous injection in the abdomen or thigh, rather than in the eye, and has the potential to treat both eyes with a single administration. This is particularly important given people with GA in one eye are more likely to develop it in the other. 8

“Geographic atrophy robs patients not just of the joy of sight but also the ability to manage everyday practicalities such as the ability to drive, read and be independent. The potential to arrest the disease progression based on the identification of such a specific target is extremely exciting. Given that GA commences around the fovea, early detection and treatment should prevent the enlargement into the fovea and preserve visual acuity. To deliver this potential therapy to our patients we need to urgently recruit suitable patients to determine the effectiveness of this very promising therapy.”

Associate Professor Wilson Heriot Director Retinology Institute

Patients 50 years of age or older with a medical diagnosis of AMD and GA in at least one eye may prequalify to participate in the GOLDEN Study. The study involves a screening period to determine whether patients can safely participate based on their medical history and current health. For those enrolled, there will be a 45-week treatment period and a 12-week follow-up period. Numerous precautions are in place to ensure the health and well-being of all current and potential clinical trial participants given the COVID-19 pandemic.

Talk to your GA patients about exploring this clinical trial opportunity

If you know a patient who fits the criteria above and would like to refer them for enrolment in the GOLDEN Study, please contact ionisNCT03815825study@clinicaltrialmedia.com or call 1800 932 037. To learn more about the clinical trial and eligibility, visit https://ionistrials.com/golden-study/. IONIS-FB-LRX is an investigational therapy and has not been approved for use by any regulatory authority. Ionis Pharmaceuticals Inc. is registered at 2855 Gazelle Ct, Carlsbad, CA 92008, United States. Pennington, K., & DeAngelis, M. (2016, December 22). Epidemiology of age-related macular degeneration (AMD): Associations with cardiovascular disease phenotypes and lipid factors. Retrieved from https://www.ncbi.nlm. nih.gov/pmc/articles/PMC5178091/ 2Friedman DS, O’Colmain BJ, Muñoz B, Tomany SC, McCarty C, de Jong PT, Nemesure B, Mitchell P, Kempen J (2004); Eye Diseases Prevalence Research Group. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol; 122 (4): 564-72 3National Eye Institute. (2019, July). Retrieved from https://www.nei.nih.gov/learnabout-eye-health/resources-for-health-educators/eye-health-dataand-statistics/age-related-macular-degeneration-amd-data-and-statistics 4Mitchell, P., Smith, W., Attebo, K., & Wang, J. J. (1995). Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology, 102(10), 1450-1460. Retrieved from 5Fast Facts of Common Eye Disorders. (2020, June 09). Center for Disease Control and Prevention. Retrieved From https:// www.cdc.gov/visionhealth/basics/ced/fastfacts.htm Keenan TD, Agrón E, Domalpally A,e t al; AREDS2 Research Group. 6Progression of Geographic Atrophy in Age-related Macular Degeneration: AREDS2 Report Number 16. Ophthalmology. 2018 Dec;125(12):1913-1928. Retrieved from: 10.1016/j. ophtha.2018.05.028. Epub 2018 Jul 27. PMID: 30060980; PMCID: PMC6246813. 7American Optometric Association. (n.d.). Macular degeneration. Retrieved From https://www.aoa.org/healthyeyes/eye-and-vision-conditions/macular-degeneration?sso=y 8 National Eye Institute. (2020, May). Low Vision. Retrieved from https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/low-vision 1

Date of preparation: September 2021

COMPANY

IVANTIS TO PAY GLAUKOS US$60 MILLION IN MIGS PATENT SETTLEMENT MIGS device manufacturer Glaukos has reached an agreement with competitor Ivantis over a patent infringement lawsuit Thomas Burns, Glaukos CEO. regarding the latter’s Hydrus Microstent for glaucoma. On 15 September, Glaukos announced it had agreed to terminate the legal proceedings it initiated in April 2018 in the US District Court for the Central District of California. Under the agreement, Ivantis will pay Glaukos US$60 million (AU$83 m), US$30 million (AU$41 m) of which will be paid by 31 December 2021, and the other US$30 million (AU$41 m) to be paid by 31 December 2022. Ivantis will also pay Glaukos a 10% ongoing royalty through April 26, 2025, based on Ivantis’ Hydrus Microstent US sales and any international sales supplied out of the US. Further, the parties have agreed to mutual licenses and covenants not to sue on the Hydrus and iStent technologies. “Since our founding in 1998, Glaukos has invested considerable time and resources to develop novel technologies that have pioneered an entirely new treatment category for glaucoma surgeons and their patients,” Mr Thomas Burns, Glaukos president and CEO, said. “We remain confident in the strength of our robust intellectual property portfolio and believe this settlement allows us to focus our full attention and resources on executing our long-term growth strategy by bringing transformative new technologies to the market for the benefit of patients worldwide.” Mr Dave Van Meter, president and CEO of Ivantis, said although the company had always believed its technology did not infringe any valid claim of any of Glaukos' patents, it was “pleased to put this distraction behind us”. “Given the upward trajectory of our business and the rapidly increasing adoption of Hydrus in the market, we are fortunate to be in a position to be able to readily absorb this settlement as we continue bringing our best-in-class MIGS technology to our customers and their patients," he said. n

INSIGHT November 2021

NEW WET AMD GENE THERAPY DEAL WORTH UP TO AU$1.9 BILLION AbbVie has announced a new partnership with US biotech company Regenxbio to develop and commercialise RGX314, a potential one-time gene therapy for neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR) and other chronic retinal diseases. The investigational treatment is currently being evaluated in nAMD patients in a pivotal trial using subretinal delivery, as well as in patients with nAMD and DR in two separate Phase 2 trials utilising in-office suprachoroidal delivery. The therapy consists of the NAV AAV8 vector, which encodes an antibody fragment designed to inhibit vascular endothelial growth factor (VEGF). Under the collaboration, Regenxbio will be responsible for completing the ongoing trials of RGX-314. AbbVie and Regenxbio will collaborate and share costs on additional trials, including the planned second pivotal trial evaluating subretinal delivery for nAMD and future trials. AbbVie will lead the clinical development and commercialisation of RGX-314 globally. Regenxbio will also participate in US commercialisation efforts as provided under a mutually agreed commercialisation plan.

AbbVie will lead manufacturing of RGX-314 for commercial supply outside the US.

Under the terms of the agreement, AbbVie will pay Regenxbio a US$370 million (AU$510 m) upfront payment with the potential for Regenxbio to receive up to US$1.38 billion (AU$1.9 b) in additional development, regulatory and commercial milestones. "AbbVie is a strong, complementary partner for Regenxbio,” said Mr Kenneth Mills, president and CEO of Regenxbio. "We expect to leverage AbbVie's global developmental and commercial infrastructure within eyecare with our expertise in AAV gene therapy clinical development and deep in-house knowledge of manufacturing and production to continue the development of RGX-314.” n

NOVARTIS TARGETS OPTOGENETICS CAPABILITY IN NEW ACQUISITION Novartis has acquired Arctos Medical, adding a pre-clinical optogeneticsbased AAV gene therapy program to its ophthalmology portfolio. “Optogenetics is emerging as a promising therapeutic approach that might restore sight to patients who are legally blind,” Mr Jay Bradner, president of the Novartis Institutes for BioMedical Research, said.

The company says optogenetics is an emerging approach that might restore sight to patients.

“The Arctos technology builds on our conviction that optogenetic gene therapies may meaningfully help patients battling devastating eye diseases.”

specific gene, and thus can potentially address many forms of IRDs regardless of the underlying mutation.

Arctos developed its technology as a potential method for treating inherited retinal dystrophies (IRDs) and other diseases that involve photoreceptor loss, such as agerelated macular degeneration According to Novartis, existing gene therapies aim to correct a specific gene, so only a small subset of patients can benefit. The Arctos technology is not limited to a

“Arctos’ proprietary, light-sensitive optogene is delivered to specific retinal cells using gene therapy, thus turning the targeted cells into replacement photoreceptor-like cells. If successful, a therapeutic based on such a technology could be used to treat any disease that causes blindness due to photoreceptor death,” Novartis stated. n

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INTERNATIONAL

FDA CLEARS FIRSTEVER OPHTHALMOLOGY BIOSIMILAR The US Food and Drug Administration (FDA) has approved Byooviz (ranibizumab-nuna) as the first biosimilar to Lucentis An Eylea biosimilar is (ranibizumab) for several eye diseases. also being developed. The therapy – developed by the Korean firm Samsung Bioepis and US company Biogen – has been cleared for including neovascular age-related macular degeneration (nAMD), as well as macular edema following retinal vein occlusion and myopic choroidal neovascularization. “[This] approval provides another treatment option for millions of people whose vision is impaired and is another step forward in our commitment to provide access to safe, effective and high-quality biological products,” said Dr Sarah Yim, director of the Office of Therapeutic Biologics and Biosimilars in the FDA’s Center for Drug Evaluation and Research. “Continuing to grow the number of biosimilar approvals is a key part of our efforts to provide greater access to treatment options for patients, increase competition and potentially lower costs.” Samsung Bioepis and Biogen entered into a commercialisation agreement for two ophthalmology biosimilar candidates, SB11, a biosimilar candidate referencing Lucentis, and SB15, a biosimilar candidate referencing Eylea (aflibercept), in November 2019. Developed by Samsung Bioepis, SB11 will be commercialised under the brand name Byooviz by Biogen in the US. The treatment has already been approved in Europe, including 27 European Union member countries on August 18, and the UK on August 31. “We are very excited to be able to open a new chapter with the approval of Byooviz in the US. This approval represents a great step toward the advancement of a new therapeutic option addressing debilitating disease progression of patients with retinal vascular disorders in the US,” said Mr Ian Henshaw, senior vice president and global head of biosimilars at Biogen. “Biosimilars could help broaden patient access to more affordable treatments and generate healthcare savings to offset rising costs of these complex diseases.” n

INSIGHT November 2021

PANDEMIC WREAKS HAVOC ON UK EYE HEALTH New research has shown the major impact of the pandemic on UK eye health, with estimates 2,986 people have lost vision due to delays in identifying and treating eye disease. With services limited to urgent and emergency cases in optometry and ophthalmology at the height of the first lockdown – and patients more reluctant to attend appointments – the new Specsaverscommissioned research aimed to quantify the impact on patients’ eye health and overall cost to the health sector. The research was conducted by Deloitte Access Economics and found of those 2,968 thought to have lost vision, 1,123 were affected due to delayed sight tests and the associated delayed referrals for treatment, while 1,863 were due to delays in scheduled treatment such as surgery for glaucoma or anti-VEGF injections for nAMD. The report found a 4.3 million drop in the number of sight tests delivered in the UK during 2020 – a decrease of 23% compared to 2019. Referrals to ophthalmology also fell by 28% compared to 2019. “The findings show the reduction in utilisation of ophthalmic procedure and services reduced the cost of sight loss and blindness to the healthcare

There were 4.3 million fewer eye tests performed in 2020.

system by £778 million (AU$1.4 b) in 2020,” the report stated. “It is important to acknowledge, however, that this reduction may have serious and ongoing implications in the coming years, for major eye conditions.” Given an average annual cost of £16,867 (AU$31,745) per person living with sight loss and blindness in the UK, the report suggested delayed tests and treatments mean the incremental cost of sight loss and blindness may be £50 million (AU$94 m) higher each year between 2021 and 2024, compared to pre-COVID costs. An estimate of three years (2021 to 2024) to clear the backlog is driven by the assumption that health services will ramp up activity by 11% to clear the backlog and reduce waitlist back to pre-COVID level. n

UC BERKELEY OPTOMETRY RECEIVES RECORD US$50 MILLION DONATION The University of California Berkeley School of Optometry has received a US$50 million (AU$69 m) donation, the largest gift ever to be received by a school of optometry in America. The gift was provided by the Dr Herbert and Nicole Wertheim Family Foundation and constitutes the lead gift for a 10-year, US$100 million (AU$138 m) investment that will expand the school’s ability to train the next generation of optometric physicians and educators to serve as leaders of primary and preventative healthcare. The school will use the funds to elevate training and research programs through an investment in innovative models of vision care, teaching and discovery. To honour the landmark gift, the school will now be named the Herbert Wertheim School of Optometry and Vision Science.

The school has been renamed in honour of the donors. Image: UC Berkeley

“We believe this gift, through the vision and foresight of Dr Wertheim, will not only transform Berkeley optometry, but will be transformative for the entire profession,” Dr John Flanagan, dean of Berkeley Optometry, said. n

RAY-BAN AND FACEBOOK SMART GLASSES BRIDGE TECHNOLOGY-FASHION DIVIDE The first generation of Ray-Ban smart glasses from the highly anticipated EssilorLuxottica-Facebook collaboration have been unveiled and are now available in Australia with a $449 price tag. The new eyewear – called Ray-Ban Stories – has been described as a new way for people to seamlessly capture, share and listen, in an announcement by Facebook founder Mr Mark Zuckerberg and EssilorLuxottica’s chief wearables officer Mr Rocco Basilico. Facebook is now the latest tech company to enter the smart glasses race, following competitors like Google and the firm behind Snapchat, which have generated mixed results. The social media giant is predicting that camera technology will become a standard eyewear feature in 10 years. “We are incredibly proud to bring Ray-Ban Stories to life with our partners at Facebook,” Basilico said.

