INSIGHT November 2023

NOV 2023

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

LESSONS FROM A DRY EYE CLINIC Treatment options when a dry eye patient presents with co-morbidities

51

Something needs to change if Australia is to avoid a major optometry shortage by 2042

36

WWW.INSIGHTNEWS.COM.AU

03

References available on page 18.

NOVEMBER 2023

MORE THAN 1,100 EXTRA OPTOMETRISTS NEEDED

FRIEND OR FOE? THE VERDICT ON AI What Aussie optometrists think about the influence of artificial intelligence in the clinic

You’d look good in Specsavers Ranked as one of Australia’s Best Workplaces for 2023.

NOV 2023

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

NEW MODELLING SUGGESTS AUSTRALIA WILL NEED 1,100 MORE OPTOMETRISTS BY 2042 A new workforce report has reinforced predications the industry is heading towards a significant shortfall of more than 1,000 optometrists over the next two decades, with deficits to be felt most in regional Australian communities.

The analysis by Deloitte Access Economics – commissioned by Specsavers – forecasts a shortage of 1,102 full time equivalent (FTE) optometrists in 2042, representing an undersupply of more than 1.5 million clinical optometry hours, or approximately a 12% shortage, compared to the total hours of eyecare expected to be in demand

by Australians by then.

This is despite projections the supply of optometrists will increase from 5,266 FTE in 2022 to 8,261 FTEs by 2042, representing a 57% increase.

The 2023 analysis echo findings

of the Optometry Workforce Report 2018-37 prepared by Deloitte Access Economics in 2018. The latest report also provides updated optometry workforce modelling post-COVID from 2022 to 2042, and considers alternative models to enhance eyecare delivery.

“Looking at the trends and forecasts in this report, it is evident there is a real need to address the shortages of optometrists in Australia, particularly in regional and rural areas,” Specsavers ANZ optometry director Dr Ben Ashby said.

“Failure to do so could lead to significant challenges in accessing and delivering eye healthcare to the whole population. The cost of avoidable vision loss to the public health system runs into the billions of dollars, therefore ignoring the serious threat posed by a shortfall

Demand and supply of FTE optometrists by location showing that Queensland will be the hardest hit state, with a nationwide shortfall of 1,120.

of optometrists will undoubtedly lead to an increased impact on the public health system and most importantly, the quality-of-life for all Australians through vision loss from undiagnosed or untreated eye conditions.”

Despite these forecasts, whether Australia needs more optometrists remains a point of contention.

Large optometry employers have consistently called for more

graduates and welcomed new optometry schools at the University of Canberra and Univiersity of Western Australia, while Optometry Australia has previously said it is concerned that graduate supply may soon outstrip demand.

When looking at supply and demand in urban and regional areas, the latest Deloitte report forecasted continued page 8

OPHTHALMIC SALARIES INCREASE YEAR-ON-YEAR Male ophthalmologists again reported the largest annual taxable income out of all occupations in Australia at $703,700 (median $511,200) in the latest available data, which also reveals increases in the average wages earned by optometrists, optical dispensers, orthoptists and practice managers.

The average income of 416 male eye doctors outranked all other medical specialities and other high-powered careers in law and finance, according to new data from the Australian Tax Office (ATO) for the 2020-21 financial year. The average income earned by this cohort is also 12% more than the previous financial year ($624,500).

The second highest earning group in 2020-21 was male neurosurgeons at $655,000 (median $486,800).

The national tax department recently released a detailed breakdown of the average taxable income for each occupation in Australia.

The 2020-21 data is the latest available, with the average taxable Australian income overall increasing from being $63,882 to $68,289 (median $50,980). However, the information is limited in nature; for example, it only includes data visible to the tax department and captures annual incomes of all part-time, casual and fulltime workers. For professions where a greater proportion work part-time, this could skew salaries down. Therefore, when comparing across professions or between men and women, it may not necessarily be a like-for-like comparison.

According to the ATO, the average taxable income of 604 Australian ophthalmologists (male and female) was $592,400, a $13% increase on the year prior. The average taxable income across 188 female ophthalmologists was $346,100, 10% more than the year before.

Meanwhile, the average taxable income across 4,799 Australian optometrists was $106,800 (median $91,641), up from $92,800 in 2019-20.

Male optometrists earned $125,600 on average, while females generated $94,100 on average.

For optical dispensers, the average taxable income was $45,500 ($54,100 males and $43,200 for females). Optical mechanics earned continued page 8

A NEW ERA IN TONOMETRY With correct intraocular pressure measurement being one of the most important factors in glaucoma diagnosis, the new Reichert Tono-Vera boasts several features to equip clinicians in ways they have never experienced before. page 40

Make every second count with high-performance OCT.

ZEISS CIRRUS 6000

Maximise patient throughput with performance OCT, proven analytics and patient-first design.

ZEISS AU: 1300 365 470 med.au@zeiss.com

zeiss.com/CIRRUS6000

Carl Zeiss Pty Ltd, NSW 2113 AUSTRALIA.

At 100,000 scans per second, ZEISS CIRRUS 6000 is the next-generation OCT delivering high-speed image capture with wider field of view and HD imaging detail.

IN THIS ISSUE

NOVEMBER 2023

EDITORIAL

FEATURES

A MOMENT OF SERENDIPITY At the O=MEGA23 conference I had one of those moments when you recognise someone but can’t place them in your life. As editor of Insight, you become familiar with many faces across the industry – but this was different.

After a Masterclass session, I plucked up the courage to say hello, and in that moment we both asked if we knew each other. Eventually, it turned out this person, Mr Michael Yen, was the first optometrist to prescribe me vision correction as a 15-year-old growing up in Christchurch, New Zealand.

16

GREENFIELD GAMBLE Warned against a greenfield practice, Dr Brendan Schelbach didn't listen – and it's paying off.

26

CARRERA COLLAB Safilo has signed an eyewear ambassador deal with Australian cricket captain Pat Cummins.

His treatment allowed me to sit my learner driver license test and ensured I no longer had anxiety about reading the whiteboard in class. But we all know the impact of your first optometrist continues throughout your life.

Today, Yen is an optometrist and oversees two clinics in Melbourne's west for the Australian College of Optometry. You can imagine it was a surreal experience for him too, recalling a patient from more than 15 years ago who is now involved in an industry publication.

If Yen looked into my eyes today, he would find an ocular toxoplasmosis scar. I found out about this last year, but at O=MEGA23 I asked the team at Optos to visualise this on their ultrawide field scan. As it turns out, there is another scar in the temporal left eye that might warrant further investigation. Something to discuss with my optometrist soon.

31

KERATOCONUS CARE Dr Judy Ku on the importance of early intervention to maintain vision and corneal integrity.

45

O=MEGA23 WRAP Highlights from the clinical program where myopia dominated the agenda.

EVERY ISSUE 07 UPFRONT

55 MANAGEMENT

09 NEWS THIS MONTH

56 SOAPBOX

53 OPTICAL DISPENSING

57 CLASSIFIEDS/CALENDAR

54 ORTHOPTICS AUSTRALIA

58 PEOPLE ON THE MOVE

These were two moments that stood out for me at the conference, but for many others it would have been the calibre of the optometry clinical program. As part of our ongoing coverage, on page 45, this issue features highlights from lectures across the three day-event. As readers will find, myopia dominated the program, but there were many other thought-provoking sessions that will help progress optometry that little bit more in Australia.

By all accounts, O=MEGA23, in combination with the 4th World Congress of Optometry, was a resounding success, and the national industry has cause to be proud of the way Australian optometry was presented to the world.

MYLES HUME Editor

INSIGHT November 2023

5

A combined OCT and fundus camera system for enhanced screening and clinical efficiency

DV1410-1023

Greater patient comfort due to the fast acquisition of high definition widefield OCT images from a single shot at speeds of 70,000 A-scans/sec.

Get in touch T 1800 225 307 E enquiries@dfv.com.au dfv.com.au

UPFRONT Just as Insight went to print, AHPRA urged practitioners to renew their registration. Optometrists have until 30 November to renew before late fees apply. Renewal is available online only – and those who haven’t done so prior to 31 December 2023 will face removal from the register. It comes as new quarterly registration data shows the number of optometrists in Australia continues to climb, increasing by 262 year-on-year to 6,762.

WEIRD A veterinary ophthalmologist in Brazil is testing whether skin from the tilapia fish can treat a pervasive problem in her field: corneal ulcers and perforations, particularly in dogs with short snouts.

“These are species with very prominent eyes. So they get injured often," the reported. Tilapia skin is rich in collagen, making it a popular resource in veterinary and human medicine.

IN OTHER NEWS, in a submission to a Federal Government consultation on crisis response, the Australian Medical Association (AMA) wants health services in rural and regional areas to be declared essential services. President Professor Steve Robson said the Lismore floods – which impacted eyecare providers – and a lack of immediate funding was problematic for patients seeking care.

“There was a lack of infrastructure almost a year after the [Lismore] disaster. The AMA campaigned for a year before local health services received funding."

FINALLY, 130 global eyecare organisations and 50,375 individuals have pledged to adopt a standard of care for myopia management. The World Council of Optometry (WCO) and CooperVision have set a new goal of 100,000 pledges. “Taking the pledge sends a clear message that organisations and practitioners understand the seriousness of myopia as a public health threat and they are taking active measures to manage that threat,” said WCO president Dr Sandra Block.

STAT

WACKY Researchers at Moorfields Eye Hospital and UCL Institute of Ophthalmology have developed an AI system that has the potential to not only identify sight-threatening eye diseases but also predict general health, including heart attacks, stroke, and Parkinson’s disease.

The research team are now making the system open-source to act as a cornerstone for global efforts to detect and treat blindness using AI.

Published by:

379 Docklands Drive, Docklands VIC 3008 T: 03 9690 8766 www.primecreative.com.au Chief Operating Officer Christine Clancy christine.clancy@primecreative.com.au Group Managing Editor Sarah Baker sarah.baker@primecreative.com.au Editor Myles Hume myles.hume@primecreative.com.au Journalist April Hawksworth april.hawksworth@primecreative.com.au Commissioning Editor, Healthcare Education Jeff Megahan Business Development Manager Luke Ronca luke.ronca@primecreative.com.au

WONDERFUL Melbourne ophthalmologist Dr Elvis Ojaimi sought approval from the TGA to implant a special IOL that had a prosthetic colour-matched iris. The device was brought in from the US and implanted in a Victorian man who suffered an eye injury from a magpie attack in 2021, as reported by the ABC.

insightnews.com.au

Client Success Manager Salma Kennedy salma.kennedy@primecreative.com.au

HITTING TARGETS

Design Production Manager Michelle Weston michelle.weston@primecreative.com.au

Advanced modelling is showing that progressive myopes could save more than 2.00D with consistent wear of some myopia control interventions. Page 45

Head of Design Blake Storey

WHAT'S ON THIS MONTH

HONG KONG INT'L OPTICAL FAIR

8 – 10 NOVEMBER

Complete calendar page 57.

NEXT MONTH

APVRS ANNUAL CONGRESS

8 – 10 DECEMBER

glasses, children’s frames and more.

The Asia-Pacific Vitreo-Retina Society conference in Hong Kong is a platform for vitreo-retinal specialists to keep abreast of the latest developments.

home.hktdc.com

2023.apvrs.org

The fair promises to showcase the latest eyewear innovations in sustainability, smart

Art Director Bea Barthelson Subscriptions T: 03 9690 8766 subscriptions@primecreative.com.au The Publisher reserves the right to alter or omit any article or advertisement submitted and requires indemnity from the advertisers and contributors against damages or liabilities that arise from material published. © Copyright – No part of this publication can be reproduced, stored in a retrieval system or transmitted in any means electronic, mechanical, photocopying, recording or otherwise without the permission of the publisher.

INSIGHT November 2023

7

NEWS

UNFILLED VACANCIES ALREADY A PRESSING ISSUE continued from page 3

an undersupply of optometrists in both areas over the projected period, from a starting point of equilibrium. The deficit in rural areas is expected to be most significant in 2042, with an approximate shortage of 799 FTE optometrists.

In urban areas the shortage is less significant, totalling 303 FTE optometrists.

However, there would still be a significant shortfall across both areas even if urban optometrists were redistributed towards rural areas, the report noted.

“This report shows a significant shortfall across both urban and regional areas,” Specsavers ANZ managing director Mr Paul Bott said.

“Within our own network alone, around 40% of Australian locations currently have an unfilled optometry vacancy, with more than 60% of those in outer-regional locations. That means just today, thousands of Australians are not able to access timely eyecare. The potential impact this will have to the eye health of Australians over the next 20 years if we continue on the same trajectory is worrying.”

According to the report, the increase in optometry supply over the projected period relies on graduates entering the workforce.

Ashby said this is evident with the introduction of two new universities offering optometry courses since the 2018 report. These are driving increasing numbers of optometrists practising in the ACT and WA. “While this is a promising sign and

exactly what the introduction of these universities was designed to do, with both universities still being relatively new, there is no long-term data on if and for how long optometrists stay in these regions. In addition, the report forecasts significant undersupply in Queensland, Tasmania, South Australia, Victoria and NSW, the states with the highest growth in demand, as well as significant undersupply in regional areas across Australia,” he said.

“Even with the projected increase in graduates forecast in this report, it still signals there will not be sufficient optometrists to even try and keep pace with increased demand.”

With Specsavers being the largest provider of eyecare and employer of optometrists in Australia, Ashby said the company understood how difficult it can be to recruit optometrists.

“And combined with the changing demands of a modern optometry workforce looking increasingly for flexibility and urban living, unfortunately the impact of this optometrist shortage is lack of accessibility for patients,” he said.

“Optometrists are the frontline of eye healthcare, and we want to ensure we have a sustainable profession and access to care model available to meet the demands of the Australian population now and into the future.”

BETTER CARE MODELS The report also looked at ways to enhance the delivery of eyecare, particularly in the wake of the COVID-19 pandemic, which created both

challenges and new opportunities.

With wait times for public eyecare services surging and an ageing population, Specsavers stated there is an urgency to review current eyecare models, with a view to enhancing those that provide most value to the health system.

“WITHIN OUR OWN NETWORK ALONE, AROUND 40% OF AUSTRALIAN LOCATIONS CURRENTLY HAVE AN UNFILLED OPTOMETRY VACANCY.” PAUL BOTT, SPECSAVERS

Interviewing stakeholders from across the Australian eye health industry, the report identified several opportunities, including enhancing the role of optometrists to upskill and fully utilise their skill set in primary care settings, as well as investing in enablers to optimise access to eye care. This included investing in training, utilising technology such as tele-optometry to alleviate accessibility barriers, better data and information sharing platforms, as well as embedding patient support services into the patient care pathway.

“The good news is there are solutions to prevent a worrying eye health future in Australia. By proactively addressing the challenges presented in the report and implementing sensible, safe and collaborative strategies with regulatory and funding support, as an industry we can overcome the potential threats to Australians’ eye health, while also creating a more balanced, future-proof and well distributed eyecare workforce across Australia,” Ashby said.

“Overall, if we always keep the goal of ensuring equitable access to quality eyecare for all Australians top of mind, we will be moving in the right direction.”

MEDICAL PROFESSIONS DOMINATE TOP 10 EARNERS LIST continued from page 3

$66,600 on average (males $68,200 and females $64,100).

Health practice managers continued to earn healthy wages, at an average taxable income of $80,800 (males $105,100 and females $77,400).

The data also revealed the average income of medical and pharmaceutical sales representatives, which was $119,367.

For orthoptists, the ATO figures show they had an average taxable income of $68,200, comprised of 866 females and 130 males.

Male orthoptists generated $80,506 on average and females $66,508.

8

INSIGHT November 2023

When men and women are grouped together, ophthalmology was one seven medical specialties earning more than half a million dollars, with the top three being neurosurgeons $604,500, ophthalmologists $592,400 and otorhinolaryngologist $577,500.

An analysis of the data also shows that there was a major gap between the total taxable income of ophthalmologists and their salaries, which is perhaps indicative of a tendency to run small-to- medium sized businesses and invest in other areas. For example, the average ophthalmology salary was $179,000, which is $413,000 less than the average taxable income for the profession.

TOP 10 EARNING OCCUPATIONS IN 2020-21 (MEN AND WOMEN): • Neurosurgeon – $604,582 • Ophthalmologist – $592,414 • Otorhinolaryngologist – $577,500 • Plastic and reconstructive surgeon – $568,439 • Urologist – $527,844 • Cardiologist – $507,684 • Orthopaedic specialist – $502,927 • Vascular surgeon – $477,280 • Diagnostic and interventional radiologist – $469,622 • Cardiothoracic surgeon – $461,185

‘SURGEON’ TITLE RESTRICTED TO FEW SPECIALTIES The Queensland Parliament is the host jurisdiction for the National Law. This means now that the Amendment Bill has been passed the changes will automatically apply in most states and territories after assent. It is anticipated Western Australia will introduce a corresponding Amendment Bill soon. South Australia and NSW will make a regulation to confirm application of the amendments in their states.

New legislation is now restricting use of the ‘surgeon’ title, with doctors registered in three recognised specialties of surgery, including ophthalmology, only allowed to refer to themselves in this way.

Prior to this, any registered medical practitioner could call themselves a ‘surgeon’ without completing specialist surgery training or being registered in a surgical specialty.

The move, welcomed by the Medical Board of Australia (MBA) and the Australian Health Practitioner Regulation Agency (Ahpra), regulates the cosmetic industry to prevent rogue medical practitioners from using the title ‘cosmetic surgeon’.

In addition to ophthalmology, obstetrics and gynaecology are the other only specialities that can now call themselves surgeons.

“This is good for patient safety and what patients asked for. It will make sure that when a medical practitioner uses the word surgeon, it means something very specific about their skills and qualifications,” Dr Anne Tonkin chair of the Medical Board of Australia, said.

Ahpra CEO Mr Martin Fletcher said passing the Health Practitioner Regulation National Law (Surgeons) Amendment Bill in the Queensland Parliament was a win for the public “and will

remove a lot of confusion when patients are making choices about cosmetic surgery”.

Unregistered or underqualified practitioners misusing the title face a criminal offence punishable by a maximum fine of $60,000 or three-years’ imprisonment, or both.

The amendment follows a commissioned review into the cosmetic surgery industry by Ahpra and the MBA in November 2021. Ahpra found that universal minimum standards for education, training and qualifications for the cosmetic industry didn’t exist, leaving patients vulnerable to rogue operators.

Practitioners misusing the title may be fined $60,000 or face imprisonment.

Since the 2021 review, Ahpra and MBA said they have made significant inroads to implement all 16 recommendations to improve public safety.

Non-surgical cosmetic procedures, including Botox and other anti-wrinkle injections and fillers, are now coming under the spotlight in an expansion of the regulator’s year-long crackdown on the nation's cosmetic surgery industry.

“Getting these services is not like getting a haircut – these procedures come with risk.

We want to ensure the public knows what safe practice looks like, and that practitioners are doing everything necessary to keep the public safe,” Fletcher said.

NEWS

EYECARE PROFESSIONALS FACING 2023/24 REGISTRATION FEE HIKE

IN BRIEF EYE-HEART CHECK Bupa Optical is using AI technology to detect underlying health problems and help patients understand whether they are at risk of developing cardiovascular disease. To date, the Microvascular Health Assessment – part of the EyeInspect AI platform – has graded 3% of Bupa customers whose heart health risk rating has been assessed as ‘poor’, with Bupa optometrists subsequently advising them to see their doctor for possible further tests and discussions before many knew they may have a health issue. “Through our Microvascular Health Assessment tool, we’re extending routine eye tests into broader non-invasive health checks which can be referred to a medical professional if any red flags come up,” said Mr Guneet Sawhney, director of Bupa Optical & Hearing.

VARILUX CAMPAIGN Essilor has announced a major media investment to drive awareness for its new Varilux XR Series lens. The lens is the first eye-responsive progressive lens powered by behavioural artificial intelligence, with predictive modelling used to recognise and adapt to consumer eye movement.

The campaign features across Australian national television, digital and out -of-home (OOH) advertising platforms to inform consumers of the benefits of the Varilux XR Series and direct them to their eyecare professional for questions regarding the series. “A new generation of Varilux always sets new standards in the market, and this media campaign is a strong commitment to raise awareness about the superior Varilux performance and support the leading eyecare professionals in our industry,” said Mr Marco Caccini, general manager of ANZ professional solutions at EssilorLuxottica.

SMART GLASSES COLLAB Global eyewear company Safilo Group and Amazon.com have announced the launch of the new Carrera Smart Glasses with Alexa, a voice-controlled virtual assistant. The two new frames will combine Alexa technology with Italian design. According to a statement, the glasses will feature open-ear audio technology which directs sound to the ears without covering them, while minimising what others around can hear.

Available in the US only, the glasses will have up to six hours of continuous media playback or continuous talk time on a full battery charge. “Safilo has always looked to the future with an innovative approach, and this is why we are very proud to collaborate with Amazon on this innovative project, offering our Italian design and the unique style of Carrera Eyewear,” said Mr Angelo Trocchia, CEO of Safilo Group.

10

INSIGHT November 2023

Australian optometrists and ophthalmologists will face an increase in their registration fees for 2023/24, with eye doctors facing a $135 hike to cover greater regulatory demands on medical professionals.

The Optometry Board has set registration fees at $347.

safe,” OBA presiding member Mr Stuart Aamodt said.

Meanwhile, the Medical Board of Australia (MBA) – which regulates ophthalmologists and other medical specialists – has set its registration fee for 2023/24 at $995, an above indexation increase of 14%. This is $135 more than last year’s fee of $860.

The Optometry Board of Australia has set the registration fee for optometrists at $347 (excluding NSW). This represents a 3% The MBA said this was “necessary to meet increase on last year ($337), but is below the growth in costs and regulatory demand”. rate of indexation.

The annual renewal fee is effective from This will cover the registration period from 9 August 2023 and for most practitioners 1 December 2023 to 30 November 2024. covers the registration period of 1 October 2023 to 30 September 2024.

Up until 2019, Australian optometrists enjoyed a consistent fee of $300, which “Ahpra and the National Boards recognise was first imposed in 2016-17 and frozen that many Australians are under financial for two years. Prior to that, the sector saw strain. Registered health practitioners consecutive fee drops from a high of $415 are no exception,” Ahpra CEO Mr Martin in 2012-13.

Fletcher said.

“Optometrists are not immune to the current economic challenges. The board recognises this and has worked to keep fees as low as possible while ensuring we can perform our vital role to keep the public

“We have worked closely together to keep fees as low as possible while ensuring the National Scheme is appropriately funded so we can perform our vital public protection work.”

OPTOMETRY NETWORK FOCUSES ON LOW VISION REFERRALS Specsavers and Vision Australia are joining forces in a new partnership to enhance the quality of care and support provided to people with low vision.

Catalysed by a shared aim of increasing access to comprehensive support and services, the partnership recognises the need for a holistic approach and streamlined referral processes in improving patient experiences, a joint statement said.

Specsavers ANZ optometry director Dr Ben Ashby said the partnership came from a realisation that Specsavers could be further supporting its patients with low vision.

“As optometrists, we’re so focussed on preventing avoidable blindness and detecting eye conditions early. We often rely on our ophthalmology colleagues to step in when patients experience low vision or blindness,” he said.

“However, thanks to organisations like Vision Australia, patients can receive services and support to power their independence – and it doesn’t have to be as a last resort. It is simply unfair that not all relevant patients wouldn’t have the opportunity to receive the extension of care that Vision Australia offers, so we’re doing

The company wants to transform how its patients with low vision access Vision Australia services.

all we can to make it easier for optometrists to refer their appropriate patients to Vision Australia when the timing is right.”

Vision Australia CEO Mr Ron Hooton said the partnership has started with a Victorian pilot which includes 10 Specsavers practices.

As the project unfolds, it is hoped that the pilot will incorporate more practices.

“This partnership is poised to enhance the quality-of-life for countless individuals which makes it truly exciting. At the moment, there are thousands of patients who never receive support from Vision Australia simply because they aren’t referred by their health professional,” Hooton said.

Viscotears

®

Viscotears® Gel PF improves the moistening of the ocular surface in the presence of dry eye sensations, burning or tiredness of the eyes, caused for instance: • by watching television for a long time • extensive computer work • dry air from air-conditioning or heating Preservative free Moistening and wetting effect1

Viscotears® Eye Gel provides soothing relief for sore, gritty dry eyes.

Its long lasting gel formulation is suited for those who: • need extra protection • added nighttime support, or • prefer a heavier gel 6H

Maintains the tear film stability for a period of up to 6 hours2 Viscous gel for nighttime protection

VISCOTEARS® GEL PF 30 × 0.6g Single dose units • Preservative-free • PBS Listed

VISCOTEARS® EYE GEL 10g Tube • Soothing, long lasting relief for sore, gritty dry eyes • PBS Listed

For more information, contact your Bausch + Lomb Territory Manager or Bausch + Lomb Customer Service 1800 251 150

Material was prepared in February 2023 References: 1. Viscotears Gel PF IFU. 2. Viscotears Single Dose Unit 2.0mg/g Eye Gel, EMC, 5.1 pharmacodynamic properties https://www.medicines.org.uk/emc/product/2311/smpc - Accessed Feb 2023 © 2023 Bausch & Lomb Incorporated. ®/TM are trademarks of Bausch & Lomb Incorporated or its affiliates. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) Vis.0001.AU.23

NEWS

UNIVERSITY OF CANBERRA OPTOMETRY CLINIC ADDS FOUR CONSULTING ROOMS offering support to the clinic when there aren’t enough testing rooms, students are getting even more opportunities to run consultations.”

The University of Canberra (UC)’s optometry clinic has expanded, allowing for a greater number of consultations and sustaining the growing number of students in optometry and vision science.

The expansion also aids UC’s collaboration with Canberra Health Services where people with chronic eye conditions such as glaucoma can bypass hospitals to receive the treatment from the university’s optometry clinic.

The clinic opened in 2020 and featured four consultation rooms, one special instrument room, one dispensing room, and a frame room. The increased footprint adds four consultation rooms and two special instrument rooms.

It also increases the specialty services available to the Canberra community. These include a Functional and Low Vision Clinic for people wanting to improve their vision for activities, people with vision impairment, and speciality contact lens clinics for conditions such as keratoconus, myopia control and binocular vision training.

“We now have a new dry eye clinic, that includes an intense pulsed light (IPL) device and we’re excited to be adding virtual reality vision training to our suite of offerings,” Dr Mei Ying Boon, Associate Professor and Discipline Lead in Optometry and Vision

The clinic can now offer more optometry services to the Canberra community.

Science in the University’s Faculty of Health, said.

“This alleviates some strain in public ophthalmology so doctors can provide more surgical interventions,” Boon said.

Optical retailer Specsavers is a major donor to the optometry clinic and works with UC to offer placement and employment opportunities for students and graduates.

With consultations led by Master of Optometry students under the guidance of clinical supervisors, the expansion provides more opportunities to run consultations and gain clinical experience.

“Specsavers shares the University of Canberra’s ambition for clinical excellence and is committed to accessible, affordable and quality care. We are very proud to be supporting the expansion of this clinic to help develop the next generation of optometrists,” said Dr Ben Ashby, director of optometry for Specsavers Australia and New Zealand.

“This semester we have been so much more productive with the four additional rooms up and running,” Master of Optometry student Mr Esman Ayan said.

“Instead of playing an ancillary role and

VitA-POS

®

Night-time protection for dry eyes Preservative-free ointment

Protects the ocular surface during sleep 300 applications

Free phone: 1800 238 742 | Email: receptionau@aftpharm.com AFT Pharmaceuticals Pty Ltd, Sydney. ABN 29105636413. | mydryeyes.com.au

BRO_OP

INNOVATION IN OPHTHALMIC ULTRASOUND

VUPAD - One System. Multiple Options.

A versatile range of portable ultrasounds providing outstanding image quality, advanced tools for every application, and an exceptional user experience.

Available with UBM / B-Scan / A-Scan / Pachymetry - Any Combination

Device Technologies is proud to be the exclusive supplier of Sonomed Escalon across Australia & New Zealand.

AUS  1300 DEVICE (338 423) eyes@device.com.au www.device.com.au

BRO_OPT_NZ Optics full page add_September 2023_V3.indd 1

NZ  0508 DEVICE (338 423) sales@device.co.nz www.device.co.nz

RA:13092023GT

For more information, please contact your Device Technologies representative.

10/3/23 10:35 AM

NEWS

NOVARTIS DISCONTINUING DRY AMD GENE THERAPY CLINICAL TRIAL

COMPANIES WARNED OVER MARKETING UNAPPROVED OPHTHALMIC DRUGS

Novartis will discontinue development of GT005 gene therapy, a subretinal injection for geographic atrophy (GA), in a blow for the macular disease community and an investment firm that will lose AU$103 million.

The US Food and Drug Administration (FDA) issued warning letters to eight firms marketing unapproved ophthalmic drug The FDA also cited products.

The gene therapy, which was in Phase 2 trials, delivered the gene for complement factor I (CFI) to the eye using a viral vector.

CFI regulates the complement pathway in the immune system, which is overactive in AMD, leading to degeneration of retinal cells.

quality issues related

These warnings to product sterility. come amidst a host of serious adverse reports linked to contaminated artificial teardrops in the US that has led to 14 patients with vision loss, an additional four requiring enucleation, and four deaths.

The decision was based on recommendations by the independent Data Monitoring Committee (DMC), concluding that “futility criteria had been met”.

The FDA states that the eye products addressed in the latest warning letters are illegally marketed to treat conditions such as conjunctivitis, cataracts, and glaucoma among others. It also cites quality issues related to product sterility.

Novartis stated that no new safety signals had been identified and the company will conduct long-term safety monitoring for participants despite discontinuation of the studies.

GT005 was the focus of the HORIZON and EXPLORE trials which included trial sites in Australia, and was targeting GA secondary to dry age-related macular degeneration (AMD)

According to the agency, these unapproved products pose elevated risk of harm to users as the products can bypass some of the body’s natural defences.

“The FDA is committed to ensuring the medicines Americans take are safe, effective and of high quality. When we identify illegally marketed, unapproved drugs and lapses in drug quality that pose potential risks, the FDA works to notify the companies involved of the violations,” said Ms Jill Furman, director of the office of compliance for the FDA’s Centre for Drug Evaluation and Research.

“Our disappointment in this outcome is first and foremost for the GA community,” Novartis said.

“We are subsequently communicating with study investigators, health authorities and relevant bodies and are committed

They are required to respond within 15 days of receipt of the letters and take corrective action. Failure to respond to the letters will result in legal action, with some companies placed on import alert which prevents entry of their products into the US. The FDA recommends that consumers who have used eye products listed in the letters to seek healthcare advice.

14

to sharing information from these early studies with the ophthalmology and scientific communities to help inform future development of gene therapies. We sincerely thank the study participants and the investigators for their participation.”

Novartis procured the GT005 program after its acquisition of Gyroscope Holdings Limited from Syncona, a healthcare investment trust, in February 2022.

Syncona received an upfront payment of US$442 million (AU$ $685 m) from a total upfront cash consideration of US$800 million (AU$1.2 b) from Novartis. Syncona was also eligible for milestone payments subject to successful clinical development and commercialisation of GT005. However, the discontinuation of the trials has resulted in Syncona writing off £54.5 million (AU$103 m) in milestone payments.

‘QUINLIVAN’ GRANT TO INVESTIGATE NORMAL IOP RANGE IN YOUNGSTERS

“We will continue to investigate potentially harmful eye products and work to ensure violative products stay off store shelves so that consumers can continue taking the medicines they need without concern.”

The companies that received the warning letters and their unapproved products were Boiron Inc, CVS Health, DR Vitamin Solutions, Natural Ophthalmics, OcluMed LLC, Similasan AG/Similasan USA, TRP Company, Inc, Walgreens Boots Alliance.

The decision was based on recommendations that “futility criteria had been met”.

Prof David Mackey, The University of Western Australia.

Western Australian ophthalmologist Professor David Mackey has been awarded this year’s Glaucoma Australia (GA) ‘Quinlivan’ Research Grant. He will use the funds to investigate the normal range of intraocular pressure (IOP) in children and young adults, and whether it predicts glaucoma later in life.

Mackey, Professor of Ophthalmology at the Centre for Ophthalmology and Visual Sciences at The University of Western Australia, was announced as the 2023 recipient by GA and its patron, governor-general Mr David Hurley.

As the world’s most published author in glaucoma genetics, he said data on the range and changes of IOP during childhood and early adulthood is limited in both people with a high genetic risk of

glaucoma and the general population.

“Although we can now provide a newborn baby their genetic risk for developing glaucoma in adult life, we do not know when we need to initiate examination or intervention in at-risk individuals,” he said.

“We lack data on the normal range of IOP in children and have presumed it is the same as for adults. Funding from the Quinlivan Research Grant will enable us to collect and analyse data from young participants in the Raine Study, whose parents have been followed by researchers for their entire lives. This will enable never-before-possible research into the genetic, lifestyle and intergenerational aspects of IOP, as well as the creation of an IOP reference range for children.”