“This is a milestone product that proves consumers don’t have to choose between technology and fashion – they can live in the moment and stay connected while wearing their favourite style of Ray-Bans. Our unique approach, combining decades of superior craftsmanship, a dedicated spirit of innovation and a commitment to delivering only cutting-edge technology has resulted in a wearable that people will truly love wearing.” EssilorLuxottica, Ray-Ban’s parent company, and Facebook have chosen the brand’s most recognisable style – Wayfarer and Wayfarer Large – to lead the line up. They are also available in various other styles such as the legendary, retro Round and the Meteor. Starting at AU$449, wearers can also choose a range of lens styles, including sun, prescription, polarised, gradient, Transitions and clear. Facebook and EssilorLuxottica stated

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Ray-Ban Stories Wayfarer.

they have engineered smart technology to support all-day wear, including an optimised Snapdragon processor, without compromising comfort and aesthetic. Importantly, the companies have kept the eyewear llghtweight – a common drawback of smart glass designs – with the Wayfarer styles just 5g more than a standard pair. Ray-Ban Stories also include a dual integrated 5-megapixel camera to capture photo and video; discreet open-ear speakers, and a three-microphone audio array to deliver rich voice and sound transmission for calls and videos. Additionally, Ray-Ban Stories has a companion app, Facebook View, in what the companies say is an easy way to edit and share content captured on the smart glasses with the ability to upload on any social app stored on a phone: Facebook, Instagram, WhatsApp, Messenger, Twitter, TikTok, Snapchat, and more. n

OPTOMETRY

n o i t a s i m u i prem

LUXOTTICA'S PLANS FOR The new OPSM Norwood store in Adelaide, South Australia.

Matteo Accornero was appointed to lead Luxottica’s retail business in ANZ a year ago and is now overseeing a major investment program across the company’s optical stores aimed at elevating the end-to-end customer experience.

hen Matteo Accornero was shoulder tapped last year by EssilorLuxottica’s CEO Mr Francesco Milleri to head up Luxottica’s retail operations in Australia and New Zealand, it was an opportunity he found impossible to resist. Based in Milan at the time, he had only been with the Italian eyewear giant for a matter of months, starting in March 2020 as integration and business development director to assist with the company’s merger with the French ophthalmic lens giant Essilor. Italy was in the throes of its initial COVID-19 outbreak, so the chance for the 37-year-old to move his young family to Sydney seemed like an ideal opportunity both personally and professionally.

“Australia is one of our biggest markets retail wise, so it was difficult to say no,” he says. “Also from a personal perspective, it’s a great country to live in, my daughters who are three-and-a-half and three-months-old are learning English, and we enjoy the outdoor lifestyle here compared to the busy and chaotic metropolis of Milan, so it ticked all the boxes.” Accornero has been responsible for Luxottica’s ANZ retail business for a little over a year now and is already driving significant change across its four retail banners: OPSM and Laubman & Pank (optical), Sunglass Hut (a dedicated sunglasses business), and Oakley (sunglasses, apparel, fashion and accessories). Overseeing more than 600 storefronts, 300 head office employees and more than 4,500 store staff across two countries is a significant task. But he’s leveraging his extensive experience in top tier management consulting. Much of that work has focused on retail, luxury, and consumer goods, including as a principal for Boston Consulting Group between Milan and Amsterdam for eight years. But it was in his role as an associate partner of McKinsey & Company in Milan where he first began working with Luxottica in 2019. As an external consultant, he was helping the Luxottica and Essilor merger identify synergies and opportunities across several markets, which

INSIGHT November 2021

involved coordinating teams in Milan, Paris, China and the US. Before long, he was invited to officially join Luxottica to continue his work in-house, before Milleri soon asked him to take up the ANZ posting. “Having seen the company from the outside as a consultant, I knew there were a lot of positive challenges coming in terms of growth and opportunities across many geographies,” he says. “And as an Italian there is a lot of Matteo Accornero, general manager of Luxottica Retail ANZ. pride to work for one of the few global leaders we have, and then with my background and passion in consumer goods and retail, it felt like it was the perfect match.” ELEVATING THE CUSTOMER EXPERIENCE Since arriving in Australia in October 2020, Accornero has wasted little time implementing his first major priority. This has been the initial rollout of a significant investment program, aimed at ‘premiumisation’ of the end-to-end customer journey. In the company’s OPSM and Laubman & Pank stores (337 and 38 stores respectively in ANZ), this has involved reassessing each customer touchpoint and investing in new initiatives that improve the in-store experience, technology and customer engagement. By the end of the year, the initiative would have been rolled out to the first 50 optical stores, with the program set to expand in 2022. “The common theme of premiumisation for Luxottica is about elevating the overall experience by getting closer to something you

knowledge around lens benefits, upgrades and coatings, so they can personalise the final recommendation based on the customer’s needs. “We consider the training of our people to be extremely important, so Luxottica have just launched a new training platform called Leonardo,” he explains. “It’s much like Netflix and is totally customised so the platform knows which banner and store you work for. It’s also capable of sending personalised training recommendations based on the product you're getting on any given week, and, of course, there are modules around all the classic selling techniques for lenses.

Luxottica is upgrading to automated technology in many stores, including the Vision-R 800 Auto Phoropter (left) and Wave Analyzer Medica 700 wavefront aberrometer.

might get in a luxury boutique, in terms of attention to details, care and service,” he explains. “But it’s not about luxury for the sake of luxury or creating a more exclusive experience, it’s about evolving from the traditional model – that was more focused on the optometrist providing eyecare – and elevating the retail experience in-store to help our customers recognise and understand the value they are getting in our products.

“The ability to personalise training and deploying it virtually without having anyone travelling, moving or gathering is really something unique.” Accornero says another key piece of new technology is the Smart Shopper tool that allows customers to interact digitally with the entire catalogue of Luxottica products in-store. It includes a virtual try on feature thanks to augmented reality and advanced proprietary virtual mirroring technologies. Accornero says the tool is used either on a large screen or on an iPad where customers can try on any colour combination, as well as eyewear that may not be in the local store’s assortment.

“At Luxottica, we saw that now is time for change and we are in a position where we can drive this change, so premiumisation means reviewing all facets of the customer experience to elevate it and offer more.”

“That means we are giving everyone access to our entire portfolio of products, which can be paid for in stores and shipped to their home after a few working days, so we believe this will be a strong innovation and something that contributes to the success of the group’s omnichannel strategy.”

Luxottica’s premiumisation plan has begun with refurbishing several stores, transforming them from functional facilities into stores that invite customers to stay and browse. This involves rethinking the store’s design in terms of lighting, layout fixtures and ergonomics, among others.

Although it was too early to provide precise data, Accornero says investment in the ‘premiumisation’ of its stores has paid off, with an overall improvement in store KPIs. While the company acknowledges the model won’t be suited to every demographic, he says Luxottica has seen enough positive results in the current pilot to warrant its extension.

These enhanced aesthetics have extended into the exam room too. Luxottica has also invested in new automated technology, such as the Vision-R 800 Auto Phoropter and Wave Analyzer Medica 700 wavefront aberrometer by Essilor Instruments, which is helping to modernise the patient experience.

“I think we are happy to a point where we have accelerated our investment plan for next year to bring it to another big group of stores, so I think our commitment and the group's commitment shows we strongly believe it is the right move.”

“Compared to previous technology, this will provide a totally digitalised workflow, which is not about shortening the examination time – they’re actually going to be exactly the same – but being better able to understand the issues that the customer has with their eyesight and allowing the optometrist to concentrate more on the relationship, rather than playing with manual adjustments,” he explains. With Luxottica now exclusively selling Essilor lenses, the next facet relates to helping patients better understand the lens technology they’re purchasing. Accornero says often customers think they’re paying for the frame, not realising that the majority of their purchase is for the lens.

ESSILOR INTEGRATION With the Essilor and Luxottica merger deal completed in October 2018, efforts have continued to focus on integrating the two global giants, which comprised more than 150,000 employees at the time of the deal. Accornero says while EssilorLuxottica has begun reviewing its regional leadership, it was yet to do so in ANZ, but changes are expected in the coming months. Currently Luxottica is based in Macquarie Park and Essilor in Surry Hills, but early next year both entities will move under the same roof at a new north Sydney facility.

“We believe there is strong opportunity to explain the value in the lens and how it meets their needs. By making customers aware about the value and benefits they have purchased, they then become ambassadors,” he says.

“Once we move into a new joint location, this will be a great way to start acting as a team, obviously respecting all customers of our businesses through strict confidentiality rules and behaviours that need to be enforced in such an environment,” Accornero says.

“We are also investing much more in what we call ‘lens storytelling’, which involves developing new store features that will showcase lenses and lens benefits, and together with Essilor we are developing technology that will allow the customer to understand the difference between the lenses on offer in a digital simulation environment.”

“Our partnership is stronger than ever, in the last 18 months we have transitioned to selling a majority of lenses by Essilor, and we will have further access to the top performing lenses. We are investing further with Essilor Instruments in technology, so we couldn’t be happier at this stage, and we are excited to see where it heads in future.” n

Accornero says Luxottica is also investing in staff training and

INSIGHT November 2021 27

GENE THERAPY

TASMANIAN CENTRE JOINS RACE FOR

s e r u c s s e n d n i l b CRISPR Two derelict buildings near Hobart are being transformed into a new world-class gene editing centre for eye disease in Australia, thanks to the philanthropic efforts of the Tasmanian Eye Institute.

n 2016, at his home RANZCO scientific branch meeting in Tasmania, preeminent ophthalmic genetics expert Professor Alex Hewitt presented on the transformative impact of CRISPR/Cas9 gene editing for inherited retinal diseases (IRDs).

It was a particularly exciting time for ocular genetics in Australia. Hewitt, of the Menzies Institute for Medical Research, University of Tasmania, and his Australian research peers had just published a breakthrough paper a few months earlier describing the world’s first ‘in vivo’ viral mediated CRISPR/Cas gene editing in the retina. This meant he and his team – including researchers from the Centre for Eye Research Australia, University of Melbourne, University of Queensland, Monash University and Jinan University, Guangzhou – had overcome the tall order of delivering gene editing machinery into the retinal cells of a live mouse using viral vectors. Altering cells while in the body (in vivo) is an incredibly complex challenge, but Hewitt and his team overcame this by splitting the load between two viruses before disabling the target mutant genes.

technology for therapeutic purposes,” the researchers concluded.

Clinical Professor Brendan Vote, who established the charitable organisation the Tasmanian Eye Institute (TEI) in 2008, was in the audience when Hewitt delivered his 2016 presentation in Hobart. That day, he committed to supporting Hewitt’s vision of translating CRISPR/Cas gene editing from the lab into real world therapies by building what he describes as Australia’s first dedicated Ophthalmic Gene Therapy Centre (OGTC). With the construction phase now almost complete, Vote hopes it will allow Australian ophthalmic enterprises to develop CRISPR treatments and join the world’s most valuable companies in the era of personalised medicine. The next decade will be truly exciting with more than 50 companies searching for treatments to the world’s biggest diseases using CRISPR technology in what he believes will be the next trillion-dollar industry.

Ultimately, Hewitt’s team recorded an 84% reduction in retinal cells containing a specific protein that was being produced by the target gene.

Vote believes establishing the OGTC would ensure Australia remains globally competitive in the synthetic biology revolution, while negating the effects of global supply chain disruption or the at-times slow pace of pharmaceutical companies to register products here.

“By demonstrating that CRISPR/Cas can also cause substantial gene modification activity when introduced by a viral delivery method in the retina, we are closer to translating gene editing

“Aside from cures that Alex and his team develop, this facility would make available critical biotechnology infrastructure for all ophthalmic researchers around Australia to translate their laboratory

INSIGHT November 2021 29

GENE THERAPY

tracked the ability to develop gene editing cures, Vote says progress towards any ‘personalised medicine’ requires standard Phase 1, 2 and 3 human studies. Therapies for human trials must be manufactured under strict aseptic conditions. “Probably the best way of thinking about gene therapy is an amalgam of pathology, medicine and pharmacy roles. An individual’s specific genetic defect must be diagnosed (doctors, genetic screening services, DNA databanks), as the therapy must be delivered ultimately into someone’s body,” Vote explains.

Professor Alex Hewitt standing before the water tank during the construction phase.

research into Therapeutic Goods Administration (TGA)-certified clinically deliverable treatments,” Vote says. ESTABLISHING THE CENTRE After the 2016 meeting, it took just one year for Vote to begin fulfilling his commitment to the OGTC through the Tasmanian Eye Institute, whose philanthropic efforts are dedicated to research, education and service in ophthalmology. Vote was flying to a conference in 2017 when he spotted a derelict heritage building advertised in a Hobart real estate magazine. Located in Lenah Valley – only 3km from Hobart CBD on over 4,000sqm – Colebrook house was built in 1866 and had fallen into disrepair as a deceased estate without power, water or sewer connection while Hobart city had grown around it. What also caught his eye was a similarly derelict water tank adjacent to the rundown heritage property. Built in the 1930s as infrastructure for the drought that never came, the water tank had never been used, except as a canvas for amateur graffiti artists.

Clinical Professor Brendan Vote,

“This requires very strict Tasmanian Eye Institute. pharmaceutical production standards, much like chemotherapy or a vaccine might be produced, with clean and ultraclean areas. Consequently, there were a lot of ‘regulatory’ hoops to jump through, not least of which addressing council development application and design planning. Ultimately the OGTC must meet PC-2 good manufacturing practice (GMP) facility, TGA-certified standards and all of our planning, design and construction has been towards this aim. “This OGTC will be the first such PC-2 GMP facility, specifically dedicated to meeting Australia’s ophthalmic needs. TGA certification should be complete by the end of the year and the facility ready to produce its first ‘CRISPR cures for blindness’ next year.” WHY CRISPR? While gene therapy techniques have existed as lab experiments for several years, the TGA’s approval of Luxturna was a major milestone for Australia in August 2020. It marked the country’s first true, ‘in-vivo’ gene therapy for any disease. The therapy helps to restore vision for patients with IRD caused by pathogenic biallelic RPE65 gene mutations and is expected to be the first of many brought to market for previously untreatable IRDs. Such approaches can be described as gene augmentation, which involves flooding the relevant cells with abundant functional copies of a healthy gene, in the hope the cell will incorporate it.

“Here were two buildings part of Hobart’s history and DNA, and the opportunity to give them a new life seemed fitting for our vision of creating Australia’s first dedicated OGTC,” Vote says.

While impressive, it’s not considered the most sophisticated approach. It can be hit and miss, with even successful gene therapies only about 1015% effective, Vote says.

“Funding for purchase of both buildings came via Tasmanian Eye Institute, which in turn has been funded largely through private donations. Sadly, though ’supportive’ of the project, to date no federal or state government funding has been forthcoming. To have such important sovereign biotechnology infrastructure within Australia will be critical in delivering therapies currently being developed not just by Professor Alex Hewitt but also other ophthalmic researchers.”

CRISPR/Cas holds much more promise because it can enter the cell and remove the incorrect DNA sequence and replace it with the correct sequence, thus permanently altering the genome. It can also simply ‘knock out’ a mutation, allowing the cell to make normal proteins.

After securing development approval from Hobart City Council, the buildings have undergone a significant facelift. The asphalt for the carpark has been laid, the ventilation systems will soon be commissioned, and indigenous artwork by local artist Mr Reuben Oates will connect the OGTC with past, present and future through vision.

Explaining this further, Vote says CRISPR has two components – a guide RNA and the Cas9 enzyme. Having diagnosed a patient’s exact genetic defect, the guide RNA acts as a messenger to find the patient’s DNA with the affected gene. Once found and bound to the gene, the Cas9 enzyme precisely cuts out the affected gene. By providing the manufactured repair (correct gene), this enhances restoration of normal gene function in 60-70% of cases. This is compared to a one-in-a-million chance if the DNA is left to repair itself naturally or 10-15% with existing gene augmentation techniques, as above.

More than $100,000 has been raised from community donations (in addition to TEI’s own contributions), but there is still some way to go to reaching the $2 million target. Major regulatory hoops also remain. Another $1 million is needed for the highly specialised equipment to obtain TGA approval, of which around $71,000 has been raised. (Fully tax-deductible donations can be made at www.tasmanianeye.org). The fundraising drive has also seen Vote’s hair change from bleached to blue before shaving it off entirely. While CRISPR has exponentially fast-

INSIGHT November 2021

“CRISPR/Cas9 is faster, cheaper, more accurate and more efficient and we will see an exponential increase in these personalised medicine cures,” Vote says.

While Hewitt is among the first to apply CRISPR/Cas to eye disease in Australia (in animal models), pharma giants Allergan and Editas have already advanced their CRISPR/Cas9 therapy to human trials, with the first patient with Leber congenital amaurosis type 10 treated in March last year. Using the gene ‘knock out’ approach, it took place at the Oregon Health &

Science University, Casey Eye Institute, and was reportedly the first ‘in vivo’ CRISPR medicine of any kind to be administered to a patient. Speaking to Insight, Hewitt says there is a long road before the production of clinical-grade CRISPR therapies in Hobart, but once operational, he and his team may initially focus on a rare form of Usher syndrome. Other IRDs such as retinitis pigmentosa, cone-rod dystrophy, and Stargardt disease would also be considered.

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These are all monogenetic diseases, typically caused by one or two ‘spelling mistakes’ in the single gene. However, it’s likely such therapies would only be useful for patients with a good degree of functional retinal cells. “It means you could potentially correct any disease-causing variant that isn’t large. Obviously major structural genomic changes wouldn’t be readily amenable to CRISPR/Cas therapy, but small changes, which would account for the majority of IRDs would potentially be amenable,” he says. CRISPR/Cas also doesn’t run into the ‘cargo size’ issue often seen in gene augmentation. The gene in Luxturna was chosen because it fit nicely into the viral vector, but some IRDs require larger genes that don’t fit commonly used viruses. “The other potential advantage is on the regulatory front. The first therapy will need full pre-clinical modelling and testing in animal models, but after it is proven to be safe, I think the bar would be lowered for other modifications because you’re essentially redirecting where that gene editing machinery needs to go,” Hewitt explains. “In the cell line you could show you are not giving off inadvertent offtargeting effects which is different to a gene augmentation approach where you might always have to do the rigorous pre-clinical screening because it is a major change in the composition of your therapy – redirecting the CRISPR machinery isn’t a major change in the machinery.” In future, Vote anticipates most CRISPR applications will be biomedical (>90%) but won’t be limited to gene therapy. He says CRISPR already plays a role in regenerative medicine such as stem cells and pharmaceuticals, including drug development and mRNA vaccines for COVID-19.

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“Aside from eyes and the variety of blinding genetic diseases, CRISPR cures will be produced for cardiovascular diseases, diabetes, Alzheimer’s, genetic haemoglobin disorders (anaemias like sickle cell and thalassaemia, and cancer (CRISPR-edited immune cells to attack tumours).” n NOTE: Fully tax-deductible donations towards the Tasmanian Eye Institute’s Ocular Gene Therapy Centre (OGTC) can be made at www.tasmanianeye.org.

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BUSINESS

FINDING YOUR SPARK:

TOP BUSINESS HABITS From setting goals and aligning values, to investing in technology and asking for feedback, there is no shortage of effective business tips for successful small-to-medium optical enterprises. Four leading Australian optometrists, an optical dispenser and a practice manager from various locations share what habits are most effective for them.

NEGATIVE FEEDBACK AN OPPORTUNITY TO GET BETTER BERNIE ZACHARIA is practice manager at Zacharia Naumann Optometry, part of the ProVision network, in the regional city of Wagga Wagga in southern New South Wales. She manages a team of up to 10 staff in the practice on a daily basis.

1. E mpower the entire team. Every member plays a vital role and is invited to make suggestions on any aspect of the business. I’m constantly asking the team what can we do better? Every suggestion is a good suggestion because it gives a fresh perspective. 2. A ctively seek feedback from patients – good or bad. Welcome negative feedback as an opportunity to improve. We recently changed our process to dedicate one team member to check-in, pre-test, and discuss lens selection with a patient, so they don’t have to repeat themselves to several staff members. This change came as a result of negative feedback. Don’t hide negative feedback – they’re like jewels. We’ve really listened to what we’ve been told. We celebrate positive feedback and share negative feedback. 3. T ransfer professional trust at handover by endorsing the dispensing skills of the team. Recognise the business isn’t just about optometrists. We’ve sought to encourage our patients to develop a relationship with each team member – optometrists, dispensers, optical assistants – as each person plays an important role. We’re a large team but we’re all equals. There is no hierarchy – that’s part of our workplace culture. 4. S trive for solution-based dispensing. Acknowledge patients’ frustration with their vision. We’ve learned, again from patient feedback, the importance of managing patient expectations. Nothing replaces natural vision. When having a conversation with a patient about lenses, we explain what a lens will do and – crucially – what a lens

Zacharia Naumann Optometry, Wagga Wagga, New South Wales.

won’t do. We set realistic expectations. We’re not pushing key performance indicators (KPIs), or recommending a particular lens based on commission. It’s a good habit to be patient-centric. Trust is number one for success, with patients and your team. Nothing is more valuable in business.

INSIGHT November 2021 33

BUSINESS

TRUST INTEGRAL TO BUSINESS SUCCESS BELINDA MUSITANO is owner and optical dispenser of two independent optometry practices, Eyes@ Australind and Eyes@Dalyellup, both south of Perth. She has completed the Dare to Lead leadership course, facilitated by well-known American professor and author Brené Brown.

1. S elf-care. I prioritise my mental and physical health. If I am not functioning well then it makes it hard to concentrate, plan or strive to achieve goals in any area – both personally and at work. I schedule time into every week to exercise, eat well and get enough sleep. Having some basic routines in place during my week also ensures I stay on task, reduce overwhelm and balance family and work commitments. 2. S et goals and plan. I am very goal focused, it helps me remain on the right path, with a plan. Each year I take time out to write down my business goals for the year. Goals are then broken down quarterly and monthly. I have monthly meetings with my team where our targets, goals and focus are communicated. This is also written up on a white board in the staff areas of each practice so that it is easy to remember and each week they can check in our how we are tracking. Each day I have a to-do list, with the must do items and then down to things that are required to do but might not be needed until the end of the week. 3. C onnect. To be able to form strong connections and trust with people is integral to business success. There are multiple facets to this thought – you need to have an excellent team of employees that you connect with, trust and share your vision and goals. By having this connection with your team, you can have better productivity, share ideas, utilise each person’s strengths, and see beyond your own blind spots. I feel you also need to connect with your patients, that they feel valued, listened to, and that you understand their needs and have their best interests in mind.

The team at Eyes@Australind Optometrist, Western Australia.

By behaving with integrity and taking the time to build a great connection with your patients, your business will thrive, and your patients will actively promote you to their social group. 4. L earn and take note. I remind myself regularly that not one person knows everything. Just because I had a great financial year doesn’t mean there is no room for improvement. I am constantly seeking new information. This may be in the form of podcasts, reading articles, listening to audio books, or talking to other business owners. I fit this into my week by listening while I go for a walk or run. Having a notebook with me at all times is also one of my habits. I write all my ideas in there that pop into my head. It creates a bank of all my thoughts, so I don’t have them playing over in my head all the time. Out of all these thoughts there are usually some great ideas that can be implemented in some way into the practice. I share the ideas with the team for feedback and thoughts on how we could use them to improve our practice.

FIND YOUR PURPOSE AND STAY MOTIVATED BY IT DR JIM KOKKINAKIS, owner of The Eye Practice in Sydney, has more than three decades of business experience, is one of Australia’s first optometrists to be qualified in ocular therapeutics, and is a senior lecturer and clinical supervisor at the School of Optometry and Vision Science at UNSW.

1. F ocus on delivering one thing. From our perspective it is about delivering peace of mind about eye health. It is not about selling glasses. Glasses are sold as a consequence of the patient’s personal need and lifestyle. 2. W e buy a new piece of technology every year. Our patients have come to expect that every time they come in for an eye test, we will do it differently and better. We do not bulk bill. 3. M ost of the eye testing and data collection is done by my support staff. My job is to analyse the data that has been collected and communicate the implication of the testing and recommend solutions for the patient’s perceived and unperceived problems. 4. A ll patients are tentatively pre-booked in the future. This appointment could be one month, three months, six months, 12 months, 18 months or three years into the future, dependant on

INSIGHT November 2021

The Eye Practice in Sydney’s CBD.

clinical need. They are advised why there is clinical need and that we will remind them well before it is time. If for some reason they cannot make the appointment, they can reschedule as they will have ample time to do so.

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BUSINESS

DISCOVER YOUR VALUES AND KEEP THEM FRONT OF MIND WHEN RECRUITING STAFF With an interest in sports and children’s vision, optometrist and joint practice owner of Hannaford Eyewear, THAO HANNAFORD is also the co-founder and director of the Academy of Advanced Ophthalmic Optics. She is a Business Person of the Year finalist in the Southern Highlands Local Business Awards 2021.

1. A sk for help. This isn’t necessarily referring to day-to-day operations but more strategic aspects of the business. For example, having an accountant who is also a business advisor helps guide the business, as well as personal goals are incredibly important. Advisors can assist with long-term goal setting and implement actions required to reach these goals including what happens beyond retirement. 2. F ind a team whose values align with yours. You can teach almost anyone to carry out tasks. However, when your team is passionate about what they do and believe in the ethos of the business, this is reflected in the way they serve and treat their patients. Vision, mission and – in particular – values, are important in any business as it is these values which patients also align themselves with. 3. M aintain integrity and humility. Having pure and honest intentions at all times when in business is important, especially in eyecare. We are here

Hannaford Eyewear, located in Bowral, in the Southern Highlands of New South Wales.

to help patients and solve their vision issues to the best of our abilities. This also means we should always strive to be better and remain humble even in times of great success. Optometry is a dynamic profession which is constantly developing so staying on top of the latest developments in science and technology is required for continual success. 4. M indfulness and work life balance. Mindfulness is important to prevent work from creeping into other aspects of your life and overshadowing you. Often it is in those ’time out’ moments where our greatest ideas come to mind. Family time and recreational pursuits or hobbies such as – in my case – martial arts and music, play a role in helping me stay balanced spiritually, mentally and physically.

GAIN FRESH IDEAS BEYOND OPTOMETRY Optometrist DR STEPHANIE YEO is practice owner of the E Eye Place in Port Coogee, south of Perth. The practice is part of the ProVision network, with a team of three optometrists and three optical dispensers. Yeo is also currently undertaking a PhD in infodemiology and behaviour change.

1. I ’ve learnt over time not to be afraid to seek professional advice, in both a personal and professional sense. I opened my greenfield practice in a new estate, as an independent, but as the business scaled up, it was no longer feasible to manage on my own, so I sought professional advice, and subsequently joined ProVision. I also seek non-optometry-related upskilling courses as well as professional advice. Venturing beyond optometry in networking has opened my eyes to fresher ideas, and an out-of-the-box perspective that helps me relate to my patients. 2. K now when to do less and when to do more. At times, in the practice, I can be juggling multiple tasks; seeing patients, edging glasses, and completing business administration tasks such as communicating with other health professionals and manufacturers. But after having my second child, I had to pull back, and take a break to avoid burnout. Stepping back or stepping sideways can give you a “balcony view” and guide where you can be more productive and add value to the practice. 3. H ave an action plan and set clear, realistic, achievable goals. If I have a KPI I want to achieve, how do I get to that goal? You need to think forwards and backwards. If you make a mistake, review the process, and don’t repeat it in future. When faced with a difficult or unappealing task, such as re-building my practice website that

INSIGHT November 2021

E Eye Place, in Port Coogee, south of Perth.

was created when I first established E Eye Place, I count to 10, then work on it for 10 minutes. 4. B e mindful of the purpose of your business. It is the benchmark of success. Knowing your purpose and having that mindset comes first, KPIs come second. I’m here for the long term as an independent practice to look after our patients – that’s the bigger picture.