INSIGHT November 2023

AUGUST

1800 637 654 AUGUST Full page ad - INSIGHT.indd 17

@eyesrightoptical 21/09/2023 2:07:14 PM

PROFILE

An honourable journey

With an astute vision for his business, strong resolve, and a wealth of clinical knowledge, it made sense that Dr BRENDAN SCHELBACH would build his Brisbane practice, Honour Optometry, from the ground up.

T

he consensus among Dr Brendan Schelbach’s optometrist peers was to avoid opening a greenfield practice. The odds of success were against him, but his story proves that it sometimes pays to go against the grain.

Schelbach’s optometry career started after completing his degree in 2005 at Queensland University of Technology, where he moved on to work in corporate optometry practices across Brisbane including a stint as store manager over the next several years. When Luxottica introduced its franchising model, Schelbach made the decision to purchase an optometry-only option, without a retail component.

However, he decided to cease operation of the franchise in 2018 when Luxottica announced that they would not be renewing the optometry-only contracts moving forward. Here, Schelbach was at a crossroads in his career. With a new-found appetite for independence, he vowed to maintain the flexible working conditions that came with being his own boss.

Dr Brendan Schelbach of Honour Optometry, Graceville, Brisbane.

Image: Kate Robinson Photography

database. That was part of the benefit with my previous franchise. I walked into a practice that had been there for 20 years and had a full appointment book to work from so that made things very easy in that situation,” Schelbach says.

“But going greenfield, I was able to work where I wanted [Brisbane].

There wasn’t the option to purchase a practice and I felt that I could make a greenfield practice work in the area [Graceville]. Having lived in this area for the last 10 years and knowing there were no other practices in the suburb, it certainly gave me the confidence that I could be successful here.”

He also enjoys the work-life balance with practice ownership.

“My wife and I also welcomed our first child in May last year, and whilst starting a new business and having a new baby might seem like a lot to have on your plate, having the flexibility to spend time with them when days were quieter was another great benefit, rather than buying an already busy practice.”

ONE-MAN BAND In saying that, opening the practice made Schelbach feel isolated at times.

Guiding him through the process was ProVision, which offers business support, services and buying power to more than 450 independent practices across Australia.

“After seven years of franchising, I just said ‘okay, we’ll call it quits early’, and got out of that, with the plan then to probably open my own practice,” Schelbach says.

In the interim, Schelbach worked as a locum, with the pandemic delaying his plans to open his practice.

A key challenge in opening any greenfield practice is the absence of a patient database without the goodwill to create a loyal, returning customer-base. Purchasing a pre-existing clinic was Schelbach’s first port-of-call. However, eager to own a practice in Brisbane and with a lack of local purchasing options, he opted to start from scratch.

A retail opportunity in the riverside suburb of Graceville opened, with Schelbach snatching up the lease and beginning operations in February 2022.

“All the information I’d been given from other practitioners was that it certainly would be the easier option to buy an existing practice with a

16

INSIGHT November 2023

Honour Optometry stocks eclectic, unique and sustainable eyewear.

Image: Kate Robinson Photography

“Having known about ProVision as a student but not really dealt with them since, I was lucky to be talking to another practitioner that was looking to open and he raised the question whether I was dealing with them. They’ve got a great team that can help in almost every aspect of opening a new practice. They have developed resources, like a 100-point checklist to make sure you’re not missing anything in all aspects of the journey, including the shopfitting, the leasing, frame buying and the accounting side of things.

They’ve got consultants to help with things like the HR that I’d never had to deal with previously,” he says.

“The ProVision network of practices has also been great resource to be able to reach out to when needed, and members evenings have been invaluable for networking with like-minded peers. It was great to be able to chat with their business coaches as well, just to make sure there wasn’t anything I was missing.”

Schelbach opened Honour Optometry with a breadth of clinical knowledge, but with little exposure to the retail aspect of optical business ownership. Eyewear stylist and optical retail expert Ms Kay Keegan proved to be an invaluable asset with her experience in front-of-house duties.

Together, Schelbach and Keegan bring the full suite of skills necessary to operate a successful practice.

“Kay is a phenomenal personality and has been working in the optical industry for over 35 years. She’s a great advertisement for the practice and lovely person to have at the front of the store as people come in.

She’s amazing at her job when it comes to selecting fabulous frames for people,” he says.

Schelbach had accumulated some assets from the franchise he operated and retained them in the hopes of opening his practice one day.

“There were cost benefits having had the franchise with Luxottica. I’d purchased a lot of the consulting equipment already and had put that away in storage with the idea of opening a practice. So that certainly brought down some of the costs compared to what others might have when opening a new practice,” Schelbach says.

With any greenfield practice, establishing a customer base is challenging, but with the support of family, friends and the local community, Honour Optometry quickly developed a loyal customer base.

Optometrist Dr Brendan Schelbach and stylist Kay Keegan. Image: Kate Robinson Photography.

“It’s been fairly organic,” Schelbach says.

“Friends, family and colleagues of both Kay and I were there to start things rolling, but the local community and other business owners have embraced us from day one as well. We truly believe that our willingness to provide care and attention, and great service to every person who has walked through our door has helped grow positive word of mouth and given others the confidence to give us a go.”

ECLECTIC, DISTINGUISHED, VIBRANT AND SUSTAINABLE According to Schelbach, much of the success of Honour Optometry can be attributed to its eyewear selection, with the eclectic, unique and sustainable range of frames garnering a positive response from locals.

“Kay also ensures that every customer is a walking advertisement for Honour Optometry by pushing their eyewear boundaries, and mine, with our more unique, interesting and beautiful frames. And whilst our customers have not necessarily sought us out for our sustainable eyewear offering, the stories behind each of the brands seem to resonate,” Schelbach says.

“They’re brands that people haven’t seen in Brisbane or even in Australia before so that’s certainly been another drawcard. You’re not going to see anybody else wearing the same frames walking down the street. Customers have been drawn to the ‘more out there’ and vibrant product that we’ve stocked. We definitely wanted statement eyewear that isn’t run-of-the- mill.”

Sustainability is a hot topic right now, and the optical industry is responding with eyewear made from various bio/recycled materials. Although Honour Optometry’s customers are initially drawn to the distinct range of products, the sustainable factor is adding value to spectacle purchases.

“You can fill the whole store with sustainable eyewear. We wouldn’t have thought that was possible two years ago. Having just been at the O=MEGA23 conference, it’s evident that it’s continuing to evolve

and there are plenty more options out there,” Schelbach says.

Honour Optometry is conscious about stocking brands that adhere to its sustainability values. Sustainable eyewear brands are made from recycled materials or with sustainable manufacturing practices. It also offers a recycling program for old eyewear and contact lens packaging.

“Audiophiles have loved our Vinylize range made from upcycled vinyl records in Budapest. And we are proud to be the first optometrist to stock Good Citizens Eyewear. Each pair is made from one plastic bottle by a father and son team in Sydney,” Schelbach says.

This, in combination with the uniquely natural ambiance and peaceful holistic environment within the practice, only adds to the patient experience.

Schelbach hopes to consolidate Honour Optometry’s sustainability model by working towards a B Corp certification. This involves incorporating sustainability and ethical business practices into the company’s corporate governance structure, effectively holding itself accountable to its ethicality.

With Seekers Optical in Melbourne as the first optometry practice in Australia to be awarded B Corp certification, Honour Optometry intends to follow in its footsteps.

“Whilst I knew of their [Seekers Optical] practice from one of our reps, I hadn’t realised they were also focused on sustainability in optometry and we thank them for blazing the way. I hope that we can be the second B Corp certified practice in Australia,” he says.

INSIGHT November 2023

17

EYEWEAR

Customers have varying levels of concern about fashion and the desire to look good.

returns, and increase the likelihood of additional sales. Katsieris calls on dispensers to be fearless: “You have the opportunity to change someone’s look, showcase their personality and style by their frame choice. What a fabulous opportunity.”

FUNCTION Function will call on all your technical expertise as a dispenser. Frames first and foremost are designed to hold ophthalmic lenses – we need to ensure the frame itself will function and allow the lenses to perform as intended. Bespoke eyewear craftsman, Mr Chris Savage, recommends this ‘F’ is given utmost attention as it “encompasses all of the other Fs”.

Prescription analysis and effective lifestyle questions will guide suitable material recommendations. A hypoallergenic material may be necessary – such as cellulose propionate, optyl, or titanium. Strength of titanium, beta titanium or nylon could be needed to accommodate specific occupations, hobbies, or age brackets. Perhaps the thicker rims of cellulose acetate would benefit holding the lenses more securely and disguising the edge thickness for the high ametropic customer.

Balancing

FRAME SELECTION FUNDAMENTALS Fashion, function, feel and financials are the four key ingredients to execute the ideal frame selection, writes experienced optical dispenser and trainer VIRGILIA READETT.

D

oes a world exist where a pair of frames does it all? Namely, do they make the customer look great, feel as though they’re not wearing spectacles at all, and enable the lenses to perform to their full potential – all without costing an arm and a leg?

Frame recommendations are an art form requiring the juggling of many, often conflicting needs of our customers. Fashion, function, feel, and financials are the fundamentals of effective frame selection. By balancing these needs – including managing these compromises - we stand to gain improved sales, reduced remakes and most importantly returning loyal customers.

FASHION Customers have varying levels of concern about fashion and the desire to look good. Whether your customer is after the latest trend or a conservative look, Ms Jacque Katsieris, managing director at ProOptics, recommends dispensers avoid being “afraid to step out of your comfort zone and your own personal choice, and venture into a different story to offer your patients”.

Your skill as a dispenser is to recommend not just what will look good, but what will function well. Draw on your technical skills – optical crosses will illustrate the thickest lens meridian and guide shape recommendations.

Consider also the base direction in prismatic prescriptions adding additional edge thickness. A shallow frame would reduce thickness for vertical prism for example. For multifocal, progressive and occupational lenses – will there be enough depth to allow these lens designs to work correctly?

The adjustability of the frame is paramount for the next F – ‘feel’, but it’s importance should not be overlooked for the optical functionality of the lenses.

Can the back vertex distance (BVD), face form angle and pantoscopic tilt be adjusted as required for the prescription and lens design to act as intended?

When function is given adequate weighting, remakes due to weight, thickness, aberrations, and reduction in size of near section, will be eliminated.

FEEL Good frame selection is essential. We don’t want to defeat the visual comfort of the lenses by then inducing physical discomfort due to poor frame selection.

Mr Tony Perkins, account manager at Eyes Right Optical echoes this, stating that when a customer discovers a frame that feels amazing, it instils a sense of confidence. “This feeling of comfort and satisfaction tends to surpass all other considerations because ultimately, it is the customer who will be wearing the frame,” he explains.

The overall frame dimensions and rim size will impact the weight and therefore comfort. For high ametropic prescriptions, we need to balance whether the extra weight is an acceptable compromise for the look and function of holding and disguising thicker lenses.

It is paramount to consider the final fitting at frame selection. How often are issues with spectacles fixed by an effective adjustment? A lot, in my experience. The first step to an effective adjustment is a frame that fits well for your customer’s physiology. Your strategic frame recommendations will reduce remakes due to unsuitable frames that cannot be adjusted well.

An appropriate bridge type and size are crucial in achieving comfort and an even spread of weight between the nose and ears. For frames with plastic bridges, shape for shape is the aim – match the shape and size of the bridge to the customers nose as closely as possible. Nose pads are ideal for small and low bridges. An adjustable frame front will enable the wrap and BVD to be altered as required for the customer.

To enhance the aesthetic appearance of the frame selection, pay attention to colour and shape recommendations. Earthy tones pair well with warm skin undertones and cool vivid-based colours such as blue navy and black with cool skin undertones. The goal of shape recommendations is to create a sense of symmetry and balance with frame shape complementing, rather than matching, the face shape.

Consider the pantoscopic angle the hinges make to the frame front and whether this is adjustable with the thickness of the temples. How does the tilt then sit with the customer’s physiology. Can the ideal range of eight to 12 degrees be achieved? Frame width will either make or break the overall adjustment. Too narrow a frame and the splay to the hinge angle will be very dramatic making it difficult to adjust. Too tight and the customer may have unwanted pressure on their temples, and in some circumstances, frames pushing forward due to this force on the temples.

Prioritising fashion during selection will help customers to feel at ease and comfortable with their frame selection. Ultimately this will reduce exchanges,

Moving to the back of the frame – does the frame have adequate temple length to achieve a suitable length to bend at the anatomical bend? Or on the flip side, is

20

INSIGHT November 2023

it unnecessarily too long – causing an unsightly long length behind the ear.

Communication is key during the frame selection process – why are you recommending one over the other, as Perkins explains: “Informed customers will appreciate why and how a particular frame feels great and justifies its value.”

FINANCIALS The customer budget should not be overlooked during lifestyle questioning.

Consideration for overall budget needs for multiple pairs and lens requirements will guide appropriate frame recommendations. Compromises on brand and material may be needed to meet the customer’s budget.

If the preference of fashion, function and feel outweigh the customer’s ideal financial expenditures, guidance on the benefit of quality products and the link to the customer’s lifestyle will build confidence to purchase. According to Perkins, customer loyalty “can only be achieved through a commitment to quality, as price alone cannot guarantee long-term loyalty”.

BALANCING ACT – CAN IT BE ACHIEVED? A trap we can fall into as dispensers is assuming which F will be most important for our customer. Customers’ preferences are as diverse as their optical needs, but effective lifestyle questions will uncover their priorities and where they may compromise. Consider when they will be using their eyewear, their occupation and hobbies, the satisfaction with their previous pair, what they are wishing to keep the same or change.

It is our duty of care to provide an appropriate service. This means the best optical recommendations that cater for individual needs and preferences.

Perkins recommends taking the time to grasp this: “This insight helps in tailoring your offerings and recommendations to align with their specific tastes and requirements,” he says.

Time taken during frame selection will be earnt back with easier final fitting at dispense and collection, reduced troubleshoots – or quicker

“REPEAT BUSINESS WHERE THE FRAME SELECTION AND FOLLOWING DISPENSE IS CARRIED OUT WITH CARE, EACH TIME, WILL LEAD TO LONG TERM CUSTOMER LOYALTY.” VIRGILIA READETT OPTICAL DISPENSER TRAINER troubleshoots, reduced remakes, and repeat customers. Compromises may be necessary to reach a happy middle ground for each F – or the customer may choose to prioritise one over the others. Katsieris explains “every customer has a different checklist in their minds”.

Once the ideal balance is achieved – albeit uneven – Katsieris inspires for the fabulous : customers looking fabulous, feeling fabulous with a frame that fits fabulously. A frame selection and dispense carried out with care, each time, will lead to long term customer loyalty. These customers could potentially find specs that meet their needs elsewhere – but they come back to you because of your outstanding service. They become advocates for your practice by referring friends and family.

ABOUT THE AUTHOR: VIRGILIA READETT teaches with ACOD and has been in optics since 2012. She holds a Certificate IV in Optical Dispensing, Certificate IV in Training & Assessing, and a Bachelor of Arts majoring in Communications.

EYEWEAR

THE PERFECT DESIGNER PIECE PRACTICES HAVE BEEN WAITING FOR With a new season, comes new passion. The designers at Face à Face continue their cultural and artistic exploration of the Italian MEMPHIS movement and discover a surprising connection with contemporary Japanese design.

With Shiro Kuramata, an unprecedented poetic element suddenly appears, such as the red roses at the heart of his transparent Glass Chair (“Miss Blanche” chair). Likewise, Japanese designers like Issey Miyake, Rei Kawakubo and Kengo Kuma express in their work the same mix of delicacy and broken aesthetics, creating a fascinating contrast.

Thus, Face à Face draws inspiration from this movement for its new JAPAN NOW! collection.

Inspired by Issey Miyake’s work, two lines of colour appear like two origami pleats around the eye. A delicious paradox between their delicate finesse and the format of the shapes, these two lines of colour resonate in captivating shades. All of them highlights that make PLEATS the perfect designer piece you’ve been waiting for.

Email: sales@eyesright.com.au

AUSSIE LEGEND, PAT CUMMINS, NEW CARRERA BRAND AMBASSADOR As worn by Pat Cummins, Australian cricket captain and Carrera’s new brand ambassador, Carrera 312 frames are destined to rewrite the rules, juxtaposing vintage references with bold contemporary frames.

The temples are a tribute to the Carrera brand history, with their ‘fin’ silhouette, rendered even more notable thanks to the visible core and the Carrera logo.

Carrera is synonymous with pioneering design and outstanding quality, designed for people who live by their own rules, continuously defying themselves and proudly approaching life standing out from the crowd. The brand offers a broad range of innovative frame styles that combine high performance technologies with sports-led design and unwavering durability.

Email: au.customerservice@safilo.com

A VIBRANT SPARK TO OPTIQUE LINE’S SUMMER CATALOGUE Providing an exceptional fit since 1970, Stepper Eyewear frames are worn by millions. This success and longevity stem from the frame design and manufacturing philosophy crafted by Hans Stepper, a German master optician. The fresh SI 30239 seamlessly merges innovation with tradition, where style meets substance.