‘HAVE A CLINICAL SPECIALTY AND BE VERY GOOD AT IT’ Bilingual optometrist DENISE LEE is practice owner of Eyecare Plus Springvale, a multicultural suburb in Melbourne’s east. She holds a Masters in Optometry and has completed a US-based clinical curriculum in behavioural developmental vision. Her practice offers all forms of dry eye and myopia control treatments.

1. I n lockdown, it's very important to stay open to ensure continuity of care to your patients, as long as you have support staff that can work. Some staff may have family members at a higher risk if they contract COVID so your staff may not want to work. Open reduced hours and space appointments apart, for example 45 to 60 minutes each. This allows you to minimise patients coming in contact with each other, each patient can be wellattended to, and you may be able to take on any urgent cases that need to be seen immediately. Ensure your patients are aware that you are open; have a phone message, a social media message and a clear sign on the front door. Patients will really appreciate that you remained open during these tough times. Have two teams if possible, consisting of one dispenser and one optometrist in case a staff member needs to quarantine. 2. D ifferentiate yourself from other optometry practices or optical stores. Have a clinical specialty and be very good at it. Keep your knowledge in this specialty field up to date. Furthermore, be therapeutically-endorsed as the training that comes with it ensures you are knowledgeable in managing a range of ocular conditions. These skills and knowledge will draw in patients of all ages, whose needs are not met satisfactorily elsewhere. These patients will often become key referrers for new patients. 3. I nvest in new technology to help you diagnose and manage conditions

early and in some cases prevent vision loss. Patients will always remember and be grateful to the optometrist that saved their sight. Equipment such as OCT scans and ultrawide retinal imaging are a must to provide top clinical care. Have a plan on how you will implement these into routine testing so that you can cover the repayments of these devices. Take time to carefully explain the results of these tests. Report to their doctor or medical Eyecare Plus Springvale, in Melbourne’s east. specialist if they have a medical condition that potentially can affect the eyes. Again, patients will appreciate this and see that you are taking care of them. 4. A t the end of each examination, always state the reason why they need to return and when. Tell them your plan for their next visit, for example OCT scan to monitor risk of glaucoma due to family history. Explain that a reminder will be sent to them, either via SMS, email, letter or phone call. Stress the importance that many eye conditions, some of which are sight threatening, will not have symptoms. Provide them a summary of their eye examination. Use a letter or printed template so that you can do this easily at the end of each comprehensive consultation.

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COVID-19

THE MANDATE MINEFIELD

s e n i c c a v D I COV

Policymakers have been facing growing calls to mandate vaccines for health workers, as well as ancillary staff. But whether this will extend to private eye health practices remains to be seen. And can you require patients to be fully vaccinated? Insight dissects the issue.

n 22 March this year, Australian eyecare professionals and their support staff became eligible for COVID-19 vaccinations; second in the queue as part of Phase 1b.

At the time Australia thought it had figured out how to beat the virus with snap lockdowns and contact tracing. Over the proceeding eight months, however, the situation has changed dramatically, driven by the highly infectious Delta variant. Instead, the nation’s worst-affected states have opted to vaccinate their way out of the crisis. The seriousness of the situation has been the impetus for a raft of daring vaccine initiatives that are having flow-on effects for the nation’s ophthalmic workforce These include mandatory vaccination workplace policies, laws allowing optometrists to prepare and administer vaccines and the Therapeutic Goods Administration loosening regulations to let businesses incentivise fully vaccinated customers with competitions and prizes. While a lot of these initiatives vary depending on the state or territory, it has raised a host of questions, particularly for owners of small-to-medium private health businesses wanting to mandate vaccines for their staff, and develop policies requiring patients to be fully vaccinated before entering the practice. MANDATORY WORKPLACE VACCINATIONS Until recently, mandatory vaccinations mainly only applied to aged care providers and hotel quarantine workers. The Federal Government has been reluctant to see such public health orders extend into other industries, with Prime Minister Mr Scott Morrison stating that doing so would amount to a mandatory vaccination program “by stealth”.

INSIGHT November 2021

As such, the Federal Government has left it up to individual businesses to take into account their particular circumstances. This lack of clear direction is challenging for many employers who are concerned they may open themselves up to legal jeopardy. Some employer groups have called on the government to provide indemnity, which has fallen on deaf ears. More recently, however, momentum has been growing behind the need to vaccinate the healthcare workforce, taking the decision entirely out of the hands of health and medical practices, perhaps much to the relief of employers. It’s been reported that the Australian Health Protection Principal Committee (AHPPC) recently met with the National Cabinet to try achieve a nationwide consensus on mandatory vaccination for healthcare workers, but whether this extends to optometrists or ophthalmologists working in their private practices remains to be seen. At the time of writing, the Tasmanian Government was initially the most audacious with a public health order requiring all health and medical professionals (including optometry practices and ophthalmology clinics and their ancillary staff and cleaners etc) to be vaccinated – regardless of whether they practise privately or publicly. It set a 31 October deadline for the first dose, with details yet to be released about the second dose. Victoria then followed suit, with a requirement of all practice staff – including administrative and ancillary roles – to be double jabbed by 15 December, or provide a medical exemption otherwise. This was broadly applied to the health sector, including private optometry clinics. Other states – such as Western Australia and New South Wales – have developed policies to mandate vaccinations for health workers, but appeared to fall short of capturing privately practising allied health

changing guidance about vaccine eligibility and supply,” he said.

"WE’VE SEEN A WILDLY VARIABLE APPROACH IN THE US WITH SOME STATES LEGISLATING AGAINST THIS KIND OF ‘DISCRIMINATION’ AND OTHERS ENCOURAGING IT" LUKE ARUNDEL OPTOMETRY AUSTRALIA

practitioners like optometrists at the time of publication. In WA, for example, an optometrist would need to be vaccinated if they are working in a public setting, a government spokesperson confirmed. In NSW, the government has written public health orders mandating vaccines for healthcare workers in public and private hospitals. Optometrists in the state, however, were required to have their first vaccination by September 20 if they lived in a local government area (LGA) of concern and needed to travel outside of that LGA for work. Those working in aged care facilities are also required to be vaccinated. The Northern Territory has indicated mandating vaccines for health workers, but whether this will be applied to eyecare professionals is unclear. The AMA has advocated for nationally consistent public health orders of state and territory governments to authorise mandatory vaccinations across the entire healthcare system, including support staff like cleaners, receptionists and contractors. “Australians must understand that we will be living with COVID-19 for a long time to come and that will inevitably involve a longer, heavier than normal reliance on our doctors, nurses, hospitals and allied health,” AMA president Dr Omar Khorshid said. “We need to bring these workers and the environment they work in out of crisis mode and the first step towards that is to protect them through vaccination. This is about healthcare worker safety and the safety of patients, and not about vaccines by force.” The AMA has also proposed nationally consistent public health orders be issued by state and territory governments to provide legal protection to any employer who can also reasonably establish worker safety would benefit from a workplace vaccine mandate. Longer term, statutory coverage may be required.

“However, employers can take some guidance from recent decisions of the Fair Work Commission, which, while not definitive, point to a trend that is moving towards allowing mandatory vaccination in more circumstances.” For optometry practices, Arundel said these decisions have clarified: • m andatory vaccination is more likely to be acceptable if social distancing is not possible in a workplace, and; • a n employer’s statutory obligations to patients, clients and members of the public are relevant to decisions regarding mandatory vaccination, particularly if the work involves providing care or interacting with vulnerable people. Fair Work’s advice included a tiered system, with Tiers 1 and 2 more likely to have reasonable grounds for mandating vaccinations. • Tier 1 work — employees interact with high-risk people (eg border control, hotel quarantine) • Tier 2 work — employees interact with vulnerable people (eg healthcare or aged care workers) • Tier 3 work — employees with public interaction (eg retail workers at essential stores) • Tier 4 work — employees with minimal face-to-face interaction Under the Fair Work Ombudsman guidelines, Arundel said optometry practices are likely to be considered either Tier 2 or Tier 3 workplaces. “The nature of optometry workplaces involves optometrists and other clinical staff interacting with each other and having close contact with patients during eye examinations. This means social distancing is not always possible, which would make most practices a Tier 3 workplace,” he said. “Optometry practices with particularly vulnerable or elderly patient bases may be considered Tier 2 workplaces. The reasonableness of a mandatory vaccination direction for Tier 3 workplaces also depends on the extent of community transmission in the surrounding area of the optometry practice and the availability of vaccines. As all allied health professionals are entitled to priority access to a COVID-19 vaccination, the availability of vaccines in not an objective problem for optometrists.” Arundel said Optometry Australia encouraged members to review the guidelines in the HR section of the OA website for implementing a vaccination policy in their workplace and to seek legal advice before making any decisions about mandatory vaccinations in their workplace. “As we move to ‘living with the virus’ and trying to vaccinate our way out of this pandemic, it is becoming increasingly likely that staff and practitioners being vaccinated will be a requirement for working in the health sector,” he said.

“SPC and Qantas have taken the lead mandating vaccines for their workforces, but we know it’s very complex and expensive for small employers to meet with the legalities required. National Cabinet needs to coordinate state and territory action to give legal certainty,” Khorshid added. WITHOUT A PUBLIC HEALTH ORDER, WHAT ARE MY RIGHTS? Even if state and territory governments do mandate healthcare worker vaccinations through public health orders, there is no guarantee they will extend as far as privately-run eye health facilities. In the absence of concrete orders, it is ultimately up to individual employers to determine if they want to mandate staff vaccinations, taking into account their particular set of circumstances. Optometry Australia (OA) chief clinical officer Mr Luke Arundel told Insight that it’s a rapidly evolving, high profile and controversial issue – and one that’s creating a confusing landscape for employers. “This lack of clear direction is challenging for many employers, given all businesses are vulnerable to external factors, including government policy changes, the impact of COVID-19 outbreaks and lockdowns, and

Experts say vaccination public health orders help to provide certainty for employers.

INSIGHT November 2021 39

COVID-19

CAN I REQUIRE MY PATIENTS TO BE VACCINATED? Once all Australians have had the chance to access a vaccine, Arundel expected the issue of ‘no jab, no entry’ to be high on the agenda for businesses.

"WHAT MEASURES WILL YOU RETAIN TO MANAGE THE RISK OF CUSTOMERS WHO HAVE MEDICAL CONTRAINDICATIONS AND CANNOT BE VACCINATED?"

“We’ve seen a wildly variable approach in the US with some states legislating against this kind of ‘discrimination’ and others encouraging it,” he said. Ms Athena Koelmeyer is the managing director of the Sydney firm Workplace Law and said the various state and territory governments would help by issuing public health orders such as those for health workers. For example, in NSW, she said the roadmap to freedom unveiled for the fully vaccinated was already quite specific as to what fully vaccinated people will be able to do – and therefore conversely what unvaccinated people will not. “Of particular interest might be the statement that unvaccinated people will only be able to access critical retail – fully vaccinated people will be able to shop provided that the store complies with the four square-metre rule. Victoria has promised crystal clear guidelines, which I suspect will be along similar lines to the NSW ones,” she said. “In summary then, I would suggest that your readers keep a very close eye on the public health order requirements that are being discussed now and which will be formalised. It is a good idea to develop not only policies, but procedures for implementing a requirement that customers be vaccinated that is consistent with the local health orders at the time.” She said properly developed procedures will be important as there will need to be some mechanism to sight the vaccination certificate of the customer – or the medical contraindication certificate if they are unable

ATHENA KOELMEYER WORKPLACE LAW

to be vaccinated. This is sensitive information under the federal Privacy Act and so businesses will need to think about what they do with the certificates sighted or collected by them. “It may be that, as the NSW Government has flagged, the Service NSW app will have a function that indicates vaccination status that will pop up when a person signs in with the QR code, meaning the business doesn’t need to collect the information itself, but it would still be a good idea to prepare the policy as if sighting was required, just in case,” she said. “The final thing for businesses to consider is what measures will you retain to manage the risk of customers who have medical contraindications and cannot be vaccinated? This might include continuing to wear masks indoors – likely to be required by public health orders for some time to come anyway – maintain proper social distancing, and maintain other hygiene measures such as extra sanitising, cleaning etc.” n

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CONTACT LENSES

HARNESSING THE POTENTIAL OF YOUR CONTACT LENS

portfolio

Attracting and retaining patients with contact lens products has become increasingly difficult with the rise of online retailers. But one major manufacturer is sticking by independents with a portfolio spanning across daily disposables and specialty contact lenses.