Adding a vibrant spark to Optique Line's Summer catalogue, the Stepper SI 30239 boasts a striking red hue. It utilises premium materials, including TX5 and titanium, ensuring lightweight eyewear that never compromises on comfort or style. This new addition embodies a sleek and seamless design, harmonising with Stepper's hallmark commitment to comfort and fit.

Email: sales@optiqueline.com.au

PRIVÉ REVAUX – EVERYTHING YOU WANT FROM A GREAT PAIR OF GLASSES Founded in Miami, Florida in 2017 by celebrities Jamie Foxx, Hailee Steinfeld and Ashley Benson, Privé Revaux was established with the aim of providing customers with everything they want in a great pair of glasses; celebrity-influenced styling, high-end features, and an affordable price-point.

A bold take on classic square glasses, the Bay Point frames mean business. The flat top look is a striking silhouette that’s sure to make a statement wherever you go, with the two-rivet detail on the front and temples completing the look.

Email: au.customerservice@safilo.com

BRITISH ART MEETS CRAFT AND ELEGANCE Collaboration at its finest – William Morris London is working in partnership with The William Morris Gallery, the world-renowned art organisation that houses and preserves one of the best collections in the world from this great artist.

William Morris (1834-1896) is a world famous designer, poet, political activist and craftsman known for designing elegant interiors and exquisite textiles that remain among the best loved and most popular designs around the world.

Today, this new line of eyewear takes the best of those iconic prints and fabrics and applies them to a stunning range of wearable eyewear. Born to be British and always up to date with the latest trends, the William Morris London brand offers a range of optical and sun collections that are both original and elegant, reflecting the independent and quirky spirit of London. Drawing inspiration from its history, culture and iconic colours, William Morris offers a colourful journey across the capital city.

Email: sales@eyesright.com.au

22

INSIGHT November 2023

NOS VIOLA – A STATEMENT PIECE NOS Eyewear embodies the essence of style and unconventional beauty, celebrating the technical and stylistic uniqueness that underpins the brand's commitment to natural and elegant design. With a nod to contemporary Italian design, NOS Eyewear pioneers eclecticism, curating exclusive styles and elegance that transcend conventions and unleash creative freedom. The ‘Viola’ shade, is a unique bold purple hue that adds depth and personality to your collection.

Explore the beautiful craftsmanship of Italian-made NOS Eyewear as it introduces the NOS S567 Viola. Precision millings, both inside and outside the rim, and choreograph soft dances of light elevate the frame's style to new heights. This model features a whimsical and edgy polygonal shape that sets you apart from the ordinary.

Email: sales@optiqueline.com.au

KATE SPADE NEW YORK – MODERN SOPHISTICATION Kate Spade New York is a brand that is strongly rooted in optimistic femininity, empowering women to be the heroines of their own story, everyday. The brand is appealing to those who are inspired by the modern sophisticated colour palette to make their own joyful design statement.

These Madrigal KATE SPADE eyeglasses play a starring role in glamorous outfits with their acetate frames, on-trend shapes and a selection of neutral, pastel and gradient options. The frames highlight the brand’s playful spirit through the metal KATE SPADE logo and the ‘So happy to see you’ wording on the inside of the temple.

Email: au.customerservice@safilo.com

STEPPER OFFERS ‘THE PERFECT FIT’ FOR EVERY INDIVIDUAL Presenting the latest Stepper Eyewear ‘Asian Fit’ collection, with its debut in Australia at O=Mega 23. This collection reflects Stepper's dedication to customisation and inclusivity, aiming to find ‘The Perfect Fit’ for every individual. Recognising the diversity in facial proportions, this collection is a significant stride toward celebrating uniqueness.

Employing cutting-edge technology with hypoallergenic materials like titanium and TX5 across the entire range, Stepper Eyewear is delighted to offer eyewear that not only provides an impeccable fit but also exudes sophistication.

The collection showcases styles that have a fresh, contemporary, and youthful aesthetic. Many of these frames incorporate discrete flex hinges, ensuring longevity and adaptability for daily wear. Stepper’s characteristic craftsmanship now features multi-tonal colour finishes and stylish rim highlights that add a touch of fun.

Email: sales@optiqueline.com.au

NEW AWARD WINNING, ECO-FRIENDLY EYEWEAR Winner of the ‘Sustainability’ category in the ODMA Awards of Excellence at O=MEGA23 and new brand for Eyes Right Optical, eco-friendly brand Project Green has been welcomed with enthusiasm by the independent practices.

Project Green creates high-end, environmentally-friendly fashionable eyewear that doesn’t compromise on quality, style, look, or feel. Launched at O=MEGA23, Project Green was the talk of the show and constantly crowded by interested delegates. The range has been particularly popular with practices wanting to up their environmentally friendly efforts.

The brand focuses on providing environmentally conscious eyewear for the patient who appreciates luxury eyewear and wants to reduce their impact on the earth. This is achieved by using Mazzucchelli biodegradable acetates, biodegradable demo lenses, the finest quality Italian hinges, reconstituted leather cases and biodegradable packaging. Project Green is also committed to planting one tree for every frame purchased through environmental charity, One Tree planted.

Email: sales@eyesright.com.au

INSIGHT November 2023

23

EYEWEAR

s t n e d n e p e ind

THE FIRST PORT OF CALL FOR Eyewear that sells through the practice and makes patients feel great is one of the hallmarks of successful independent optometry practices in Australia. Two business owners discuss how they achieve this through their relationship with Eyes Right Optical.

S

tarting a greenfield optometry practice is a nerve-wracking time for any new business owner. Aside from getting the equipment and eyewear mix right, there are significant upfront investments – and it often takes a long time before the owners begin to draw a wage.

This was the reality for optometrists and business partners Ms Daniela Scalora and Ms Carole Anjou when they started Anjou & Scalora Optometrists in the leafy Melbourne suburb of Deepdene almost eight years ago.

As an independent, the duo knew they had to curate a balanced frames range that made them standout with colourful and playful designs, but also included classic, best-seller pieces that would provide the stability they needed at such a delicate moment. With previous experience in independent optometry, Eyes Right Optical was their first port of call when it came to their eyewear.

The family-owned firm is one of the leading wholesalers to the independent optical market in Australia and New Zealand, and Anjou & Scalora were particularly keen to begin stocking some key brands like Face à Face, ProDesign and WOOW. The portfolio continues to expand as well, with 2023 additions such as the high-end sustainability brand Project Green, William Morris and Charles Stone.

“The first two brands we took on straight away were Face à Face and ProDesign; we had both worked in other practices where these both performed very well, so we wanted to ensure we continued having a relationship with those brands. We knew that women enjoyed them, they are well-made and they have great reputations,” Scalora says.

But they quickly found the relationship went much deeper than product.

24

INSIGHT November 2023

“We were starting a practice from scratch, which effectively meant any money we were putting into the practice was our own. We weren’t taking anything out of the practice and, in fact, it was very exciting the first time we actually paid ourselves which wasn’t for a long time,” Scalora says.

When the owners of Anjou & Scalora Optometrists approached Eyes Right Optical, owned and operated by Mr Mark and Ms Lisa Wymond, the eyewear supplier extended a generous offer that gave the practice extended terms to pay off the initial order. This was a godsend for a new business with significant upfront costs and overheads, with little cash coming in.

“As a new practice seeing patients here and there, it helped us on the path to where we are today. We could have paid it within a shorter timeframe, but it would have put us in a much deeper hole. Because of that, there’s no question we will remain loyal customers to them because they’ve always been really good to us,” Scalora says.

When Anjou & Scalora Optometrists was first established, the practice went with brands and designs they were familiar with, but this has progressively become more colourful over the years as the portfolio supplied by Eyes Right Optical continues to evolve with industry trends.

“With ProDesign we have a trusted, well-known range. Some of those designs have been around for years and they still sell, while every season Face à Face come out with beautiful colours and acetates. Some of these were released at O=MEGA23 in September, even before SILMO Paris, and are gorgeous, so we placed an order,” Scalora explains.

“We’re not the only practice that stocks Face à Face, but we knew we had to have it because there’s a certain woman that’s had that eyewear before and continues to want it because it’s trusted, comfortable and different.”

Beyond product, Eyes Right Optical places an emphasis on aftersales service. Its reps can offer insights into eyewear trends, help practices

individualise their frames range and leverages sophisticated IT capabilities.

“Their reps know their ranges well, they can tell us the best sellers without even thinking about it,” Scalora says.

ABOVE, LEFT TO RIGHT: Independent practice owners Daniela Scalora and Carole Anjou; Face à Face eyewear on display; Eyes Right Optical owners Mark and Lisa Wymond at O=MEGA23 in September; and Vision West owner and dispenser Paul Clarke.

Many designs within its portfolio have won awards, including two categories at the recent ODMA Awards for Excellence 2023 (Men’s Optical Frames category, Face à Face Paris – Neonnm, and Sustainability category, Project Green).

Australian optical industry is fortunate to have access to high calibre eyewear, equipment, lens and service providers who can support independents to differentiate the services from one another and corporate networks.

Anjou & Scalora Optometrists also appreciate the personal touch in their business dealings. This is largely because Eyes Right Optical is a second-generation family business that was originally established in 1992 by Ms Gaye and Mr David Wymond before being succeeded by their children Mark and Lisa in 2018.

“We also love that brands like Face à Face and ProDesign both are covered by two-year warranties, which we hardly ever have to use,” Scalora says.

“We also appreciate that when we call Eyes Right Optical, we know who we’re talking to. We predominantly work with distributors that are smaller and local, rather than big multinationals, which makes a big difference when you’re running a busy independent practice.”

STAVING OFF THE COMPETITION WITH EYEWEAR MIX More than two decades ago, well known Australian optical dispenser Mr Paul Clarke recalls an in-depth industry survey doing the rounds about how the perceptions of optometry. Most considered their optometrist to be clinicallyfocused or purely commercial. There was no in-between. But when the results were presented to practice owners in Perth, he asked why a practice couldn’t straddle both spheres.

“Perth was the last destination for this roadshow, and the person who was running the survey said, ‘you’re the first person who has asked me that’, which amazed me,” he says.

“Obviously things have changed now, and for our practice I would proudly say we have managed to embrace both ends. We have a very strong clinical component of the practice with four rooms that are fully booked, sitting alongside an amazing product range focused on kids and the middle to upper end of the market.”

Clarke was there when his practice, Vision West, was founded 38 years ago.

He was an employee then but acquired an ownership stake five years later in 1990 and today owns it alongside optometrist Mr John Palassis. Crucial to their success has been the close ties formed with industry suppliers. Clarke says the

“The relationship with suppliers is fundamental for a well-functioning optometry business. Eyes Right Optical would fit into that category of an exceptional supplier, as do several others we do business with,” he explains.

Vision West began its commercial relationship with Eyes Right Optical around 30 years ago. Clarke recalls they first came together at an ODMA Fair. Both businesses were in their infancy, but he was attracted to the company due to its product and the way then-owners Mr David and Ms Gaye Wymond conducted their business. “And now that Mark and Lisa have taken over the businesses, we can tell they have carried on that culture and I think they should be very proud of where they’re taking the business now,” Clarke says.

Vision West’s first big order was placed on ProDesign eyewear, which the practice continues to stock today, alongside Face à Face, WOOW and other brands. Kensie eyewear is also popular among paediatric patients that comprise about 60% of the practice’s patient base.

“Eyes Right have product that fits well with our mix, including some very upmarket eyewear; the Face à Face ranges have featured very well here for a long time, and we have quite a following of patients seeking that eyewear,” he says.

“We look after each other. We always respect them by making sure our accounts are paid on time, and both parties are always polite over the phone.

In turn, they are always on hand to offer support and if we need something urgently for a patient, there’s a good possibility their reps will drop in to provide what we are after.”

Located on the street front but part of the Karrinyup Shopping Centre, Vision West has worked hard to gradually build its business, notwithstanding intensifying competition within the centre.

“There are now seven practices located near us that are a mix of corporate and independent, but despite this, we’re not bothered at all by the product they stock,” he says. “That’s because we’ve got standout eyewear and Eyes Right Optical is an integral part of that,” he says.

INSIGHT November 2023

25

EYEWEAR

Australian cricket captain Pat Cummins wearing Carrera optical frames.

Carrera collaboration

SAFILO INVESTS IN HOMEGROWN TALENT Safilo has made a bold move to stamp its mark on the national eyewear market with the signing on of Australian Test and One Day International cricket captain Pat Cummins as an ambassador of its proprietary eyewear brand, Carrera.

W

hen Mr John Howard was the Australian Prime Minister in the late nineties to early noughties, he once quipped he held the second-most important job in the country. The top job, he said, really belonged to the captain of the Australian cricket team – a leader among leaders who can inspire a nation.

Today, that mantle belongs to Mr Pat Cummins, considered one of, if not the best, bowler in world cricket. Deemed the most marketable athlete in Australia, he also demonstrates a daring, bold attitude on the field, while standing up for issues like sustainability.

For the Carrera eyewear brand – a proprietary label of global eyewear company Safilo – Cummins embodies many of the qualities that make the brand so popular among Australians. As such, Safilo and Cummins have signed a new ambassador deal that will see the international cricket star wear and promote Carrera eyewear off the field, in a major boon for Safilo’s main customer-base: independent optical practices.

A photo shoot took place between Cummins’ cricket commitments in Sydney in early September with him wearing Carrera optical and sunglasses. The images will be made available for point-of-sale marketing and window displays in practices that sign-on to participate in the campaign, with Safilo also planning a national out-of-home advertising campaign to run in Australia and other markets.

Mr David Pearson, who oversees Safilo’s Asia Pacific operations and returned from Singapore to Sydney two years ago, says Carrera is Safilo’s

26

INSIGHT November 2023

strongest brand in the Australian market – and by collaborating with Cummins over the coming years he hopes to take the brand to new heights.

It’s also an example of Safilo’s unique position as a global eyewear company with the agility to localise its strategy in markets like Australia.

“We’re excited about what the Carrera collaboration with Pat Cummins will do for independent optical practices in Australia,” he says. “Some people have the perception we’re a big multinational, but we are rooted and invested in Australia. It’s a line in the sand moment for us here and I think we are the only company that’s made a bold effort to invest in local talent to promote global brands on this scale.

“THIS WILL BE SOMETHING THAT CAN HELP PRACTICES SPARK CONVERSATIONS WITH THEIR PATIENTS AND IS SOMETHING NO OTHER EYEWEAR BRAND IS OFFERING.” DAVID PEARSON SAFILO

“This will be something that can help practices spark conversations with their patients and is something no other eyewear brand is offering. He’s been named Australia’s most marketable athlete this year and will drive traffic into optical stores.”

Pearson says Carrera eyewear has been a strong performer in the sunglass channel for some time and has grown significantly in its optical collections. It’s distinguishable by bold styles and shapes, and has generated a loyal following.

“The Carrera optical collections have gone from strengthto-strength in the last three to four years. They include good commercial styles with some distinctive design elements.

It’s become a staple for independents, a well-recognised brand that is competitively priced and considered accessible fashion. It stands for something, but at the same time isn’t for everyone. It’s for people that want to stand out,” he says.

“It’s also instantly recognisable with the branding located on the nose piece, which is against industry norms, but that’s the point.”

MUCH MORE THAN A CRICKETER Pearson says the brand ethos fits nicely with the profile Cummins has built over his career. In addition to being incredibly photogenic (Pearson says almost every style he tried on looked great), he goes about his business in a daring and bold manner, offset with trademark Aussie humility. He’s also a spectacle wearer, as seen off-field in The Test series on Amazon, offering a behind-the-scenes account of the Australian men’s cricket team. Cummins can also be seen wearing glasses on his Instagram feed, another platform where he will promote Carrera eyewear to more than 1.2 million followers.

“He also stands for sustainability and the environment, and that’s something that our company is on the journey with. As a company and the Carrera brand, we aren’t perfect, but we are working on it and it’s great to have alignment in that regard," Pearson adds.

The partnership will be centred on “Pat the person, rather than the cricketer”, Pearson explains. This will mean the campaign will be more lifestyle focused, but in saying that Cummins has just started wearing another Safilo brand, SMITH Optics, on the cricket oval.

Interestingly, Cummins has history with the Carrera brand and once appeared on the cover of David Jones magazine in a pair of sunglasses from a previous collection.

“Carrera is a really strong global fashion brand and that fits well with who Pat is and where he’s going,” Pearson says. “He’s much more than a cricketer, he’s a businessman, a family man – he has many sides to him.

This is the person who has got a whole lot more to offer the world.”