ith the lean operating structures and the increasing sophistication of e-commerce operators today, never has it been more important for independent optometrists to provide a premium service to wrestle back control of their contact lens business. The presence of online stores – that offer convenience and rock-bottom rates for major contact lens brands – has chipped at the bottom line of mainstream optometrists for years. And it shows no sign of abating, with a recent IBIS World report showing online glasses and contact lens sales in Australia have increased 7% annually since 2016, reaching $140 million this year. While many big-name contact lens manufacturers have made their products available to e-commerce operators, Menicon is one major player who refuses to do so, in the name of protecting the independent’s business interest. Mr Angelo Doumbos, the managing director of Menicon Australia, says the company is perhaps best known among local practitioners for its traditional strengths in rigid gas permeable (RGP) orthokeratology (ortho-k) lenses and contact lens care solutions. But it has seen an increasing number of optometrists add its Miru daily disposables to their contact lens offering. “We’re fiercely independent so consumers won’t find our contact lenses on major online retail platforms, but they can find them on the optometrist’s own e-commerce site if they have one,” he says. “While we might not get much visibility for that, we are trying to send a strong message to independent optometrists that we are here for them. If their patients are happy with our contact lenses, it is highly unlikely they will go elsewhere or purchase them online. Many independents have cottoned on to that and love us for it.” Doumbos says e-commerce will become more sophisticated as artificial intelligence and big data evolves. But patients still need to visit the optometrist for their prescription. If they are satisfied with the experience and impressed with a product they haven’t seen anywhere

INSIGHT November 2021

else, it creates an opportunity for the practitioner. “To help facilitate that repeatability of sale, we are also developing a platform to enable practitioners to sell via their own e-commerce website, so patients have that online convenience. As the market evolves it will still boil down to the customer experience in the practice, and ultimately that is a conversation we love to have with the practitioner about their contact lens portfolio. There is huge value still to capture in the contact lens market.” CELEBRATING SEVEN DECADES Menicon is Japan’s oldest contact lens manufacturer that today services more than 80 countries as the world’s fifth largest contact lens company. This year marks its 70th anniversary. The company has unique origins that can be traced to the Tamamizuya optical shop in the city of Nagoya. That’s where, in 1950, 19-year-old Kyoichi Tanaka first heard of contact lenses from the wife of a US Army officer. From this encounter, he developed Japan’s first corneal contact lens in 1951. Thus, Menicon was spawned. Its products have been present in Australia since the early 1980s when the then-groundbreaking Menicon O2 – the first RGP lens – was introduced, along with its partner lens care solution, O2 Care. Its products have been continuously available in Australia since then through various distributors. This changed in 2011 when the parent company (Menicon Co Ltd) acquired the distribution business of Mr Mark Whibley to establish the wholly owned subsidiary, Menicon Australia, in Adelaide, South Australia. Whibley retired as managing director of Menicon Australia in July 2020, handing the reins to Doumbos who has 17 years’ experience in the optical industry, many of those working for Hoya. Menicon’s Australian operation is modest, with around 10 staff that includes sales reps in New South Wales, Victoria, South Australia and Western Australia. This is expected to expand as the company launches new

to enhance the monitoring and communication process between eyecare professionals and patients. There’s also plans to allow more topographers to communicate with the software to facilitate lens ordering. Following the European launch of Menicon Bloom, the company penned a global strategic collaboration with Johnson & Johnson Vision. Johnson & Johnson will focus on expanding availability of the lenses around the world, while Menicon will develop and manufacture the therapeutic contact lenses to manage the progression of myopia in children. SUSTAINABILITY OBJECTIVES As one of the world’s major contact lens manufacturers, Menicon has an expansive global footprint that comprises two production facilities and a technology centre in Japan, a laboratory in The Netherlands, and a major contact lens solutions facility in France. This is in addition to a distribution centre in Germany and a site in Singapore where its Miru 1day Menicon Flat Pack is manufactured. In 2019, it also acquired Soleko, a major Italian contact lens company.

The Miru 1day Flat Pack is eight times thinner than conventional blister pack, requiring 80% less raw material.

products in daily disposables, RGP lenses, ortho-k and its Menicon Bloom system, the world’s first first ortho-k lens with a myopia control approval. In the Australian market, Doumbos says a key priority is to raise the profile of Menicon among practitioners. “Australia has always been regarded by Menicon as an important region. “Our eyecare professionals are world-class and we’re lucky to have highly educated and experienced optometrists. But also, our multicultural diversity provides a unique position in the global market for research and development.” To date, Doumbos says Menicon’s largest contribution is within myopia management and ortho-k, as well as RGP lenses. Its contact lens care solutions Menicare Plus and Progent are highly regarded products for RGP lenses. Ortho-k lenses such as Menicon Z Night and Alpha Ortho-K have been growing month-on-month since their introduction. Recently, the company’s Miru daily lenses have been building a fanbase too. It features the unique Miru 1day Menicon Flat Pack packaging, which, at barely 1mm thick, is eight times thinner than conventional blister packs. As such, myopia control and daily disposables are the two main growth targets for Menicon in Australia and New Zealand. “We make unique, hard to replicate technology on our disposable lenses. For example, Smart Touch technology, exclusive to Menicon in our Miru family, gives the wearer unique value of ultimate hygiene and convenience,” Doumbos says. “There is no need to touch the inner surface of the lens upon wearing the lens. And now with hygiene being ever more important as highlighted by COVID-19, the eyecare professional has a unique offering to the customer.”

With contact lens production and packaging being major contributors to pollution and waste, Doumbos says the company is acutely aware of the need for sustainable development goals. He says the plastics used in the manufacturing process are regarded as a high-quality resource, so the company seeks to use it effectively inside and outside of its factories. “For example, at the Seki and Kakamigahara plants in Japan, the plastics used in these factories are utilised as a raw material for various plastic products by a local recycling company, and in the Singapore plant, approximately 40% of the used plastics are reused as a raw material for the secondary packaging. The remaining plastics are handed over to a recycling company,” he says. “On the roof of the Emmen Plant in The Netherlands, 550 solar panels were installed which can provide 150 MWh of electricity annually. Water is recognised as an important resource for contact lenses. At the Kakamigahara Plant, established in 2015, a pure water production device has been adopted to save 50% of water usage.” The company has also looked further than its manufacturing processes. The daily disposable Miru 1day Menicon Flat Pack requires 80% less plastic compared to conventional products. The package is produced by reusing 100% of plastics from the contact lens manufacturing process. Elsewhere, a new manufacturing technique has seen the company achieve up to a 30% reduction in plastic materials used in its bottles for lens care products. “With RGP lenses produced at the Emmen Plant in The Netherlands, we were looking for a sustainable solution with the development of new packaging for our lenses and our mailing envelopes,” Doumbos adds. “They are now made from a more sustainable and recyclable material, so we can further reduce our footprint.” n

Within the myopia category, Doumbos says Menicon has blazed a trail with the Menicon Bloom Myopia Control Management System. The system features Menicon Bloom Night, the first CE-approved ortho-k contact lens for myopia control management. It was approved in Europe in 2019 and will be launched in Australia this year. “There’s a lot of excitement because now you have an ortho-k lens that has a specific myopia control certification,” Doumbos says. “Traditionally ortho-k has been used off-label so this is a major milestone. With the availability of disposable soft contact lenses for myopia, as well as spectacle lenses and atropine, having an approved ortho-k lens now means eyecare professionals have more options to manage their myopia patients.” Doumbos says the Menicon Bloom system is a holistic approach to myopia management. It includes specialised software called Bloom Easyfit that guides the optometrist through the fitting process. A specially designed mobile phone app, Menicon’s Bloom app, has been developed

Menicon Australia managing director Mr Angelo Doumbos (left) and Heidi Hunter, clinical optometrist and director of Custom Eyecare in Newcastle, NSW.

INSIGHT November 2021 43

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EYE INJURIES Corneal penetrating injury caused by a stick. Image: courtesy Prof Tim Roberts.

HOME IS WHERE THE HARM IS

s d n e r t g n i g Chan a m u a r t e y in e

New research on eye trauma sustained during the COVID-19 pandemic, coupled with the launch of an international live registry of eye injuries, is building a bigger picture on patterns and emerging trends, as RHIANNON BOWMAN discovers. WARNING: The following article contains content regarding domestic violence and graphic images.

here aren’t many trends COVID-19 hasn’t upended; fertility rates are falling, regional property prices are booming, universities are in deficit with more than 40,000 staff losses, and supply of illicit drugs has been disrupted. Eye trauma hasn’t escaped the clutches of the pandemic either, but not necessarily in ways one might expect. Investigations into intimate partner violence-related ocular injuries in the US, a resurgence of bow-and-arrow-related ocular trauma in India, and paediatric eye injuries in Western Australia have all been examined through the lens of the COVID-19 pandemic. In the WA study, researchers found the number of eye injuries during lockdown was stable compared with pre-pandemic numbers, but the nature of those injuries changed, from outdoor sports injuries to in-home injuries. A drop in non-accidental injuries – a clinical term to describe intentional abuse – came as a surprise to the researchers who thought this number would go up. Now, such ocular injuries and others — resulting from household and DIY accidents, fireworks, car accidents, falls, alcohol-fuelled incidents and more — can potentially be documented in a new international online registry. A registry may also illustrate the impact of previous “social change” on eye injuries, demonstrated in research that has shown that fewer orbital fractures were treated at St Vincent's Hospital after lockout laws were introduced in Sydney in 2014, for example. One of the leading experts behind the concept and creation of the registry is Australia’s own Ms Annette Hoskin, Research Fellow from

the Save Sight Institute (University of Sydney) and Lions Eye Institute (University of Western Australia). Passionate about preserving sight by preventing eye injuries, Hoskin is also Essilor’s global standardisation manager, and Optometry Australia’s representative on Standards Australia’s committees for eye protection, spectacles and sunglasses. She recently spoke at the Asia Pacific Ophthalmic Trauma Society (APOTS) symposium, titled ‘COVID-19 and Ophthalmic Trauma: Lessons Learnt and the Way Forward’, as part of a virtual Asia Pacific Academy of Ophthalmology (APAO) 2021 congress held in September. Hoskin says there has been new data published on changes in trends in eye injuries associated with lockdown, including her own work on the new registry called the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES IGATES is a secure online registry available internationally for the collection of ocular trauma data. In ocular trauma, injuries can be initially classified as adnexal (eyelids, conjunctiva, lacrimal and orbital soft tissue), closed-globe or open-globe, where an open-globe injury is defined as a full-thickness wound. From there, an open-globe injury (OGI) can be described as secondary to blunt trauma or due to a laceration. “We have made significant advances with IGATES, resulting in two papers published recently,” Hoskin says. One paper is on eye injuries from fireworks used during celebrations

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EYE INJURIES

and more targeted.” Hoskin says the registry will live-document changes in types of eye injury, which the IGATES team will continue to monitor. They hope future studies with more rigorous methodology, and including a larger number of institutions internationally, will enable trends associated with OGIs to be identified to inform strategies for prevention of these injuries. PAEDIATRIC EYE INJURIES IN WA In a separate study last year, a group of researchers in Hoskin’s hometown of Perth set out to evaluate accidental and non-accidental eye injuries in children presenting to Perth Children’s Hospital (PCH), the only public paediatric centre with specialist ophthalmology services in the state, during the nationwide COVID-19 lockdown. With both accidental and non-accidental eye injuries a significant cause of long term visual impairment in children, the researchers wanted to determine whether the frequency or nature of these injuries differed from pre-pandemic presentations. Colleagues Professor David Mackey, Dr Maria Franchina and Ms Magda Blaszkowska, from the Centre for Ophthalmology and Visual Science at The University of Western Australia, joined forces with Mr Joel Lewis, Dr Alice Johnson, Dr Antony Clark, and Dr Geoffrey Lam from the Department of Ophthalmology at Perth Children’s Hospital. “Understanding when and how such injuries occur is key to developing adequate prevention strategies,” the cohort wrote in their paper, published online in Clinical and Experimental Optometry in August. Lid and forehead laceration following a dog bite. Image: courtesy Prof Tim Roberts.

"WE HAVE DEVELOPED AN INTERNATIONAL ONLINE REGISTRY FOR EYECARE PRACTITIONERS TO COLLATE AND ANALYSE EYE INJURIES" ANNETTE HOSKIN SAVE SIGHT INSTITUTE/ LIONS EYE INSTITUTE and the associated vision loss, and the other is on epidemiology and outcomes of open- globe injuries. Although neither paper is specifically reporting on COVID-related injuries, the latter study’s purpose was to utilise an ocular trauma registry to determine the demographics, nature of injury, and associations of severe visual loss for OGI. Thirteen hospitals in seven countries use the IGATES platform. Patients presenting between April 2009 and 2020 with OGI, with or without adnexal involvement or intraocular foreign body, were included. From a cohort of 746 patients, OGI occurred more frequently in males in industrial settings and females at home. However, overall, those who were aged 61 years or older, female, and suffered an eyelid injury or foreign body, were at higher risk of severe vision loss from OGI. Hoskin and Dr Rupesh Agrawal, a senior consultant ophthalmologist at National Healthcare Group Eye Institute at Tan Tock Seng Hospital in Singapore, who has been working on IGATES for six years, believe the registry enables fast and easy tracking and analysis of eye injuries internationally and are keen to collaborate. “We have developed an international online registry for eyecare practitioners to collate and analyse eye injuries,” Hoskin says. “We took the first registry as a test case, published the data from that, and then reviewed and revised it, to make improvements. We have now re-launched as a brand new entirely online platform that is more flexible,

INSIGHT November 2021

The research team conducted a retrospective review of the medical records of paediatric patients presenting to the emergency department and specialist ophthalmology clinic at PCH with an ocular injury and those presenting to the hospital Child Protection Unit with physical injuries during March to August 2020, and the same period in 2019. They theorised that the prolonged period of school and playground closures and a reduction in after-school activities due to COVID-19 restrictions would significantly alter the epidemiology of accidental eye injuries in the paediatric population. In their view, the unparalleled recent circumstances arising from the COVID-19 pandemic provided a unique opportunity to evaluate the risks associated with prolonged time spent in isolation and activity restriction. They found there was no significant difference in the total number of accidental eye injury presentations during the lockdown period (110 during March-May 2020 compared to 123 during March–May 2019) despite a significant decrease in emergency department attendance overall. “We were expecting a reduction in eye injuries overall given that sports and other outdoor activities were not taking place. However, injuries continued to occur (and increased) in the home environment, so overall there was no difference in frequency,” Mackey and Franchina said. Their review showed closed-globe injuries were the most common accidental eye injury presentation during lockdown (70/110, or 64%), followed by adnexal injuries (39/110, or 35%) and open-globe injuries (1/110, or 1%). More males than females attended with an accidental eye injury (75/110, or 68%), with a mean age of 6.2 years. Mackey, Franchina and their colleagues noted the nature of the ocular trauma did change, with fewer sports-related injuries and more householdrelated injuries, including three minor chemical eye injuries through misuse of hand sanitiser. “Injuries at home involved backyard sport, sticks, common household items such as knives, forks and pencils, and foreign bodies entering the eye such as sand, wood, glitter and small plastics,” the authors said. In contrast, the authors noted, referrals to the hospital Child Protection Unit for suspicious injuries declined during lockdown. “The drop in non-accidental injuries was a surprise as we thought it would go up,” Mackey says. They shared concerns raised in public health

"THE DROP IN NONACCIDENTAL INJURIES WAS A SURPRISE AS WE THOUGHT IT WOULD GO UP [DURING COVID-19 LOCKDOWN]"

NEW RELEASE OUT NOW

PROF DAVID MACKEY UNIVERSITY OF WA

literature that stringent social distancing and lockdown measures during the COVID-19 pandemic could lead to possible increased rates of child abuse and intimate partner violence due to increased parental and economic stress, reduced social support and financial instability. Instead – and in contrast to reports of increased family violence in WA during the height of the pandemic – the overall number of referrals to the Child Protection Unit for investigation of non-accidental injury decreased during the lockdown period. But even during times of unprecedented social isolation and restrictions, accidental eye injuries continue to occur. “Although eye injury presentations have changed in other parts of the world since the start of the pandemic, during COVID-19 lockdown in Western Australia, accidental paediatric ocular and adnexal trauma sustained at home continues to be a significant cause for hospital attendance,” Mackey, Franchina and their colleagues wrote. EVOLUTION OF CLINICAL REGISTRIES Last year Sydney-based ophthalmologist Professor Tim Roberts, a consultant at Royal North Shore Hospital and clinical associate professor at the University of Sydney, noticed a distinct change in eye-related injury patterns during the peak of the COVID-19 lockdown in 2020. “Typically, ophthalmic emergencies at Royal North Shore Hospital result from car accidents, alcohol-related incidents, and falls,” he says. “But during COVID-19 [last year], we saw fewer of these types of emergencies, and an increase in DIY and home-based accidents. For example, a yoga mishap with a theraband resulted in a bleed in the eye for one patient.”

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An eye that sustained acid burns. Image: Lions Eye Institute/Chris Barry

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EYE INJURIES

"A YOGA MISHAP WITH A THERABAND RESULTED IN A BLEED IN THE EYE FOR ONE PATIENT" PROF TIM ROBERTS VISION EYE INSTITUTE

Twelve-months later, Roberts can only assume yoga enthusiasts have improved their technique, as these injuries have been largely absent from the emergency department this year. “A local hospital emergency department reflects the local demographic in lockdown, and we’re seeing a noticeable reduction in presentations with eye injuries,” Roberts says. He says the number of open-globe and closed-globe injuries and lid lacerations are roughly the same – and that’s encouraging. “The good news, figuratively speaking, is that patients are still coming to emergency, as it has been anecdotally documented that some patients are avoiding coming to hospital for fear of contracting COVID. There is enormous hesitancy, especially amongst the elderly population,” Roberts says. “We can conclude from the numbers presenting to emergency that, hopefully, people are still coming to the emergency department if they have sustained a serious eye injury.” Roberts says the pattern of eye injuries is consistent with lockdown restrictions; where pre-COVID he treated injuries arising from falls, workplace accidents, and sporting mishaps, now, the majority of injuries stem from accidents at home, like a foam dart fired from a toy gun. Roberts’ observations are in line with a study published last year that showed that during COVID-19 lockdown, ocular trauma amongst adults was more likely to be sustained at home and more likely to result in a delayed presentation for emergency care. Concurrent with changing patterns in injuries, is an evolution in collating and analysing collective data on said injuries, Roberts notes. “We tend to find over the last decade there has been an increase in international collaboration, and interestingly, over the last two years, in lieu of international conferences and meetings that can’t take place, there has been a rise in online meetings and data-sharing.” In Roberts’ opinion, the benefit of an international registry, like IGATES, is that it promotes goodwill to share knowledge and benchmark results. “It can be complex, time-consuming and sometimes cost-prohibitive to run a large prospective study, but registries can overcome this to some extent, with data that reflects clinical practice, albeit not in a controlled study setting,” he says. “It can be very hard to benchmark results, aside from peer-reviewed publications. One advantage of a registry is it acts as de facto benchmarking, allowing surgeons to better analyse their individual outcomes.” INCREASE IN DOMESTIC VIOLENCE Mackey, Franchina and colleagues took family violence into consideration in their WA study pertaining to paediatric eye injury and noted there is indirect evidence to suggest an increase in the wordlwide incidence of domestic violence since the start of the pandemic. While, on paper, non-accidental injury decreased during the lockdown

INSIGHT November 2021

period, Mackey et al. raised the possibility that the incidence of nonaccidental injury did not decrease but that children who suffered injuries were not identified due to the closure of day-care centres and lack of interaction with extended family, friends and education providers who commonly report child abuse. Citing research, the colleagues also note parental drug use is a wellrecognised risk factor for non-accidental injury. “Given that the pandemic has interrupted drug supply chains, this has likely led to less use amongst vulnerable parents,” Mackey et al wrote. “It is also possible that perpetrators of family violence may have transferred abuse from children to intimate partners.” Roberts agrees that lockdown magnifies normalcy of life, so alcohol consumption or an already volatile relationship is exacerbated. Three oculoplastic surgeons in the US — Dr Dane Slentz, Dr Andrew Joseph, and Dr Shannon Joseph — co-authored a paper on intimate partner violence–related oculofacial injuries during the COVID-19 pandemic, published in JAMA Ophthalmology in May 2021. Citing survey data from the US Centers for Disease Control and Prevention, the surgeons reported that prior to the COVID-19 pandemic, one in four women and one in 10 men experienced intimate partner violence in the US. In March 2020, law enforcement agencies observed an increase in domestic violence calls to US police departments by 27% in some regions after stay-at-home orders were implemented, according to Slentz, Joseph and Joseph. They said the medical community has also observed a rise in the incidence and severity of intimate partner violence-related physical injuries, including head trauma, facial fractures, and visceral organ damage. They wrote: “The stay-at-home orders intended to curb the spread of COVID-19 may have inadvertently isolated many individuals who experience intimate partner violence with their abusers and/or triggered the development of new instances of violence.” Slentz, Joseph and Joseph believe that ophthalmologists and oculofacial plastic surgeons can play a particularly vital role in strategies to effectively screen for and prevent intimate partner violence. “Intimate partner violence-related ocular injuries can be vision-threatening and include intraocular haemorrhages, traumatic cataract, retinal detachment, and globe rupture,” they wrote. “In addition, intimate partner violence-related physical injury is responsible for 7.6% to 10.2% of orbital and zygomaticomaxillary complex (ZMC) fractures in women.” The surgeons argue the effects of the pandemic are expected to be long-lasting. They anticipate a substantial number of individuals in the US will continue to spend a significant portion of their time at home, which they attribute to a high unemployment rate and the fact many school systems are continuing to practise virtual learning. With Australia’s unemployment rate at 4.6% as of July, and remotelearning the status quo in some states, many Australian’s may also be spending a significant portion of their time at home. The impact this has on eye trauma trends may be revealed in IGATES data in years to come. n

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PROFILE

y r t e m o t op

A REFUGEE'S JOURNEY TO

Cafa Huynh was the youngest Vietnamese refugee to be pulled off a sinking boat in a daring rescue in 1981. Today, he is clinic director of a franchise optometry practice in Hurstville, Sydney. He speaks with Insight about his road to optometry in Australia.

n June 21, 1981, Cafa Huynh was one of almost 100 men, women and children saved from a sinking fishing boat in the South China Sea by the Royal Australian Navy.

They were among millions of people who fled Vietnam after the end of the Vietnam war in 1975. Their fishing boat, the Nghia Hung, was built to carry just 30 people, but was reportedly “up to the gunwales” as it pulled out of the mouth of the Saigon River under the weight of 99 passengers. Stormy seas and monsoon winds engulfed the boat on the second day, with water getting into the diesel compartment, blowing the engine. By the fourth day at sea, the drinking water was contaminated, their food stocks had diminished and the overloaded boat was badly leaking.

When their fate seemed sealed, fortune intervened. A Royal Australian Navy plane spotted black smoke and descended for a closer look in the deteriorating evening light. It notified the aircraft carrier HMAS Melbourne, 10 nautical miles away, which came to the rescue. By the time the rescue began, it was in big seas in the pitch dark. Huynh was eight months old at the time – the youngest refugee to be rescued that night in what became known as Melbourne Group 99 — or MG99. He was on the fishing vessel fleeing Cholon – Ho Chi Minh's Chinatown – with his mother, 20, and father, 27. “I’m their first-born and was their only child at the time. We didn’t

Cafa Huynh (left) with his Australian-born sister Terry sitting on the steps in front of their home in Lakemba, southwest Sydney.

Cafa Huynh, eight-months-old, with his parents after being rescued by HMAS Melbourne.

INSIGHT November 2021

Cafa Huynh, eight-months-old, with his father onboard HMAS Melbourne after being rescued. Image: Australian War Memorial

Wearing glasses after he was diagnosed with myopia.

have any relatives in Australia – we were the first of our family to leave Vietnam. My siblings were later born in Australia,” Huynh says. His parents initially settled in Lakemba, a multicultural suburb southwest of Sydney. “I went to kindy and started primary school at Lakemba Public School. The school opened in 1983, and I started there in 1985. We moved during primary school, and I spent the second part of primary school at Beverly Hills North Public School. Then I went to Sydney Technical High School, where I did my HSC,” he says. His interest in optometry developed early when he was diagnosed with myopia as a child. “I’ve been wearing glasses since my first year of primary school,” he recalls. “My first memory of the optometrist was receiving a pair of 1980s-erafashion glasses. I distinctly remember they were government-subsidised glasses because we couldn’t afford to buy a pair. Ironically, when we could later afford to buy glasses, I still preferred those '80s pair.” In high school, Huynh elected to complete Year 10 work experience in the eyecare sector. “I did my work experience at Daniel Tilia Optometrist in Rockdale – which has now closed,” he says. (Daniel Tilia is now undertaking a PhD in associations between binocular vision disorders and contact lens dissatisfaction at UNSW). “I chose optometry, and that work experience, plus parental support, cemented my interest in the profession as a career.”

Specsavers co-founder Mr Doug Perkins (from left), Cafa Huynh, Matthew Edwards and Dame Mary Perkins at the opening of Specsavers Hurstville, the company’s 200th store in Australia and New Zealand.

At around that time, about 12 years ago, Specsavers entered Australia. “Specsavers were asking for people interested in opening new stores. My wife (then girlfriend) and I decided to close our practice after four years in business,” he says. Specsavers opened a practice in Hurstville, and Huynh joined as clinic director. His wife now works as a locum.

After completing high school, Huynh was accepted into the Bachelor of Optometry at UNSW in 1999 and graduated in 2004, in the time before therapeutics was included in the degree.

FULL CIRCLE

After graduating, he was offered a job with OPSM in Singleton, a rural town on the banks of the Hunter River, 200km north of Sydney.

He says relatives on his father’s side have also emigrated to Australia, but relatives on his mother’s side stayed in Vietnam, so he has extended family there.

“I was interested in going to the country, and seeing a different part of Australia,” Huynh says, who knew only Sydney and Canberra, where his family went on holidays. Before commencing in the role, where he would be the only optometrist employed in the practice working alongside an optical dispenser, OPSM first sent him to Adelaide for three months to work with another optometrist as way of induction into the workforce.

Huynh has been back to Vietnam once since his arrival in Australia as an eight-month-old.

“My daughter came to Vietnam with my wife and I, when we went for a holiday. She developed a swollen eyelid while we were there, so we took her to an ophthalmology clinic in a general hospital. I saw what eyecare was like first-hand in Vietnam. It may seem chaotic, however it felt more like an efficient assembly line due to large volumes of patients.

Following a short stint in Adelaide, he moved to Singleton, where he spent a year as one of only two optometrists in the town.

“I have a cousin there that works in a hospital [in Ho Chi Minh], and they were able to get us an appointment. Being an optometrist, I was concerned about orbital cellulitis which could be more serious,” he says.

“Singleton is small … I was exposed to different pathology and had to learn to triage patients, as some travelled a long distance to see me,” he says.

Earlier this year, Huynh received a Facebook message from fellow rescued refugee, Mr Stephen Nguyen, who was organising a 40-year reunion for MG99 survivors.

After a year in Singleton, Huynh moved back to Sydney, and joined Paris Miki Optical in Eastgardens. Three years into the role, he began to get “the itch” to open his own practice. With his then girlfriend, now wife Shirley Lam – an optometrist – they opened their own wholly independent greenfield practice in Hurstville, a suburb 16km south of Sydney’s CBD, which Huynh describes as similar to Box Hill in Melbourne’s east. “We were ambitious. It was a completely new practice, starting from scratch. It was tough, doing everything ourselves, even the smallest of things.”