Pearson expects the campaign to have the biggest impact in Australia and India, another market that’s important to Carrera eyewear. In fact, his Carrera collaboration was unveiled at a launch event on 5 October in India, dovetailing with the ICC Men’s Cricket World Cup 2023 that also began that day.

In the images, he is wearing eyewear from the most current and previous Carrera collections. Some standouts from the photoshoot see him sporting the 8885 model (optical) and the 8064 (sunglass).

“We’ve also got a couple of more edgy shots with him wearing classic Carrera-designed eyewear with the traditional logo position. The photoshoot looks incredible and we’re very excited to show the market,” Pearson says.

The collaboration is expected to run over several years. Whether this results in a Pat Cummins collection in future is not yet known, but Pearson says both parties are excited about what the partnership will bring. For now, it’s expected the out-of-home advertising will be placed on platforms like bus shelters and buses in local areas. For practices,

Independent optical practices will have access to marketing material featuring Pat Cummins wearing Carrera optical and sunglasses.

CURIOUS ABOUT CARRERA? Synonymous with pioneering design and outstanding quality – Safilo says Carrera is a statement brand since 1956 for people who live by their own rules, continuously defying themselves and proudly approaching life standing out from the crowd.

The brand was started by Wilhelm Anger and inspired by the Carrera Panamericana car race – one of the most dangerous open-road, border-to-border races in Mexico that ran from 1950-1954.

Other famous faces that have worn Carrera eyewear over the years include actor, activist and race-car driver Paul Newman as well as film legend Al Pacino and, more recently, Usher, Rihanna and Chris Hemsworth.

Carrera’s collections are composed by three main product families: •C ARRERA FLAG – the boldest expression of Carrera inspired by the archives with an eye on fashion and always one step ahead.

• CARRERA SIGNATURE – the brand’s evolution combining classic shapes with a dash of urban lifestyle.

•C ARRERA ACTIVE – reinterpreting the brand’s roots in sport with a streetstyle attitude.

they can expect access to various marketing materials, with around nine images selected from the photoshoot.

“For us, that was one of the important parts of the collaboration, that we’ve got great images we can put in store. We’ve got a point-of-sale and window campaign that all our customers stocking Carrera can use,” he says.

“It’ll be something interesting optometrists, dispensers and other practice staff can talk about with their patients when it comes to selecting eyewear, and is just in time for the Australian summer season.”

INSIGHT November 2023

27

KERATOCONUS

“We realised we have to make this really easy,” he says.

After many queries from surgeons, the duo decided to develop the website which took six months. The tool is designed for use by surgeons of different levels of experience and is not only targeted at the junior level.

“You don’t drive through the streets of a new city without a GPS, and this is the same thing for the surgery,” Dr Cronin says.

CAIRS hasn’t traditionally been the most accessible surgery due to technological constraints. The required femtosecond laser is expensive and uncommon technology, often requiring surgeons to move lasers from clinic into operating theatres. However, with a recent uptake of CAIRS surgery, which started locally in Brisbane and is now performed in operating theatres nationwide, the website will prove more useful and provide one less impediment to performing the surgery.

The impact of the CAIRS Plan tool has also extended beyond national borders with the technology receiving praise at the European Society of Corneal and Refractive Surgeons (ESCRS) Conference on 8-12 September 2022. The conference, held in Vienna, provided Cronin and Gunn with an opportunity to demonstrate the functionality of their system.

CAIRS Plan is a new online tool for ophthalmologists to streamline keratoconus surgical plans.

“I was blown away by the response from the conference. People were coming up to us and saying, ‘why hasn’t’ someone thought of this sooner?’, and ‘finally, I will definitely be using this for every case’,” Dr Cronin says.

WHO ABOUT KERATOCONUS?

CAIRS Plan also garnered a response from topographer manufacturers, with companies expressing interest.

CAIRS

An Australian ophthalmology duo are streamlining keratoconus surgical procedures with their development of the CAIRS Plan tool, which they are making free to colleagues.

With this positive reception of CAIRS Plan at ESCRS, the next step is facilitating easy importation of data directly from the topographer which will extend its applications to different types of topography. Cronin hopes to see scleral and limbal photography incorporated which will allow visualisation of blood vessels and allow for placement of corneal rings with even greater precision.

As opposed to integrating CAIRS Plan directly with existing software, which will incur stringent and expensive medical regulatory requirements, the proposal is to allow surgeons to effortlessly upload their topographical maps directly to CAIRS Plan.

C

Products were once required to achieve CE marking to guarantee adherence to European General Safety and Performance Requirements (GSPR). However, since the implementation of the European Medical Device Regulation (EU MDR), there are increased risk assessment requirements.

Allowing easy import of data to topographers avoids these regulatory hurdles as the website does not perform any measurements or provide any medical advice.

First performed in Australia in 2021 by Gunn, CAIRS is an alternative to traditional methods of implantation of acrylic intracorneal ring segments, which may result in allergenic responses due to the cornea not always responding well to plastic. With a high failure rate, Dr Soosan Jacob, from Dr Agarwal’s Eye Hospital and Research Center in India, developed CAIRS, an alternative method that augments the corneal stroma with additional cornea without removing any of the patient’s corneal tissue.

“This keeps medicine moving quickly and makes it adaptable,” Cronin says.

AIRS Plan, developed by Brisbane-based ophthalmologists Dr Brendan Cronin and Dr David Gunn, is a free online tool to help surgeons prepare for corneal allogenic intrastromal ring segment (CAIRS) surgery. A new surgical method, CAIRS is used to treat keratoconus, a condition associated with the thinning of corneal tissue and loss of structural integrity, resulting in a conical shape.

Cronin and Gunn have also designed surgical instruments to match the tight radius of curvature required for CAIRS transplants, which were previously not available. These have recently received TGA approval and are soon expected to be available internationally.

A key feature of CAIRS is biocompatibility, which distinguishes it from traditional methods. With the use of corneal tissue, it has been reported the body is far less likely to trigger adverse reactions – a normal response to foreign bodies such as acrylic implants. Integration with existing tissue prevents migration or corneal melting and erosion, as is the case with poorly positioned acrylic implants.

Now with access to a new type of surgery, Cronin and Gunn are taking it a step further with CAIRS Plan; a new online tool for ophthalmologists to streamline surgical plans to ensure they execute the surgery as intended.

The only one of its kind, Cronin says it allows ophthalmologists to upload corneal topography scans of the patient’s own cornea and create a map of where to accurately place the grafted corneal ring segments.

Cronin and Gunn sought to develop CAIRS Plan after conventional preparation methods, such as the use of spreadsheets to organise data, were complex, inaccessible and impractical. It also sparked a series of instructional videos on Dr Cronin’s YouTube channel.

28

INSIGHT November 2023

Dr Brendan Cronin (left) and Dr David Gunn, Queensland Eye Institute.

CARRERA 8885

POWERFUL

PREDICTABLE

PROVEN GO FOR THE #1 MIGS DEVICE WORLDWIDE * Powerful technology for sustained intraocular pressure and medication reduction. Predictable outcomes from a truly tissue-sparing procedure. All on a proven platform with the most clinical evidence of any MIGS device.

Experience the latest evolution of the iStent® legacy of excellence in your practice. *Based on units sold. iStent inject® W IMPORTANT SAFETY INFORMATION INDICATION FOR USE. The iStent inject® Trabecular Micro-Bypass System (Model G2-W) is intended to reduce intraocular pressure in adult patients diagnosed with mild to moderate primary open-angle glaucoma (POAG) currently treated with ocular hypotensive medication. The device can be implanted with or without cataract surgery. CONTRAINDICATIONS: The device is contraindicated for use in eyes with primary angle closure glaucoma, or secondary angle-closure glaucoma, including neovascular glaucoma, because the device would not be expected to work in such situations, and in patients with retrobulbar tumour, thyroid eye disease, Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS: This device has not been studied in patients with uveitic glaucoma. Patients should be informed that placement of the stents, without concomitant cataract surgery in phakic patients, can enhance the formation or progression of cataract. The surgeon should monitor the patient postoperatively for proper maintenance of intraocular pressure. iStent inject is MR-Conditional, meaning that the device is safe for use in a specified MRI environment under specified conditions; please see labelling for details. Physician training is required prior to use. Do not re-use the stent(s) or injector. ADVERSE EVENTS: Postoperative adverse events include but are not limited to: corneal complications including edema, opacification and decompensation, cataract formation (in phakic patients), posterior capsule opacification, stent obstruction, intraocular inflammation (nonpre existing), BCVA loss and IOP increase requiring management with oral or intravenous medications or surgical intervention. Please refer to Directions for Use for additional adverse event information. CAUTION: Please reference the Directions For Use labelling for a complete list of contraindications, warnings and adverse events.

GLAUKOS AUSTRALIA PTY. LTD. Suite 109/12 Corporate Drive • Heatherton VIC • 3202 • AUS • tel 03 9551 2220 • www.glaukos.com © 2022 Glaukos Corporation. Glaukos®, iStent®, iStent inject® and iStent inject® W are registered trademarks of Glaukos Corporation.

Australian Sponsor: RQSolutions Pty Ltd / New Zealand Sponsor: Toomac. PM-AU-0208

LEARNING OBJECTIVES:

CPD

0.75

At the completion of this article, the reader should be able to improve their management of keratoconus ...

CLINICAL CPD HOURS This activity meets the OBA registration standards for CPD

Including: • Understand the crucial role optometrists play in identifying candidates for CXL • Understand how imaging modalities have improved a clinician’s diagnostic ability for early stages of keratoconus • Be able to provide patient education on CXL protocols and post-operative recovery.

EARLY DIAGNOSIS AND TREATMENT OF KERATOCONUS: THE OPTOMETRIST’S ROLE While ophthalmologists play a critical role in managing moderate to advanced stages of keratoconus, Dr JUDY KU delves into the vital role that optometrists have in early diagnosis and treatment, ultimately contributing to better patient outcomes.

DEFINING KERATOCONUS eratoconus (KC) is a bilateral asymmetric, ectatic corneal condition that is characterised by progressive thinning and steepening of the cornea, causing irregular astigmatism and visual disturbances.

K

Typically, it develops during adolescence or early adulthood; children are more likely to have severe disease at the time of diagnosis (27.8%) and progress more rapidly (88%).1,2

as allergic keratoconjunctivitis, eczema and atopic dermatitis which often leads to chronic eye rubbing.

Contact lens wear is also an association and thought to be linked to microtrauma.

There is growing evidence that a history of asthma is associated with an increase in the severity of keratoconus.6 Other risk factors include a positive family history, Down’s syndrome, floppy eyelid syndrome and connective tissue diseases (Marfan’s syndrome).

Optometrists need to be aware of these risk factors which may trigger further investigations to identify early keratoconus.

THE IMPORTANCE OF EARLY DIAGNOSIS As keratoconus tends to affect young adults in their prime, it has a significant impact on a patient’s quality-of-life. In addition, paediatric keratoconus (onset before 18 years of age) tends to be more advanced and progress more rapidly than adult keratoconus.1,2

ABOUT THE AUTHOR: Dr Judy Y.F. Ku MBChB, FRANZCO Honorary Clinical Associate Professor, Faculty of Health, School of Optometry and Vision Science, QUT Cataract, Anterior Segment and Glaucoma Surgeon, OKKO Eye Specialist Centre

Conservative treatments such as spectacles and contact lenses (CL) may not be sufficient as the disease progresses and, in advanced cases, corneal transplantation may be necessary. With the advent of corneal collagen cross-linking (CXL) which halts progression, the rates of corneal transplantation have reduced substantially.3 This is why early diagnosis and prompt treatment of keratoconus is essential in preventing progression and mitigating its impact on patients’ quality-of-life.

EPIDEMIOLOGY AND RISK FACTORS The prevalence of keratoconus has been estimated at 1:375 to 1:2000 people. A much higher rate has been reported among certain ethnic groups, in particular Asian, Middle Eastern, Maori and Polynesians.4 A recent Australian study, based on a predominantly Caucasian young adult population, has shown an even higher prevalence (one in 84) than previously reports.5 In turn, this has important public health implications and due to this, early screening and treatment is recommended to improve quality-of-life and reduce social and financial burden.

The etiology of keratoconus is not fully understood, but it is thought to be an interplay between genetic predisposition and environmental factors, as well as biomechanical factors such as eye rubbing and ocular compression. Atopic disorders are well documented risk factors, such

Figures 1A and 1B. Slit lamp photos of a patient with advanced keratoconus in the left eye (Figure 1A, top) showing an inferior conical protrusion and stromal thinning. In contrast, there were no signs of keratoconus in the right eye (Figure 1B bottom) on the slit lamp, but obvious asymmetric astigmatism and inferior steepening on Pentacam tomography.

INSIGHT November 2023

31

CPD

Figures 3A and 3B. Patient a with juvenile open angle glaucoma developing ocular allergies to glaucoma drops, leading to eye rubbing and undiagnosed keratoconus.

a consequence, identification of those suitable for CXL at early stages would ensure that they are amenable to less-invasive treatments and maintain their functional vision in spectacles and contact lenses for as long as possible.

Figure 2. iTrace aberrometer showing ‘simulated E’ in a keratoconus patient demonstrating ‘flaring of light and visual distortion’. These are common symptoms reported by moderate to severe keratoconus patients.

KERATOCONUS – KEY RISK FACTORS

Corneal collagen cross-linking is a highly innovative and minimally invasive technique that has been proven to slow progression and reduce the rates of corneal transplantation. As

NOMENCLATURE FOR MILDEST FORM OF KERATOCONUS Various terms have been used interchangeably to describe the mildest form of keratoconus. To avoid confusion, it has been proposed to further define these terms:7

Frame R3338C

• Family history of keratoconus •A topy and asthma •H istory of eye rubbing •C ontact lens wear

There has been a paradigm shift in the management of keratoconus, with a particular focus on early intervention to maintain vision and corneal integrity.

In addition, keratoconus patients usually develop myopia and astigmatism and may seek corneal refractive surgery/laser vision correction. Screening for subclinical asymptomatic keratoconus is critical in avoiding refractive surgery-induced corneal ectasia in this population.

Available with Biometric Intelligent Glasses

INTRODUCING COLORMATIC® 3: THE NEW GENERATION OF COLORMATIC® Rodenstock’s ColorMatic® 3 lenses change from clear to dark and fade back to clear again 30% faster than the previous generation – making them our fastest photochromic lenses ever.

For more information, speak to your Rodenstock Account Manager.

Figure 4A. Patient A’s Pentacam tomography illustrating right moderate keratoconus with steep keratometry, thinned central corneal thickness and significant posterior elevation.

1) Forme fruste keratoconus (FFKC) – contralateral eye of KC patients with no clinical signs or topographic abnormalities

Frame R3338C

2) Keratoconus suspects, preclinical or subclinical KC – corneas with no slit lamp signs but inferior corneal steepening/asymmetry on topography with unaffected visual acuity

CLINICAL DIAGNOSIS OF MILD KERATOCONUS RELIES ON IMAGING Identification of milder forms can be challenging as the majority of cases are asymptomatic with no obvious clinical signs (Figures 1A and 1B). It requires the optometrist/ophthalmologist to have a high index of suspicion, especially in patients with risk factors.

The availability of various imaging modalities has improved a clinician’s diagnostic ability for early stages of keratoconus. Placido disc-based topographers are now commonly available in optometry practices which can reveal clues such as irregular astigmatism and localised corneal steepening. However, these are based only on the anterior corneal surface and thus tear film instabilities can have a significant impact on its accuracy.

Corneal tomography (for example, Pentacam) on the other hand is a 3D imaging system which measures both the anterior and posterior corneal surface along with a full pachymetric map. Abnormal posterior corneal changes and/ or pachymetric changes are typically the first indicators of subclinical keratoconus despite normal anterior curvature. Therefore if there is clinical suspicion, but the initial topography is normal, the optometrist should refer the patient to their local ophthalmologist for further specialised testing.

CLINICAL PRESENTATION OF MODERATE TO SEVERE KERATOCONUS Optometrists, being primary eyecare providers, are well-positioned to detect clinical findings suggestive of keratoconus during routine exams.

In moderate to advanced keratoconus, significant visual distortion may be reported – for example, ghosting and halos, sensitivity to glare and flaring of

Figure 4B. Pentacam tomography of the left asymptomatic eye with slightly thinned central corneal thickness and mild posterior elevation.

vision at night time and blurry vision (Figure 2).

Patients may present with frequent changes in glasses prescriptions and a progressive increase in astigmatism. Classic signs such as scissoring reflex or the Charleaux/oil droplet sign on retinoscopy are further diagnostic clues. Other slit lamp findings include stromal thinning/scarring, conical protrusion, Fleischer’s ring, Vogt’s striae, thickened corneal nerves and Munson’s signs.