ABC’s Australian Story featured the reunion in an episode in August. It was held at HARS Aviation Museum at Albion Park, where the Royal Australian Navy plane that spotted their sinking fishing boat is housed. Mr John Ingram, a former commander in the Royal Australian Navy who was in charge with bringing the refugees on board the HMAS Melbourne, and the ship’s crew, attended the reunion, along with Australian Story producers and film crew, and SBS radio journalists. Huynh enjoyed the opportunity to meet those who saved the lives of himself and his parents in person.

Having been bitten by the travel bug, Huynh started working with CliniCall, a domiciliary service, part-time, in addition to working in his own practice.

“It was nice to shake their hands and show what I’ve accomplished and how I’ve developed a life in Australia. I want them to feel proud of what they’ve done,” he says.

“I travelled to Adelaide and up to Queensland, providing optometry services to aged care. But after four years, I was getting tired from managing the Hurstville practice, and the everyday administrative tasks that came with that,” he says.

"I feel a sense of proudness to call Australia home and to carry on the Australian dream." n

As the youngest to be rescued and immigrate, Huynh has largely been raised in Australian cultures and customs.

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CAREER

People

ON THE MOVE A wrap on the latest appointments and industry movements within the Australian ophthalmic sector.

PROVISION APPOINTS NEW REGIONAL OPERATIONS MANAGER Adam Taylor has joined ProVision as regional operations manager for Victoria, NSW and Tasmania, leading a team of business coaches in these respective states. Adam brings a depth of experience and a new perspective, having previously worked in leadership positions at McDonalds, Dominos, Baker’s Delight, as well as George & Matilda. He is passionate about supporting independent businesses to thrive and cultivate their own success in a competitive landscape.

NEW MARKETING SPECIALIST HAS SPECIAL INTEREST IN BIG DATA David Van Dijk joined ProVision’s marketing team as senior content marketing specialist and will lead the content strategy and development of consumer marketing campaigns and to drive new patient acquisition and retention for eyecare services in ProVision member practices. David’s extensive in-house and agency experience offers a rare combination of content, brand and digital marketing skills with a keen interest in big data and marketing analytics.

NSW GLAUCOMA SPECIALIST TAKES ON RANZCO ROLE Dr Mitchell Lawlor is a Clinical Associate Professor of Ophthalmology at the University of Sydney who specialises in glaucoma and diseases of the optic nerve. He was recently appointed as chair the NSW QEC (qualification and education committee), where he now leads the education network of college fellows across NSW.

NEW MANAGER OF CPD PUBLICATIONS Optometry Australia has appointed Sam Bonwick as its education publications and content strategy manager. Sam is responsible for delivering the organisation’s flagship CPD publications, Optometry Connection and Clinical & Experimental Optometry, investigating content extensions and gaps in CPD education publishing. He was previously a publisher at Cengage Learning, responsible for a portfolio of education resources aimed at secondary schools.

COMMITTED TO TRAINING QUEENSLAND’S NEXT-GEN SPECIALISTS Dr Sunil Warrier, a Brisbane based cataract, glaucoma and ocular oncology specialist, takes over the role of chair of QEC (Training Committee) for RANZCO Queensland. He has been the director of training for the past six years and has recently stepped up to the position of chair. He is committed to the training of the next generation of specialists in the state. The program has grown exponentially over the last few years to include 17 trainees.

BAUSCH + LOMB REVEALS NEW PROFESSIONAL SERVICES MANAGER Judy Kwan joined Bausch + Lomb as professional services manager, leading clinical product education and optometric support across Australia. She has over 15 years of experience in clinical practice, contact lens research and clinical supervision of optometry students. She has been heavily involved and is passionate about providing contact lens education across Australia.

Do you have career news to share? Email editor Myles Hume at myles.hume@primecreative.com.au to be featured. 52

INSIGHT November 2021

SHOWING KIDS WHAT THEY CAN DO CAN:DO 4KIDS AIMS TO ENABLE LOW VISION CHILDREN ACROSS ALL AREAS THROUGHOUT THEIR LIVES. THE SERVICE WORKS COLLABORATIVELY WITH ORTHOPTISTS TO SUPPORT CLIENTS AND THEIR FAMILIES, WRITES TRACEY STUART.

an:Do 4Kids provides an expansive and varied range of services that support children who are blind or have vision impairment, from birth to throughout their schooling years.

TRACEY STUART

"OUR THERAPISTS ARE SPECIALISTS, NOT GENERALISTS, AND ARE CONSTANTLY UPSKILLING AND REMAINING ABREAST OF NEW TRENDS AND RESEARCH"

With an established reputation for quality intervention, Can:Do 4Kids (AKA Townsend House) works with families and other service providers to ensure the individual is supported in a consistent manner across all areas of their life. Referrals are not required, we encourage parents, teachers, specialists, service providers and especially orthoptists to make a call or send an email. All we require is carer's consent. Services can be provided in various ways such as day care, school, home, hospital, the community, in person or via Zoom and other telehealth platforms. We also run sessions from our North Adelaide, Welland or state-of-the-art facility at Noarlunga, SA. Our organisation recognises the importance of being ‘allies in health’ and are proud to have established relationships with local orthoptists. Recently, our commitment extended to hosting and providing a tour to this group at our Noarlunga site. The outcome has allowed for more meaningful discussions resulting in the best client outcomes. Can:Do 4Kids provides a comprehensive assessment program that can incorporate a mix of standardised and functional assessment tools. Building on information provided at intake and from the assessment, an intervention program will be designed in cooperation with the carers, to assist the child with their habilitation, rehabilitation or general development, allowing them to maximise their potential. These programs may incorporate: occupational therapy, speech therapy, orientation and mobility, adaptive technology, art therapy, and early intervention. Our therapists are specialists, not generalists, and are constantly upskilling and remaining abreast of new trends and research. The Can:Do 4Kids therapy team consists of highly qualified staff who draw on their collective knowledge and many years of experience when designing services and programs. Our adaptive technology specialist Adriana Sapio is a senior occupational therapist with a Graduate Certificate in Education (vision

Can:Do 4Kids' assessment program involves a mix of standardised and functional assessment tools.

impairment), while our senior occupational therapist Lucy Farran also has a Masters in Orientation and Mobility. Hayley Matthews another Masters-level qualified orientation and mobility specialist, specialises in school aged children. Early intervention specialist Rachelle Cochrane has expanded her Bachelor of Education qualification with training in cortical vision impairment. Can:Do 4Kids offers a comprehensive early intervention service which also encompasses groups and has a focus not just on the child but on the primary carer’s welfare and whole family functioning. We value the role a caregiver’s wellbeing has on their child’s development and implement a key worker approach when possible during the first 12 months. Our early intervention groups provide a platform for parents to connect with other parents and families. This gives them an opportunity to discuss what living with vision impairment looks and feels like now, 12 months from now and beyond. Our adaptive technology service aims to support and meet the needs of the child and family. Ultimately, the aim is to provide the child with independent and equal access to their visual environment. This means availability of resources and equipment they can trial in all environments they intend to use that aid. Many Can:Do 4Kids clients will access our orientation and mobility service, where the focus is on both safety when moving through space

and knowing where you are while doing so. Aides such as canes and electronic travel aides may be prescribed, along with learning how to maximise residual vision. Training occurs in many environments and lighting conditions, increasing in complexity as developmentally appropriate to do so. We understand functional vision loss can result from many varied causes, other than ocular, such as cortical vision impairment, acquired brain injury, traumatic brain injury and neurological conditions, and design training programs that cater for the additional complexities of perceptual, cognitive and physical limitations. One-on-one therapy can be supported by the client attending a group program where they can practise their skills in a fun and appropriate group setting. This might be a cooking class, art group or movement session to name a few. For teenagers, there are also social group outings that facilitate friendships and social skills. n

ABOUT THE AUTHOR: TRACEY STUART has worked in the vision loss sector for over 30 years. With qualifications in Developmental Disabilities (Flinders) and Orientation and Mobility (La Trobe), she is Manager of Group Programs at Can:Do 4Kids. ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au

INSIGHT November 2021 53

MANAGEMENT

MANDATING STAFF VACCINATIONS THE VAGUE LEGALITIES OF FORCING STAFF TO RECEIVE A COVID-19 VACCINE IS HAZARDOUS FOR EMPLOYERS WHEN THERE ARE NO PUBLIC HEALTH ORDERS. KAREN CROUCH PROVIDES KEY INFORMATION ABOUT THIS COMPLEX ISSUE.

KAREN CROUCH

"IF AN EMPLOYEE REFUSES TO BE VACCINATED, CONSIDER WHETHER YOU CAN MOVE THEM TO A POSITION WITHIN THE PRACTICE THAT HAS LESS EXPOSURE"

t the time of writing this article – amid such a fastchanging environment – key issues around employers’ rights and responsibilities to direct staff vaccinations were unclear. The government has encouraged businesses to make their own assessment/decisions but with limited formal guidance on their rights and protections. Without legal precedents on the matter, employers are faced with the need to decide, roll the dice and see where it lands. To keep the health industry up to date, we have collated some relevant, current information that may assist health practice employers in making these complex decisions – in the event that mandatory vaccination policies aren’t enforced on the health sector. Regulations and legislation: COVID-19 is an evolving situation subject to change as additional/ new information and developing consequences of medical, legal, economic or social conditions come to hand, requiring deeper consideration of existing regulations. Consequently, some employer

decisions may be subjected to a caseby-case review by relevant authorities. Vaccination mandates: These are not currently permissible unless a state/territory government legislates to cover specific circumstances (e.g. aged care, airport workers, certain healthcare). At this point, there are mandates in some states requiring health practice employees to be vaccinated. Without public health orders, there is some legislation containing guidance on which employers may have reasonable grounds for mandating – of course subject to case-by-case review. Fair Work Act: Current employment contracts may be amended to include mandatory vaccination but its enforceability would be subject to Fair Work assessment on a case-by-case basis. It is unclear as to whether this is a pre-requisite to mandating or an action that will be undertaken if an objection is raised by an individual or group such as a union. (WHS) Safe environment: Current WHS legislation requires employers to maintain a safe workplace and, subject to a comprehensive Risk Assessment (to be documented and register

maintained) proving COVID-19 is a potential risk to staff/patients/visitors, the employer may require employees to be vaccinated, even as a contract term (existing or by amendment); • Note: WHS Risk Assessment example does not cover possible risk of COVID-19 being acquired from an unvaccinated staff member; • Opportunities to place unvaccinated staff in low-risk areas/jobs should be explored; • An alternative requirement to mandating staff vaccination is the requirement of unvaccinated/antivaxers to attend regular COVID-19 tests and present ‘negative’ results. However, it may be impractical/costly as the employer must allow time off to attend tests and practice resources will be reduced by such absence. In-house testing may be a possibility. Employers have the right to seek evidence of specific reasons why an employee refuses vaccination (e.g. medical condition, religious grounds). When/if mandating vaccination, the employer must take care not to offend anti-discrimination laws. icare (workers compensation): Covers processes and responsibilities employees have to support their respective claims including evidence that COVID-19 was indeed acquired in the workplace and not while the employee was engaged otherwise. icare is still working with regulators to determine changes to processes. Safework Australia: Healthcare workers (other than those prioritised in Phase 1a of the National Rollout Strategy) include – but not limited to – those working in hospitals, general practices, pharmacists, allied health, and other healthcare services. These workers are a priority population for vaccination in Phase 1b of the rollout strategy.

To provide clarity around mandatory workplace vaccinations, the Fair Work Ombudsman has ranked industries into four tiers with Tier 2 being employees who interact with vulnerable people.

INSIGHT November 2021

This organisation’s advice, role and the National Rollout Strategy confirms recognition of medical practices being classified high priority, thereby deserving serious consideration by

Employers/Employees when deciding to mandate a COVID-19 vaccination. Review/authorisation decision to mandate: As most critical decisions may be subject to case-by-case review, it is advisable to submit such opinions for authorisation by the relevant government authority. As this process may result in one or several government authorities’ discussions to reach a decision, it could delay any proposed, earlier action (i.e. amend employment contract immediately and await reaction, if any). There will still be outstanding decisions for employers to consider: • Practicality of moving unvaccinated, including dissenting, staff to a low-risk work environment; • Practicality and cost of requiring regular COVID testing; and • If the above options are not practical, what action should be taken in respect of staff who do not wish to be vaccinated, other than those with legitimate reasons. If termination is considered the only option, unfair dismissal regulations (Fair Work Act) must be considered.

anni ver sar y 19 5 1 - 2 0 2 1

A recent article was published by the Sydney Morning Herald on 2 August 2021 in which high profile barrister Mr Arthur Moses, SC, said there was good reason to think that an employer is within its rights to direct workers whose job required contact with vulnerable members of the community to get vaccinated. He also stated: “There is a term implied in law in every contract of employment requiring an employee to obey the ‘lawful and reasonable directions’ of their employer." The Fair Work Ombudsman has updated its latest guidelines, ranking industries into four tiers with Tier 2 being employees who interact with vulnerable people (healthcare, aged care workers). The body states it is "unlikely to be reasonable" to make Tier 4 workers (minimal face-to-face interaction) get vaccinated, which further suggests it may be “likely to be reasonable” to mandate vaccination for Tier 2 employees. Relevant factors Moses suggested for employers making the decision include: • Whether a workplace is open plan; • How many employees worked in the

space? Are employees required to work in proximity to one another?; • Whether the job exposes unvaccinated employee to many people; • Health and safety laws requiring employers to ensure health and safety conditions for employees. Takeaway summary: if an employee refuses to be vaccinated, consider whether you can move them to a position within the practice that has less exposure to other people and consider whether to require them to provide regular negative COVID test results. If that is not practical and you feel you have to let the employee go in order to protect your workplace and people entering it, take legal advice on unfair dismissal/anti-discrimination action you may be exposed to prior to terminating staff. For now, stay safe!

KAREN CROUCH is Managing Director of Health Practice Creations Group a company that assists with practice set ups, administrative, legal and financial management of health practices. Contact Karen on email kcrouch@ hpcnsw.com.au or visit www.hpcgroup.com.au.

DISPENSING

MYOPIA MANAGEMENT FOR DISPENSERS – PART 1 MYOPIA'S PREVALENCE HAS DRIVEN THE DEVELOPMENT OF INNOVATIVE INTERVENTIONS, INCLUDING SPECTACLE LENS OPTIONS. GRANT HANNAFORD EXPLAINS HOW DISPENSERS CAN FIT INTO THE MYOPIA MANAGEMENT TREATMENT PLAN.

GRANT HANNAFORD

"ONCE A DESIGN HAS BEEN SELECTED BY THE PRACTITIONER, DISPENSERS WILL BE VITAL FOR IMPLEMENTATION OF TREATMENT, EDUCATION AND FOLLOW UP"

yopia management is a rapidly developing field, with spectacle lens interventions advancing significantly. The risk for developing additional conditions such as cataract, retinal detachment and myopic maculopathy is elevated in myopia and risk is linked to power. Consequently, myopia represents one of the most significant challenges for optometry today, perhaps more so since the challenges raised by the COVID-19 pandemic and myopic development. These articles will look at dispensing in practice regarding myopia management. Part 1 is an overview for the dispenser, while Part 2 assesses specific lenses and their applications. References cited are available at www.aaoo.net.au/MFD1. While treatment pathways encompass various techniques including pharmaceutical and contact lens options, this discussion is limited to spectacle lenses. In November, we will also provide a more detailed overview in the Myopia Management for Dispensers webinar via the AAOO CPD program (www.aaoo.net.au). The growth of the eye during childhood is dependent on coordinated development between the refractive and physiological components of the eye, interruptions to which may result in the emergence of refractive error. Myopia can be considered as an excess in power of the refracting elements of the eye or an eye length that is too long for the refracting power of the eye. It is somewhat relative so using standard values for ages we can reach broad definitions for causes for myopia of ‘refractive’ or ‘axial’. The sensitivity of this emmetropisation phase to interruption represents the time of greatest risk for the emergence of refractive error, for the same reason it is also an ideal time to attempt to influence the ocular development to optimise refractive outcomes. While generalisations are always risky, many of the interventions in use at this time rely on manipulation of blur at the retina, either overall or in the periphery, to try and influence growth and refractive development. The range of spectacle lens families have been studied with relation to myopic development.

INSIGHT November 2021

Dispensers Checklist (1) Make a big impact on myopia treatment in your practice

No Substitutions

Fit Correctly

Review

Follow practitioner advice on lens recommendations

Adhere to lens fitting protocols and requirements

Implement a review schedule for monitoring progress

Educate

Outdoor Time

20/20/20

Ensure the patient and parents understand the treatment

Encourage 2 hours of outdoor play time

Look 20 feet away, for 20 seconds every 20 minutes

A six-point checklist that can help optical dispensers have a more effective role in myopia management.

Following is a brief look at lens concepts that may be useful for dispensers talking to patients: •S ingle vision – no evidence to support wear influences refractive development1, consequently this often provides our reference for the efficacy of other treatments. •M ultifocals (bifocals, PPL/PALs) – create areas of competing focus in the eye with the plane formed by the ‘add’ triggering a slowing of axial growth. The efficacy of these varies with lens type. Practitioners may also examine binocular vision function which may lead to prescribing prism control bifocals2, 3. •M yopia correcting lenses – aspheric single vision lenses incorporating a treatment zone consisting of areas or rings of aspheric lenslets. The two main designs in this field create either areas or volumes of competing focus in the eye to slow ocular growth4-9. While the effectiveness of these options varies, a range of factors will influence the outcomes, from binocular vision criteria to wearing patterns, so not every option will be appropriate for a given patient. Once a design has been selected by the practitioner, dispensers will be vital for implementation of treatment, education and follow up/compliance. Implementation – after prescribing by the practitioner, the dispenser will need to ensure the lenses are correctly implemented. This includes the selection of an appropriate frame in terms of not

only fitting, but also lens requirements. All relevant lens options have specific requirements such as minimum fitting heights/depths, tilts, wraps and MSU. The dispenser should be familiar with the requirements of the lens design to ensure optimal outcomes.

Education – children and parents will require coaching on how to use the spectacles and performance expectations. Designs may have zones of lower effective acuity which need to be explained to avoid rejection. Remember, the patient is engaging in a treatment regime, so 6/6 is not necessarily going to be the best visual outcome for them at that point in time. Similarly, do not change the lens design without practitioner consultation. Lens designs for myopia control may not be interchangeable. Follow up – the patient should engage in regular reviews to evaluate the effectiveness of the treatment. It may be necessary to modify the lenses periodically and the dispenser can ensure patients are compliant with lens usage and attending reviews as required. The next article will look at the specific fitting requirements for lenses mentioned here and their features and limitations. n

GRANT HANNAFORD is the co-founder and director of the Academy of Advanced Ophthalmic Optics. He owns a private practice and is a senior lecturer at the UNSW SOVS. He is currently a doctoral candidate at the School of Optometry Aston University researching ocular biometry and development.

2021 CALENDAR NOVEMBER 2021

DECEMBER 2021

SOCIETY OF INTERNATIONAL OPHTHALMOLOGY BIENNIAL MEETING

14TH ASIA-PACIFIC VITREO-RETINA SOCIETY (APVRS) CONGRESS

Geneva, Switzerland 11 – 13 November ingrid.schattling@hcuge.ch

Virtual 11 – 12 December 2021.apvrs.org

2021 ANNUAL GENERAL MEETING OF ORTHOPTICS AUSTRALIA Online 20 November orthoptics.org.au

JANUARY 2022 OPTI 2021 Munich, Germany 14 – 16 January opti.de/en

100% OPTICAL London, UK 22 – 24 January 100percentoptical.com

To list an event in our calendar email: myles.hume@primecreative.com.au

FEBRUARY 2022 MIDO EYEWEAR SHOW DIGITAL EDITION Milan, Italy 12 – 14 February mido.com

RANZCO ANNUAL SCIENTIFIC CONGRESS Brisbane, Australia 25 February – 1 March ranzco.edu

MARCH 2022 COPENHAGEN SPECS Copenhagen, Denmark 5 – 6 March copenhagenspecs.dk

VISION EXPO EAST New York, US 31 March – 3 April east.visionexpo.com

APRIL 2022

77TH ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE

AUSTRALIAN VISION CONVENTION (AVC)

Brisbane, Australia 26 February – 28 February orthoptics.org.au

Queensland, Australia 9 – 10 April optometryqldnt.org.au/avc

SPECSAVERS – YOUR CAREER, NO LIMITS All

Specsa Graduate opportunities - NSW ve stores rs no The Specsavers Graduate Recruitment Team has several exciting graduate opportunities available across with O w CT New South Wales. With continued growth in providing eyecare to patients across ANZ, now is an exciting time to join a company that is leading and defining the future of the optical profession. At Specsavers you will have access to cutting edge technology and be part of the driving force bringing optometry to the forefront of the healthcare industry.

SRS – Full time/part time positions in Perth At Specsavers, our vision is to passionately provide the best value eye care to everyone –simply, clearly, and affordably. We are currently seeking dedicated and driven optometrists to join our Specsavers family. We have full-time & part time roles available across the State. We will provide you with a great working environment with a supportive team, state of the art equipment – including OCT, and the opportunity to deliver optimal patient care whilst further developing your clinical skills. Interested in relocating to NZ? Specsavers has a range of opportunities for NZ optometrists looking to return home. From North to South, we have fantastic opportunities for optometrists at all levels. You will have the chance to advance your skills and become part of a business that is focused on transforming eye health outcomes in New Zealand. Be equipped with the latest ophthalmic equipment (including OCT in every store) and develop your clinical experience across a range of interesting conditions and an ever-growing patient base. You’ll also have the support of an experienced dispensing and pre-testing team, the mentorship of store partners and access to an exemplary professional development program. Specsavers highest mobile optometry package ever! Specsavers is looking to grow our community based Mobile Optometry Teams in Western Australia. You will experience a diverse demographic of patients and see a wide variety of cases, whilst being able to explore different regions of Australia. We are looking for optometrists with a minimum of 3 years’ experience who have the desire and flexibility to travel. As a Specsavers optometrist, you will work with state-of-the-art equipment, receive a fantastic salary package including benefits and continuous support towards your ongoing professional development. Optometrist Joint Venture Partnership opportunity – Specsavers Hawkes Bay, NZ Specsavers has an exciting opportunity for an experienced optometrist to join us as a Joint Venture Partner in New Zealand’s Hawkes Bay. Known as New Zealand’s Art Deco capital, Hawke’s Bay is located on the east coast of New Zealand’s North Island. We’re offering a guaranteed market rate salary + dividends, back-office support, and a loyal established customer database.

SP EC TR VISI UM T -A NZ .CO M

SO LET’S TALK! In a few short years, Specsavers has achieved market share in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or enquire about other opportunities, please contact us today: QLD, NT, VIC & TAS optometrist enquiries: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134 WA, SA, NSW & ACT optometrist enquiries: Madeleine Curran – Recruitment Consultant

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader

cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries:

apac.graduateteam@specsavers.com

SOAPBOX

SWOOPING SEASON A SERIOUS MATTER

BY THOMAS CAMPBELL

hen I first moved to Victoria and began working as an eye doctor in the Royal Victorian Eye and Ear Hospital (RVEEH) Emergency Department, I was stunned by how often I saw patients with birdrelated eye injuries. Intrigued, I searched the medical literature but was only able to find 89 reported cases of eye injuries caused by birds anywhere in the world. In contrast, a simple search of the Australian news revealed an enormous number of articles detailing bird-related eye injuries, including six recent potentially blinding events related to the aggressive territorial behaviour of the Australian magpie (Cracticus tibicen). Public concern about bird attacks is so high in Australia that a website (www. magpiealert.com) has been launched specifically to provide information on bird attack hotspots in an attempt to warn pedestrians, runners, and cyclists of the risk. In 2019 alone, this website registered 3,799 attacks by birds in Australia – mostly magpies – of which 14.3% resulted in some kind of injury. To explore the disconnect between the medical literature and on-theground reporting, my colleagues and

INSIGHT November 2021

I looked into how many people were affected by bird-related eye injuries at the RVEEH between 2012 and 2017. To our astonishment, we found that 287 people had suffered eye injuries caused by birds during that period – triple the total number of cases that had ever been reported in the literature across the world. Fortunately, most people suffered only minor injuries, but a noteworthy minority (around 1–2%) suffered horrifying penetrating eye injuries. One of the worst series of cases happened last year in Sale, regional Victoria, when a rogue juvenile magpie attacked multiple people and inflicted serious injuries requiring emergency eye surgery. These cases were reported in this magazine at the time. Although injuries of this severity are rare, they are potentially devastating. Several patients have required multiple, staged surgeries after the primary closure including lensectomies for capsular breach. Fortunately, most patients have eventually recovered good vision. The magpie was the most common culprit of these attacks. More than a quarter of the RVEEH patients in our study explicitly identified the 2017 Australian Bird of the Year as their attacker, suggesting that the affection is not mutual. The other bird most commonly involved in such attacks

was the pee-wee or mudlark (Grallina cyanoleuca). These two birds are similar in appearance, which raises the possibility of misidentification (in both directions). One particularly interesting finding is that bird-related eye injuries are growing in frequency, with the number of injuries more than tripling between 2012 and 2017. This steady increase is also evident on magpiealert.com, where the number of self-reported attacks has grown over time. The reason for this is unclear, but one possibility is that urbanisation has led to a loss of natural nesting sites, resulting in an increase in inter-bird competition for nests and a corresponding increase in aggressive defensive behaviours. Most of the attacks occur from May to October, with a peak in late September. This seasonal variation is significant as it allows for a targeted approach to public safety campaigns. The data suggests that local government authorities, schools, and businesses should begin bird-swooping safety campaigns in early winter and continue them through to early spring. One example of such a campaign can be found on the Victorian Government website, including a hotspot map of reported swooping birds and a list of the top 10 safety tips (https://www. wildlife.vic.gov.au/managing-wildlife/ swooping-birds). Eyecare professionals should offer patients the following simple but effective advice: always wear a broadbrimmed hat and sunglasses when outside during swooping season. If an aggressive bird makes someone its unwitting target, these everyday items will help to keep their eyes safe from roving beaks and claws. n Name: Thomas Gordon Campbell Qualifications (in abbreviations): MBBS, DPhil (Oxon) Organisations: Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, and the NQ Eye Foundation Position: Fellow Location: Melbourne, Australia Years in the profession: 8

SEVERAL PATIENTS HAVE REQUIRED MULTIPLE, STAGED SURGERIES AFTER THE PRIMARY CLOSURE INCLUDING LENSECTOMIES.

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Insight November 2021

Articles inside

MANAGEMENT

SOAPBOX

OPTICAL DISPENSING

PEOPLE ON THE MOVE

UPFRONT

ORTHOPTICS AUSTRALIA