CASE REPORT: DUAL PATHOLOGIES Be mindful that patients can have co-existing diseases. Case A is a 32-year-old man with a history of juvenile open angle glaucoma who has been on glaucoma medications since the age of 10. This caused intermittent ocular surface inflammation and irritation (Figures 3A and 3B). When he was referred for ongoing glaucoma care, we noted much higher astigmatism and reduced BCVA in the right eye (6/21 unaided 6/9 with +0.25/-2.75 x 55) compared to his left eye (6/18 unaided 6/6 with -1.50/-0.25x 10). His pachymetry was also asymmetric (RE 487um LE 528um).

Upon further questioning, he admitted to being a frequent eye rubber as he became sensitive to the glaucoma drops. He also reported a gradual deterioration of his right vision over the past nine years and a family history of keratoconus involving his brother. Pentacam tomography confirmed moderate keratoconus in the right eye and subclinical keratoconus in the left eye (Figures 4A and 4B). He subsequently underwent CXL in the right eye and had selective laser trabeculoplasty (SLT) to reduce his dependency on glaucoma drops. This case illustrated the fact that as clinicians, we must remain vigilant and when there are suspicious features (e.g. asymmetric astigmatism and thin central corneal thicknesses), even in the presence of co-existing disease, one should still investigate further to exclude keratoconus.

EARLY TREATMENT OF KERATOCONUS The most important goals of non-surgical management are to increase corneal stability and provide visual rehabilitation. From the outset,

it is important to verbally educate the patients and carers about the importance of avoiding eye rubbing. Any associated atopy should be managed with the assistance of other disciplines such as general practitioners and dermatologists.

Some patients may require systemic antihistamines/steroid sparing anti-inflammatories if their eczema/atopic dermatitis is severe. Any ocular allergies or dry eyes should be treated with regular mast-cell stabiliser/antihistamine drops and lubricants.

Glaucoma drops related ocular allergies should be co-managed with their ophthalmologist to consider alternative treatment such as SLT or minimally invasive glaucoma surgery (MIGS). In terms of optical correction, optometrists typically provide a step-wise approach – that is, start with spectacles, soft contact lenses, rigid lenses then specialised CL such as hybrid, piggy-back, scleral and mini-scleral.

CORNEAL COLLAGEN CROSS-LINKING Although optical correction assists with visual rehabilitation, only CXL can halt progression.

The original Dresden protocol involves epithelial debridement, soaking the cornea with riboflavin drops for 30 minutes, followed by exposure to ultraviolet light for 30 minutes, thereby strengthening the collagen fibres.

Optometrists play a crucial role in identifying suitable candidates for CXL and referring patients in a timely fashion. It is prudent to provide any past refractive/topographic history to demonstrate

SUSPICIOUS PARAMETERS These topographic parameters may arouse suspicion and initiate examination for further evidence of KC. •A stigmatism > 5D •K eratometry values (K1 /K2) > 48D •M aximum keratometry (Kmax) reading > 49D •T hin pachymetry < 470um •A symmetric bowtie pattern

INSIGHT November 2023

33

CPD

progression which is required by Medicare.

As keratoconus progresses asymmetrically, paediatric patients often present late as they tend to maintain good binocular visual function until both eyes are affected. In addition, their corneal instability could progress in months rather than years. Hence all paediatric patients should be referred early to consider CXL due to its progressive nature rather than wait until signs of visual degradation have been detected.

The prognosis of corneal transplantation for paediatric patients is also much worse than adults due to an increased risk of rejection. Moreover, they need to be followed up long-term by their optometrists even after CXL as the regression rate is 24% in patients aged 15 years or younger.8 If CXL is being deferred in patients less than 15 years of age, then topography should be repeated every three months to closely monitor for progression.

On the other hand, adult keratoconus patients should be separated into two categories: a) Progressive KC Regardless of age, adults with symptoms or signs of progression or a number of risk factors, should be referred early to consider CXL or potentially other surgical correction if indicated. b) Non-progressive KC Keratoconus generally stablises in the third or fourth decade of life and some of these adults have managed well with optical correction with no progression for years. These patients do not need CXL but should instead be monitored by their optometrists. On the other hand, if they become CL intolerant, they should be referred for alternative management.

Contraindications for CXL include: 1) V ery thin CCT (<400um) 2) P revious herpetic infection as it may result in viral reactivation 3) S evere corneal scarring 4) Reduced wound healing e.g. Neurotrophic keratopathy 5) S evere ocular surface disease 6) Pregnancy and breast feeding These patients need to be educated about the importance of monitoring, greater risk of progression and possible surgical intervention in the future.

POST-OPERATIVE CARE After CXL, all patients require antibiotics and topical steroids. Acute pain management in the first 24-48 hours is crucial, which include a bandage contact lens, eye patch, cycloplegic drops (in paediatric groups) and regular systemic analgesics. It generally takes four days for epithelialisation to occur.

Regular preservative-free lubricants encourage faster healing. It is not uncommon to develop a mild stromal haze which decreases with topical steroids by two months postop. Over the ensuing months to years, there would be gradual central flattening and some may notice a mild improvement in vision.

34

INSIGHT November 2023

Figure 5A. Accelerated corneal collagen cross-linking using the Glaukos’ iLink V System (KXL machine & Vibex Riboflavin).

After initial recovery, optometrists have an essential role in visual rehabilitation by managing patient’s contact lenses/spectacles and to monitor for progression. It is also an opportunity to ensure that their ocular allergies continue to be managed.

OTHER TREATMENTS There are several adaptations of the original CXL protocol, with the goals of avoiding the need for epithelium debridement (transepithelial CXL), thereby reducing pain and the risk of infection, and reducing treatment time (accelerated CXL).

However, the interest in transepithelial CXL is diminishing due to its inferior efficacy compared to epi-off CXL. Accelerated CXL is gaining popularity which reduces the UV time down to eight to 10 minutes, yet achieving similar efficacy to the standard protocol.

Intrastromal corneal ring segments (ICRS) is based on the principle that adding synthetic segments in the corneal periphery induces central flattening. This is a useful intermediary option for patients intolerant of CL and delay the need for keratoplasty.

Corneal allogenic intrastromal ring segments (CAIRS) is a new promising technique which utilises donor corneas. This improves biointegration with the host cornea, thereby reducing the risk of extrusion, infection and inflammation.

Corneal transplant is reserved for severe keratoconus not amenable to other treatments.

Apart from penetrating keratoplasty, partial thickness transplants such as deep anterior lamellar keratoplasty (DALK) was developed

NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.

to reduce the risk of graft rejection. Recently Bowman’s layer transplantation has been proposed to treat advanced KC and delay the need for DALK or PK. Further details of these procedures are beyond the scope of this article. After any corneal transplantation, optometrists play an important collaborative role in managing residual astigmatism and monitoring.

SUMMARY The early diagnosis and treatment of keratoconus relies on the expertise of both optometrists and ophthalmologists working in tandem. Optometrists, being primary eyecare practitioners, play a crucial role in detecting early keratoconus through thorough history taking (identifying key risk factors), comprehensive eye examination and imaging. Their collaboration with ophthalmologists ensures timely referral, accurate diagnosis, and the implementation of the most appropriate treatment strategies.

By working together, optometrists and ophthalmologists can effectively manage keratoconus thereby improving patients’ quality-of-life, and preventing further visual deterioration.

REFERENCES: 1. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of pediatric corneal collagen cross-linking in children and adolescents. J Refract Surg. 2012;28(11):753–758.

2. McAnena L, Doyle F, O’Keefe M. Cross-linking in children with keratoconus: a systematic review and meta-analysis. Acta Ophthalmol. 2017;95(3):229–239.

3. Chan C. Corneal cross-linking for keratoconus: current knowledge and practice and future trends. Asia Pac J Ophthalmol. 2020;9:557-564.

4. Sahebjada S, Chan E, Sutton G, Pang CP et al. Keratoconus International Consortium (KIC) – advancing keratoconus research. BMC Ophthalmol 2023;23:337.

5. Chan E, Chong EW, Lingham G, Stevenson LJ, Sanfilippo PG, Hewitt AW et al. Prevalence of keratoconus based on Scheimpflug imaging: the Raine Study. Ophthalmology 2021;128(4):515-521.

6. Sahebjada S, Chan E, Xie J, Snibson GR, Daniell M, Baird PN. Risk factors and association with severity of keratoconus: the Australian study of Keratoconus. Int Ophthalmol.

2021;41:891-899.

7. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: an updated review.

Contact lens anterior eye. 2022;45(3):101559 8. Mazzotta C, Traversi C, Baiocchi S, et al. Corneal collagen cross-linking with riboflavin and ultraviolet A light for pediatric keratoconus: ten-year results. Cornea 2018;37(5):560-566.

Are you an ambitious person?

You’d look good in Specsavers

Chanuka Optometrist

If, like Chanuka, you love the idea of a fulfilling career in optometry with lots of opportunities to progress, you’ll shine at Specsavers. www.spectrum-anz.com

LEARNING OBJECTIVES:

CPD

At the completion of this article, the reader will be able to improve their management of dry eye disease ...

CLINICAL CPD HOURS This activity meets the OBA registration standards for CPD

Including: • Recall the pathophysiology of dry eye disease • Recall the mechanism of action of the various dry eye treatment options • Identify the causes of a patient’s symptoms of dry eye • Implement effective management strategies for DED and co-morbidities.

DRY EYE DISEASE AND CO-MORBIDITIES

Effective dry eye management relies on accurate identification of co-existing factors and implementing a patient-centred management plan. ALISSA MAILLET offers an up-to-date survey of the treatment considerations when dealing with co-morbidities.

D

ry eye disease (DED) is a highly prevalent ocular disorder with significant effects on patient quality of life. In Australia, the prevalence of DED is reported to be in the range of 5-15% of the population.1 The condition is characterised by both patient-reported symptoms and clinical signs, resulting from inflammatory changes to the tear secreting glands and ocular surface causing a loss of tear film homeostasis. DED is chronic and worsening in nature due to the vicious cycle of inflammation impacting on tear film dynamics, with poor tear quality causing further inflammation.

The clinical presentation of DED varies greatly from patient-to-patient, but commonly involves symptoms of dryness, burning, stinging, with or without foreign body sensation.

PATIENT IMPACT In addition to the symptoms of ocular discomfort FIGURE 1. The vicious cycle theory of dry eye disease.

Image courtesy of Prof Christophe Baudouin.

experienced in DED, since the tear film carries important optical characteristics, tear film instability has a significant impact on the vision. Light scattering, glare, photophobia, and loss of contrast sensitivity all contribute to difficulties with aspects of vision, colour perception, social functioning, and driving which can lead to a reduction in vision- and health-related quality-of-life (QoL).2 The impact of the disease has been shown to have a significant effect on the ability to conduct activities of daily living, and the symptoms and ocular pain experienced lead to feelings of frustration, depression, and anxiety. Additionally, the time and energy required to manage and treat the condition can be stressful and overwhelming, further contributing to mental health issues.

RISK FACTORS Evidence from large clinical trials indicates that the risk of disease increases with age and for female

Alissa Maillet

BOptom BSc(Hons) GCHETL FHEA Lecturer in Optometry and Vision Science Optometrist and contact lens practitioner PhD candidate, Deakin University School of Medicine, Faculty of Health

gender as tear production decreases with ageing and hormonal changes. Screen-based near work and contact lens wear are also shown to increase the prevalence of dry eye symptomatology especially in younger age populations.3

HEALTH-RELATED ASSOCIATIONS Many common chronic health conditions have associations with DED. Autoimmune conditions such as Sjogren’s syndrome, rheumatoid arthritis, lupus, sarcoidosis, and immune disorders such as diabetes and thyroid dysfunction cause decreased tear production via interrupted metabolic activity of the lacrimal and meibomian glands and corneal nerve damage.4 Asthma and atopic disease both predispose to DED via increased presence of inflammatory cytokines and cells on the ocular surface.5 Recent studies have also suggested that affective disorders such as anxiety and depression and chronic pain conditions such as irritable bowel syndrome and fibromyalgia are linked to DED symptomatology, with both cause-and-effect relationships being found.6 Further, medications commonly taken on a regular basis by these at-risk populations such as antihistamines, antidepressants, hormone replacement therapy, and blood pressure medications further exacerbate the symptoms of dry eye.7

OCULAR CO-MORBIDITIES Anterior blepharitis, meibomian gland dysfunction, and Demodex infection exist as co-morbidities with DED. In anterior blepharitis, the sebaceous glands secrete too much oil causing increased shedding of skin cells, which in turn provides a commensal environment for bacteria.

The progressive biofilm maturation along eye lid margin or the presence of Demodex mites results in increased inflammation and lipase activity which

36

INSIGHT November 2023

controlled and treated with topical antihistamines or mast cell stabilisers in preference to oral antihistamines where possible.

FIGURES 2A AND 2B. Microblepharoexfoliation (MBE) using BlepEx instrument (left). 2B: Eyelid debridement-scaling (LDS) with golf spud for reduction of lid margin debris and bioburden (right). Images: James Armitage, Deakin Collaborative Eye Care Clinic.

changes the composition of meibum. Thickened meibomian gland secretion eventually leads to obstruction of the meibomian glands, keratinisation of ductal system, meibum stasis and eventual gland atrophy.

EFFECTIVE MANAGEMENT STRATEGIES Historically, and generally (even today) the management of DED has been relatively conservative and has focused on treating symptoms, with little regard to classification, the underlying causes and correlates of the disease.

The underlying principles for effective dry eye disease management are: 1) treating the contributing eyelid or ocular surface inflammation; 2) conserving

tears; and 3) improving tear quality and production.

REDUCING OCULAR SURFACE INFLAMMATION Both pharmacological and non-pharmacological interventions can be used to break the ‘vicious cycle’ of inflammation associated with DED. Topical steroids are used as short-term treatment courses initially of two to six weeks to interrupt the inflammatory cycle when and when flare-ups occur.

Longer term inflammatory control can be achieved by using topical immunomodulators such as cyclosporine A and lifitegrast or oral tetracyclines. Cyclosporine A is especially indicated when treating dry eye patients with associated autoimmune disease. Co-existing allergy should be

LID CLEANSING PRODUCTS The removal of lid debris and scurf generated in anterior blepharitis to reduce bioburden, and Demodex mites is necessary to control eyelid inflammation. Historically, practitioners have recommended diluted baby shampoo as lid cleansing product; however, baby shampoo may have a detrimental effect on meibomian glands and goblet cell health. Greater reduction in symptomatology can achieved with dedicated eyelid hygiene product, specifically those containing anti-microbial agents such as tea tree oil, terpinen-4-ol, 0.1% hypochlorous acid (HOCl) or okra polysaccharide complexes. All products are shown to have similar efficacy but HOCl and okra are less toxic to ocular surface, which can lead to greater compliance because they are more comfortable for the patient to use.

EYELID EXFOLIATION Lid scrubs only achieve eyelid cleaning. That said, multiple studies suggest that in-office eyelid exfoliation treatment combined with eyelid hygiene is more effective than lid scrubs alone.8 The aim of in-office treatment is the reduction of lid margin bioburden and debris, epithelial keratinisation, and meibomian gland capping.

Eyelid debridement-scaling (LDS) using a golf

CPD

MEIBOMIAN GLAND EXPRESSION In-office thermal treatments are shown to be most effective for treatment of MGD when followed by therapeutic expression of meibomian glands using a Mastrota paddle or forceps.

Clinical signs and patient symptoms (conjunctival injection, blink rate and Ocular Surface Disease Index (OSDI) Scores) can improve for up to two months after treatment, even when the quality of the expressed meibum is not visually changed, most likely due to the reduction in lipophilic bacteria concentrations in newly produced meibum.12

FIGURE 3. Therapeutic meibomian gland expression with a Mastrota paddle. Image: James Armitage, Deakin Collaborative Eye Care Clinic.

spud or purpose-designed debrider involves physical removal of mucous, hyper-keratinised tissue at the mucocutaneous junction, and meibomian gland blockages from the lid margin via physical scraping.

Microblepharoexfoliation (MBE), using instruments such as BlephEx, NuLids, or single-use Ocusoft SwabStix, uses detergent-based cleansers and friction to remove excess oils, scaling, and scurf from the lash line. MBE is better than LDS for decreased in bioburden and lipase activity, whereas LDS is better than MBE for improving MG expressibility.8 Where MGD and anterior blepharitis co-exist, LDS can be followed by MBE for maximum effectiveness.

TOPICAL ANTIBIOTIC AND MANUKA HONEY OINTMENTS Where recalcitrant anterior blepharitis is present, and eyelid inflammation is not adequately controlled by a combination of in-office lid treatment and home lid hygiene, topical antibiotic or manuka honey-based ointment can be used on the lid margin.9,10 A short course of topical antibiotics (at night for two weeks) is usually sufficient to break the acute inflammatory cycle, whereas manuka honey ointment can be used longer term (three months or ongoing).

EYELID WARMING FOR MGD Eyelid warming is a mainstay of treatment for MGD, used to soften or liquefy secretions in obstructed glands. For optimal effect, compresses should be heated to approximately 45°C and applied for five to 15 minutes. These conditions are difficult to achieve with hot towels, so heat-bead or electric warming eye masks, where temperature is easier to standardise and maintain, should be used in preference, and may result in greater patient compliance due to ease of use and reduced preparation.

Due to lack of uniformity of manufacture, consistent temperature and heating times are still difficult ensure, so patients who demonstrate low compliance or fail to achieve lasting improvement with self-treatment can be offered the option of undertaking treatment with in-office thermal systems (Blephasteam, LipiFlow, TearCare, iLux, etc.). In-office treatments have been shown to be more effective than home therapy, and symptomatic improvement may be maintained for up to nine months after treatment.11

38

INSIGHT November 2023

INTENSE PULSED LIGHT (IPL) IPL treatment helps to improve tear composition and stability in patients with MGD. IPL utilises light in the visible spectrum to induce thermolysis of melanin and haemoglobin resulting in reduced inflammation and telangiectasia along the lid margin and improved cellular function of the meibomian glands. Additionally, heating of the meibomian glands, liquefication of meibum, and reduction of bacteria and Demodex mites that results from treatment is beneficial.13 Treatment involves the application of brief light pulses with a high-output flash lamp, through an interfacing gel, in a radial pattern under the inferior eyelids, across the nose, and to the temples.

Typically, an initial treatment course of three to four sessions over a three-month period is recommended, with further treatments conducted as required for recalcitrant disease or maintenance.

Further, IPL can be used to resolve acute chalazia when performed direct-to-lid with metal corneal shields.

CONSERVING TEARS Evidence suggests that silicone punctal plugs could provide symptomatic relief in severe aqueous-deficient DED. Tear retention is achieved by blocking puncta with silicone or gel-like plugs or via a surgical procedure that can permanently close the tear ducts. For a less permanent solution, dissolving collagen plugs can be trialled to determine effectiveness of tear retention in improving symptoms and clinical signs.

However, caution should be used in the presence of ocular surface inflammation because, theoretically, occlusion of tear outflow could prolong the presence of pro-inflammatory cytokines on the ocular surface. Potential complications are spontaneous plug loss, epiphora, ocular irritation and foreign body sensation, as well as inflammatory effects to the tissue surrounding the plugs which can result in permanent change to the lid anatomy when they are left in long term.

IMPROVING TEAR QUALITY AND PRODUCTION Meta-analysis showed improvement tear stability and tear secretion (TBUT and Schirmer test) in DED patients taking omega-3 fatty acid supplements (EPA and DHA fatty acids).14 Omega-3 fatty acids act by improving the lipid profile of meibum which results in a more stable tear film; and contain anti-inflammatory lipids which reduce inflammation in the lacrimal gland allowing for increased tear production and reduced ocular surface inflammation. Additionally, evidence suggests that supplements containing

flax seed oil (ALA fatty acids) in addition to fish oils, may also improve symptoms (reported by OSDI) in addition to clinical measures.

ARTIFICIAL TEAR SUPPLEMENTS Ocular lubricants are the mainstay of DED therapy.

They act to increase tear volume and stabilise tear film which reduces corneal epithelium/ palpebral conjunctiva friction, replace deficient tear components, reduce tear hyperosmolarity, and dilute tear inflammatory cytokines.

Non-preserved lubricants should be chosen to avoid preservatives (especially BAK), and formulations should be specifically recommended to suit the patient’s requirements with respect to viscosity, osmolarity and constituents.

BIOLOGICAL TEAR SUPPLEMENTS Biological fluids applied to the anterior ocular surface as tear replacement have potential advantages over artificial tear supplements in that they serve as not only a lacrimal substitute for lubrication purposes, but also contain other bioactive agents that mimic natural tears more closely and may promote healthy cell growth and healing of the ocular surface.

Autologous serum (AS) is blood serum purified from patient then diluted with saline (20% concentration most common) which can be accessed through ophthalmologist referral and subsidised by Medicare. The greatest effect is shown within the first three months of treatment; however, some patients report ongoing preference for AS over artificial tear supplements.

CONCLUSION The historical approach of ocular lubricants and hot towel compresses is neither sufficient nor acceptable practice where so much evidence for the effectiveness of further management strategies exists.

Patients with DED should be reviewed monthly during initial treatment until significant improvement of signs and symptoms is achieved, then less frequently as the patient becomes comfortable and compliant with ongoing home therapy.

With so many people affected by DED, implementing effective management strategies and education in our practices gives the opportunity to increase patient satisfaction, loyalty and create word-of-mouth referrals to increase business and revenue.

NOTE: References to appear in the online version of this article.

NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.

PRE

Vizo-PF Dorzolatim

SE

R VA

TIV

Introducing

E

FREE

Preservative-Free Eye Drops

Dorzolamide (as HCI) 20 mg/mL, Timolol (as maleate) 5mg/mL PBS Information: Restricted benefit. Treatment of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma when concomitant therapy is appropriate.

The only preservative-free Glaucoma eye drop treatment in a multi-dose bottle

E REDUC HELPSTIC WASTE PLAS

MINIMUM PRODUCT INFORMATION

see full Product Information (PI).

Before prescribing, please review the full product information at www.aftpharm.com/prescription/vizo-pf-dorzolatim.

Pregnancy Category C, (see full PI). A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Indications: Treatment of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma when concomitant therapy is appropriate.

Contraindications: Reactive airway disease, bronchial asthma or a history of bronchial asthma, or severe chronic obstructive pulmonary disease; sinus bradycardia, sinoatrial block, second or third degree atrioventricular block, overt cardiac failure, cardiogenic shock; hypersensitivity to any component of this product.

Precautions: Adverse reactions found with systemic administration of beta-blockers may occur with topical administration.

Cardio-respiratory reactions; vascular disorders should be treated with caution; masking of hypoglycemic symptoms in patients with diabetes mellitus; masking of thyrotoxicosis; surgical anesthesia; immunology and hypersensitivity, the dorzolamide component is a sulfonamide; concomitant therapy with carbonic anhydrase inhibitors; not been studied in patients with acute angle-closure glaucoma; choroidal detachment has been reported; increased potential for developing corneal oedema in patients with low endothelial cell counts; beta-adrenergic blockade has been reported to increase muscle weakness; patients should be advised to seek their physician’s advice if they develop an intercurrent ocular condition or any ocular reactions; Dorzolamide/timolol 2%/0.5% has not been studied in people wearing contact lenses; not been studied in patients with hepatic impairment; not been studied in patients with severe renal impairment (CrCl < 30 millilitre/min); for use in the elderly and paediatric use,

Interactions with other medicines: See Contraindications and full PI; specific drug interaction studies have not been performed with Vizo-PF Dorzolatim.

The potential exists for additive effects and production of hypotension and/or marked bradycardia with timolol maleate; disturbances have been reported with oral carbonic anhydrase inhibitors; mydriasis resulting from concomitant use of timolol maleate and adrenaline has been reported.

Adverse effects: Most frequently reported adverse effects were: ocular burning and stinging, taste perversion, corneal erosion, conjunctival injection, blurred vision, tearing, and ocular itching; urolithiasis was reported rarely; others (see full PI).

May affect some patients’ ability to drive and/or operate machinery.

Dosage: One drop in the affected eye(s) two times daily; when substituting for another ophthalmic antiglaucoma agent(s), discontinue the other agent(s) after proper dosing on one day, and start Vizo-PF Dorzolatim on the next day.

If another topical ophthalmic agent is being used, the other agent should be administered at least ten minutes apart; efficacy in paediatric patients has not been established (for more information regarding safety in paediatric patients ≥ 2 and < 6 years of age, see full PI).

To avoid contamination of the solution, keep the container tightly closed, do not let the dropper tip touch any surface.

Unopened bottle: Store below 25°C. Protect from heat. Opened bottle: Store below 25°C. Discard contents 4 weeks after opening the bottle. Protect from heat.

AFT Pharmaceuticals Pty Ltd, 113 Wicks Road, North Ryde, NSW 2113. Phone: 1800 238 742.

ABN 29105636413. Date material prepared: July 2023

EQUIPMENT

With correct intraocular pressure measurement being one of the most important factors in glaucoma diagnosis, the new Reichert Tono-Vera boasts several features to equip clinicians with accessible and cutting-edge tonometry technology.

HERALDING A NEW ERA FOR

T

onometers are one of the most employed pieces of equipment during a routine visit to the eye clinic, therefore ease-of-use and non-invasiveness are enticing features sought out by busy, modern-day clinicians.

Australian medical device supplier, Device Technologies, will feature a new portable tonometer, Tono-Vera, among its suite of ophthalmic technology late in 2023. In fact, Australia and Hong Kong are expected to be the first two Asia-Pacific countries to access the device. Developed

by Reichert, a leader in tonometry and glaucoma diagnostics, Tono-Vera is an alternative to traditional tonometer options with an accessible user interface that the company says yields accurate results.

Although traditional tonometers, such as the Goldmann applanation tonometer, are the gold standard of intraocular pressure (IOP) measurement, they have some drawbacks that Tono-Vera seeks to overcome. Limitations include the requirement of a slit-lamp, upright position of the patient, and the use of pharmaceutical agents such as topical anaesthetics and fluorescein.

“The ‘standard’ method of tonometry, Goldmann tonometry, requires a skilled user and takes time to execute. In addition, it requires numbing drops and fluorescein to be placed in the eye which is uncomfortable for the patient and costly,” Mr Tedd Ho, regional sales director at Reichert, says.

“Finally, Goldmann requires high-level disinfection between uses which is very time consuming and cumbersome. Other handheld tonometers require less skill than Goldmann but are still subject to operator variability since it is critical when taking an IOP measurement to make the measurement on the central cornea.”

According to Reichert, the Tona-Vera tonometer uses gentle rebound technology; where a probe bounces off the cornea and its deceleration is used to measure IOP. Mr Jarrod Power, product manager of Device Technologies, says healthcare professionals have enjoyed rebound tonometry for its approachability and the ability to avoid pharmacological agents.

40

tonometry

“The Tono-Vera gives healthcare professionals a choice for the first time in rebound tonometers, with a new interface to guide the clinician in achieving the best quality of measurement from the device,” he says.

Specifically, Ho says the device’s patented ActiView Positioning System is the star of the show. The alignment system features a coloured view of the eye, with interactive alignment prompts to guide the user to the apex of the cornea before automatically taking the measurement.

Colour rings also indicate the reliability of the reading. This increases the objectivity of Tono-Vera readings relative to other tonometers, according to Reichert.

“With its new guided interface, the Tono-Vera gives clinicians a standardised positioning system using colour coding in a neat, augmented image of the patients’ eye to provide the confidence that measurements taken, no matter who took them, will be of the highest standard for superior clinical confidence,” Power adds.

He says the alignment feature optimises positioning, thereby minimising the chance of recording improper measurements.1 “When you have a range of clinicians taking the measurements, standardising the technique and positioning of the measurement has been difficult. Studies showed that measurements taken in the incorrect position led to improper measurements, which could affect clinical decision making,” Power says.

According to Reichert, an accessible user interface and objective readings allow Tono-Vera to accommodate for increased patient volume coupled with high staff turnover in eyecare practices.

“Ophthalmology and optometry practices worldwide are struggling with increased patient volume,” Ho says.

“To combat this, more and more tests are being delegated to technicians and nurses. Simultaneously, modern eyecare practices are complaining of high levels of increased staff turnover. This is disruptive because inexperienced staff can obtain poor results from measurement devices if not used properly and training new staff takes time.”

The Tono-Vera base allows the device to be docked and charged if this is the model in use. It also allows for storage of tonometer probes.

INSIGHT November 2023

RR1947

IOP WITH FEWER PROBE ACTIVATIONS Another feature of the Tono-Vera is its ability to achieve an accurate IOP measurement in as little as three-probe activations, Reichert says.

Adding to its efficiency, the Ocu-Dot tonometer probes are single use probes that eliminate the need for disinfection between patients.

records, thereby streamlining the consultation process.

“The ‘three-plus’ measurement mode, which permits accurate IOP measurement in as little as three probe activations, further expedites the speedy measurement. Other handheld tonometers require six to 10 measurements for a reliable IOP value,” Ho says.

Device Technologies will provide introductory special pricing, meaning the Tono-Vera will be competitively priced for the market.

Reichert states that portability of the Tono-Vera can also improve ergonomics for the practitioner because patients can be measured in seated or supine positions. Its ergonomic and symmetrical design allows for use by both right- and left-handed users too.

With the addition of the Tono-Vera, Ho says Reichert is offering the most comprehensive line of tonometry solutions.

“Left-handed clinicians will rejoice that the interface is designed for ambidextrous use. This will also help with access when the clinician needs to acquire a measurement from either side or more awkward positions,” Power says.

“Reichert has a history of innovation and quality extending back nearly 190 years. We invented the lensometer, the phoropter, the non-contact tonometer and the ocular response analyser. We are world-leaders in the tonometry market. No one knows more about tonometry than Reichert,” he says.

Tono-Vera will be available in both rechargeable and AA battery models. Users can also enjoy the convenience of interchangeability of these battery packs.

“We expect the Tono-Vera to be enjoyed by all clinicians alike. Being portable and with very little learning curve, it can be utilised in a huge range of situations, from the travelling clinician, shared between clinical rooms in a fixed practice or sole clinician. Its primary use will be in ophthalmology and optometry, but it will also have great clinical indication in emergency and general medicine,” Power says.

Also included in its scope of features, is Bluetooth compatibility.

Tono-Vera can be connected directly to patients’ electronic health

With TGA approval expected by the time of print, Reichert hopes to deliver on orders in the last quarter of 2023.

REFERENCE: 1. Muttuvelu DV, Baggesen K, Ehlers N. Precision and accuracy of the ICare tonometer–Peripheral and central IOP measurements by rebound tonometry. Acta ophthalmologica. 2012 Jun;90(4):322-6.

The ActiView Positioning System displays a coloured view of the eye, with interactive alignment prompts.

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

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

Minimum Product Information: XALATAN® (Latanoprost 50 µg/mL) Eye Drops. Indication: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.

Contraindications: Hypersensitivity to ingredients. Precautions: Change in eye colour due to increased iris pigmentation; heterochromia; eyelid skin darkening; reversible eyelash and vellus hair changes; macular oedema often associated with aphakia / pseudoaphakia; other types of glaucoma; contact lenses; severe or brittle asthma; herpetic keratitis; driving or using machines – transient blurry vision; elderly: no data; children: do not use, no data; lactation- metabolites present in breast milk, risk / benefit. Pregnancy: Category (B3) Interactions: other prostaglandins, thiomersal. See PI for details. Adverse Effects: Eye Disorders: blurred vision, burning, conjunctivitis, excessive tearing, eye pain, foreign body sensation, hyperaemia, iris hyperpigmentation, itching, punctate epithelial erosions, grittiness, stinging, eyelash and vellus hair changes, punctate keratitis, blepharitis, eyelid oedema, localised skin reaction on eyelids; Systemic: bronchitis, upper respiratory tract infection, eczema, rash, urinary tract disorder, abnormal liver function, myalgia, arthralgia, dizziness, headache, rash, chest pain, asthma, dyspnoea . See PI for details and other AEs. Dosage and Administration: One eye drop in the affected eye(s) once daily. Other eye drops should be administered at least 5 minutes apart.

A first choice for glaucoma management1

✔

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

RR1947 Xalatan ½ Page Ad.indd 1

References: 1. Clinical Practice Guide for the Diagnosis and Management of Open Angle Glaucoma.

Optometry Australia 2020 2. Australian Commission on Safety and Quality in Healthcare Active Ingredient Prescribing Guide - list of medicines for brand consideration December 2022 Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma.com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2023 Aspen group of companies or its licensor. All rights reserved. Prepared: July 2023 AU-LAT-072023-07653

25/7/23 3:16 pm

DRY EYE

Alcon’s Systane Hydration is the company’s latest multi-dose preservativefree lubricant eye drops.

of the cornea, therefore protecting damaged cells to allow for repair and renewal, 5 Alcon states.

All in all, the combination of HP-Guar and borate with HA has been shown to have an additive effect providing two times greater moisture retention compared to drops with HA alone in a laboratory study.1 Summers has welcomed the addition of Systane Hydration to her dry eye tool kit, with the therapy designed to address the symptoms of moderate to severe^ dry eye – and can be used for dry eye patients before and after ocular surgery.6 Approximately 82% of patients experience moderate to severe dry eye symptoms following cataract surgery.7 And peri-operative management of existing dry eye can reduce post-operative dry eye symptoms and may influence post-operative outcomes.6 The product is also suitable to use with soft contact lenses.

“By listening to what the research is telling us, Alcon has innovated to come up with Systane Hydration,” says Summers, who practises in Darwin.

A new take ON LUBRICATING EYE DROPS

A new product from Alcon is shaking up the eye lubricant category and piquing the interest of clinical optometrists and tear film researchers in Australia.

I

n Australia’s Top End, patients have many reasons to visit optometrist Ms Helen Summers’ with a dry eye complaint. Bushfires, a long dry season and heightened allergy responses are among the contributing factors, along with long periods of exposure to air conditioning and fans.

With a younger demographic, there’s also a high number of post-refractive surgery patients seeking relief, as well as older patients recovering from cataract surgery or treating chronic conditions like glaucoma with eye drops.

For most optometrists, lubricating eye drops are a first-line defence in such instances. It’s a market that has matured significantly over the years, with a greater emphasis on preservative-free products.

Alcon Vision Care is one company considered an innovator in the preservative-free lubricant eye drop category, resulting in its latest product: Systane Hydration Lubricant Eye Drops 10mL. Summers and other Australian optometrists gained access to the over-the-counter (OTC) product earlier this year, which has become a go-to solution for many of her patients seeking dry eye relief.

According to Alcon, the lubricant adopts Systane’s Intelligent Delivery system of HP-Guar and borate in combination with 0.15% hyaluronic acid (HA)* for long-lasting dry eye relief. 1-3 Upon instillation, the HP-Guar and borate crosslink to form a viscoelastic meshwork,4 forming a mucomimetic bandage over the ocular surface and therefore increasing the retention of demulcents. 5 Additionally, HP-Guar preferentially binds to damaged areas

42

INSIGHT November 2023

“The innovation lies in the formulation, with the product being ideal for patients I see with aqueous deficient dry eye, and also those having post-refractive and cataract procedures. By retaining the moisture on the ocular surface for longer, there is an improved tear film osmolarity. We are able to create a better outcome, not only in comfort, but for recovery too. It’s important we see the clinical difference, but what’s the point if the patient doesn’t feel the soothing effect as well? Systane Hydration is offering an improved tear film, more comfort for the patient and better outcomes from the procedures.”

Summers has also prescribed Systane Hydration in patients taking glaucoma eye drops to help counteract the chronic dry eye effects of preservatives like benzalkonium chloride (BAK).

“I see a lot of ocular surface toxicity (medicomentosa) due to chronic exposure of BAK from long term use of glaucoma drops, allergy drops and ‘misuse’ of OTC antibiotic drops, and ‘red-eye’ drops. Even some of the so-called ‘safe preservatives’ cause reactions in some patients. To recover after the use of medicated drops during surgery and post-surgery, (anti-inflammatories, antibiotics) a preservative-free option for dry eye relief is so important,” she says.

“For my post cataract or refractive surgery patients, Systane Hydration has played an important role. You might say it fills the uneven surface or compromised areas of the cornea which helps improve patient comfort levels.

“We need to remember people with dry eye can be quite desperate by the time they visit the optometrist. Dry eyes are tired eyes, and impacts their quality of life. So, it’s great to have a product like Systane Hydration as a starting point where I can be confident patients are likely to notice a difference.”

Alcon has innovated beyond the formulation too. The multidose bottle features Alcon’s patented PureFlow technology, helping the company eliminate the need for preservatives. It is designed with a one-way valve to ensure no contaminated liquid can be re-introduced into the container and a fine silicone membrane to filter returned air. 8 The bottle also has a low squeeze force and features a blue tip to aid targeting of the eye for ease of instillation.”8 Summers expects this will be of benefit to elderly patients who may have dexterity issues. But there’s environmental benefits as well, with multi-dose bottles considered friendlier to the planet than single-use ampoules.

PERFORMANCE IN UNSW STUDIES Systane Hydration is also of interest to the ophthalmic research community in Australia, with studies under way to investigate its effectiveness in dry eye patients also dealing with diabetes or migraines.

Associate Professor Maria Markoulli is from the School of Optometry and Vision Science at UNSW whose research interests lie within tear film biochemistry and the ocular surface.

She first became aware of Systane Hydration through Alcon when UNSW started looking into possible treatments for study patients with diabetes. In particular, UNSW researchers sought an eye drop that was preservative-free,

given the often-delicate corneas of patients with diabetes.

Of interest to Markoulli is that Systane Hydration is well-tolerated by patients, with her unpublished preliminary data indicating it provides symptomatic relief to patients with diabetes and dry eye disease.

“We have been working with Alcon, specifically on Systane Hydration, on two studies. The first looked at patients with diabetes and showed they were four times more likely to have dry eye disease if they had co-existent neuropathy,” she says. “When we treated those with dry eye disease with either Systane Hydration or saline as a placebo, we saw an improvement in symptoms with Systane Hydration when used four times a day for one month.”

“The second study is still a work in progress and involves us treating patients who have both migraine and dry eye disease, our aim being to evaluate whether managing dry eye disease helps alleviate the severity and possibly the frequency of migraine. This work will be presented in 2024.”

When looking at the lubricants landscape, Markoulli says the industry is in a much better position than years gone by, with more options, and many of these being preservative-free – but there was still some way to go.

“Going preservative-free in the management of dry eye disease is a ‘no-brainer’ now. We know that the use of preservatives can contribute to iatrogenic dry eye disease. The more options we have that are preservative-free, the better for our patients” she says.

“One challenge that we have now is that in many cases there is a lack of studies evaluating the clinical efficacy of these lubricants in certain patient cohorts. For example, we don’t have many head-to-head comparisons, or studies showing lubricant efficacy in those who have lost corneal nerves due to various conditions. We also don’t know a lot about when we should be implementing therapy post-operatively, e.g., post cataract surgery, or post refractive surgery.”

“GOING PRESERVATIVE-FREE IN THE MANAGEMENT OF DRY EYE DISEASE IS A ‘NO-BRAINER’ NOW. WE KNOW THAT THE USE OF PRESERVATIVES CAN CONTRIBUTE TO IATROGENIC DRY EYE DISEASE.” A/PROF MARIA MARKOULLI UNSW

REFERENCES: 1. Ranagarajan et al. Effects of a Hyaluronic Acid/Hydroxypropyl Guar Artificial Tear Solution on Protection, Recover and Lubricity in Models of Corneal Epithelium. J Ocul Pharmacol Ther 2015; 31(8): 491-497 2. Davitt et al. Efficacy in Patients with Dry Eye After Treatment with a New Lubricant Eye Drop Formulation. J Ocul Pharmacol Ther 2010; 26(4): 347-353 3. Rolando et al. Protecting the Ocular Surface and Improving the Quality of Life of Dry Eye Patients. J Ocul Pharmacol Ther 2009; 25(3): 271-277 4. Springs, C. Novel Ocular Lubricant Containing an Intelligent Delivery System: Details of Its Mechanism of Action. Dev Ophthalmol 2010; 45: 139-147 5. Labetoulle et al. Efficacy and safety of a dual-polymer hydroxypropyl guar- and hyaluronic acid-containing lubricant eyedrops for the management od dry-eye disease: a randomized double-masked clinical study. Clin Ophthalmol 2018; 12: 2499-2508 6. Favuzza et al. Protecting the Ocular Surface in Cataract Surgery: The Efficacy of the Perioperative Use of a Hydroxypropyl Guar and Hyaluronic Acid Ophthalmic Solution. Clin Ophthalmol 2020; 14: 1769-1775 7. Jayshree et al. A Prospective Study of Dry Eye after manual Small Incision Cataract Surgery in a rural population of Bagalkot. J Clin Res Ophthalmol 2017; 4(2): 25-29 8. Nemera Novelia Product Leaflet *contains sodum hyaluronate, the salt form of hyaluronic acid ^recommendation based upon expected on-eye viscosity

See more, know more with more Insight Subscribe FREE and receive the latest news

Find jobs and advance your career with Insight’s Classifieds

Insight is mobile and tablet friendly

Get to know the newest products from suppliers across Australia

Insight’s new website keeps you updated on the latest industry news and information. With a world-class responsive design, Insight is now accessible seamlessly on any device, 24/7.

Sign-up FREE to our eNewsletters and industry reports delivered weekly straight to your inbox.

www.insightnews.com.au

EVENT

Dr Noel Brennan presenting on a new myopia control soft contact lens prototype from Johnson & Johnson Vision.

s

O=MEGA23

HIGHLIGHTS FROM THE CLINICAL PROGRAM Myopia dominated the clinical program at O=MEGA23 and the 4th World Congress of Optometry, but there were also many other thought-provoking sessions that Insight attended.

I

n a small breakout room in the depths of the Melbourne Convention and Exhibition Centre, one of the most lively discussions took place at the O=MEGA23 conference. There, Melbourne optometrist Mr Jim Papas was presenting on a new TGA-approved myopia management intervention from Australian-based firm Eyerising International.

Papas is the director of clinical optometry for the company that has developed a therapy based on repeated low-level red-light (RLRL) technology in the treatment of myopia. The treatment emits low level single wavelength red light, increasing blood flow and metabolism causing re-thickening of the choroidal layer, thereby helping slow elongation of axial length.

Being a new approach to myopia that effectively stimulates the body’s own healing mechanisms – and recently receiving regulatory clearance in Australia (aas well as in Europe, New Zealand, Malaysia) – it’s no surprise that myopia authorities like Dr Kate and Dr Paul Gifford were in attendance to hear what the company had to say. Also of significance is the statement that Eyerising’s device has been shown to have up to 87.7% treatment efficacy in patients with high compliance in one study.

Papas presented alongside Dr Nellie Deen, from the Australian College of Optometry (ACO), where RLRL is being investigated in a clinical study in Australia. All up, five clinical trials are also under way globally, and a sixth (a multicentre, real world clinical evaluation in the EU) is planned.

RLRL is an exciting development in the myopia field. The Giffords, as well as optometrists from the ACO, had many questions for the company.

A lively discussion took place about its mechanism of action, safety and rebound effects which Papas and Mr Paul Cooke, CEO of Eyerising, engaged with by explaining the technology and highlighting studies supporting RLRL in myopia management.

Specifically, Eyesrising presented information showing more than 150,000 children have undergone RLRL therapy, with nearly 80,000 daily users in China. As reported by its Original Equipment Manufacturer (OEM) side-effect reporting centre, only five out of the 80,000 users in China have reported severe adverse events (1:20,000). Importantly, none of these were severe and all recovered.

“This is exactly what these sessions are about,” O=MEGA23 organiser and Optical Distributors and Manufacturers Association (ODMA) CEO Ms Amanda Trotman told Insight.

“It’s a forum to hear directly from researchers and industry, and drill down into topics with back-and-forth discussions. And for anyone who is launching a product, it’s an opportunity for them to hear feedback or what the concerns may be, so they can work to address them on the spot and through their marketing.”

The debate was robust and indicative of a conference where myopia took centre stage in the clinical program.

INSIGHT November 2023

45

EVENT

The main plenary theatre was full to hear outgoing World Council of Optometry president Prof Peter Hendicott deliver his update.

DAY 1 Prof Peter Hendicott – Global optometry update This year’s O=MEGA23 was held with the 4th World Congress of Optometry. This meant there were around 200 overseas attendees, including some high profile figures.

Early on delegates were given an update on the World Health Organization’s World Report on Vision and its relevance to optometry.

This was delivered by outgoing WCO president Professor Peter Hendicott, an Australian, who posed many thought-provoking questions about what future role optometry will play to address eye health inequalities globally.

Major challenges that lie ahead, he said, including ensuring optometry has the relevant competences to broaden its scope and maximise its participation in health delivery.

“The challenge that gets put to optometry when we increase our scope is that patient safety will be adversely affected,” he said. “We need evidence, through research and clinical pathway development trials, that when optometry is involved in health systems in a different way, that it’s effective, it’s safe, outcomes are improved through early detection, and costs are reduced.”

He said the WHO and UN had highlighted the lack of human resources, but given it takes five to seven years to train an optometrist and 15 years for an ophthalmologist, the industry needs to think of smarter ways to utilise the practitioners it already has.

“We need to look at how optometry can work and deliver eyecare effectively with others, in an eyecare pathway that is continuous. We need to think about how we can use technologies, devices, artificial intelligence, and the rest, to improve access,” he said.

Dr Susan Cotter – Flipping the script on uncorrected hyperopia Dr Susan Cotter, one of two keynote speakers of the conference and president of the American Academy of Optometry, kicked off her session by renaming the lecture live on-stage from ‘Can correction of refractive error change a child’s life trajectory?’ – as listed in the program – to ‘Can correction of hyperopia change a child’s life trajectory?’.

“I was afraid that if people knew I was talking about hyperopia, instead of myopia, they wouldn’t want to come,” she quipped.

Hyperopia in children has been a relatively neglected field, but Cotter found comments from as far back as the 1970s calling for eyecare professionals to take more notice.

46

INSIGHT November 2023

She told an anecdote of a six-year-old patient named Diane who couldn’t complete school assignments, was disruptive in the classroom, and had a short attention span. After prescribing spectacles to correct her moderate hyperopia, one month later Cotter received a call from Diane’s teacher describing the U-turn in the young girl's behaviour and academic performance.

“It makes you wonder what would have happened if Diane never visited the optometrist. If she doesn’t learn to read, she doesn’t do well in subjects, now she doesn’t like school, maybe she drops out of high school, and she doesn’t go on to university. The trickle-down effect can be profoundly life-altering; it can influence not only educational performance but also career prospects and future earning potential,” she said.

Cotter demonstrated prevalence rates of hyperopia, with one US population-based study showing rates between 15-20% in children under the age of six. Collated data from population-based studies in the US, Singapore, and Sydney showed the prevalence of more than +2.00D Dr Kate and Dr Paul Gifford held an intriguing session answering some of the big questions in myopia.

showed increased reading speed when hyperopia was corrected.

Her favourite study was by the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study Group who compared four- and five-year-olds with +3.00D to +6.00D of uncorrected hyperopia, with age-matched emmetropic children from the same schools.

They found significantly worse visual function in the uncorrected moderate hyperopia group, as well as deficits in sustained attention, visual perception, as well as visual motor integration. Importantly, on literacy tests, those with moderate uncorrected hyperopia did significantly worse.

“So, can correction of moderate hyperopia change a young child’s life trajectory? I think it can," Cotter said. "We certainly have evidence pointing in that direction and it’s up to us as optometrists who are seeing children to be on the look out and pay special attention to these children who might benefit from optical correction.”

Professor James Wolffsohn – The power of consensus The answer is 17 years, but what is the question? This was how Professor James Wolffsohn captured the attention of delegates with his presentation showing how consensus reports are developed and how they can be utilised to elevate clinical practice.

of hyperopia was 21% in 4-year-olds.

“And if they didn’t have amblyopia or strabismus, the majority of them were not wearing an optical correction,” she added.

With this in mind, Cotter cited a Queensland University of Technology study showing the condition’s impact on reading performance, especially when it came to comprehension. Other researchers also

The question was: what is the time lag in the translation of research into clinical practice? Noting this is a long time, he addressed the conflict between clinical intuition and the need for standardisation based on research evidence.

“If that was your cancer, would you want someone using techniques that were developed 17 years ago?,” said Wolffsohn, the second keynote speaker and Professor of Optometry at Aston University in the UK. When it comes to the term “evidence-based practice”, he said three

Quantify brain waves associated with human sensitivity to provide effective visual clarity and comfort

EVENT

components matter. The clinician first needs to consider the patient’s own preferences, and then build in their own clinical experience and available research evidence.

Highlighting inconsistencies in the industry, he used the example of dry eye diagnosis.

Dr Noel Brennan – A new 'breakthrough' contact lens for myopia In one a well-attended session, Australian scientist and inventor Dr Noel Brennan, a fellow for Johnson & Johnson Vision, provided insight into a “breakthrough” soft contact lens for myopia control the company has developed.

One 2017 survey involving 1,139 practitioners showed the median number of tests – such as verbal symptoms, fluorescein breakup time, corneal staining – was seven, but some practitioners were performing as many as 28.

At the heart of this lens design is the application of “non-coaxial optics” that he said “breaks the nexus” between efficacy and vision experienced in current designs that have originated from presbyopia correction principles and adopted a ‘near-add’ focus.

“It just can’t be like that in clinical practice because if perform 28 tests then no one would ever get diagnosed,” he said.

Traditionally, he said contact lens developers have had three knobs they can tweak to strike the balance between efficacy and vision, namely changing the power in the treatment zone, changing the size of the treatment zone and changing the location of the treatment zone.

Also in 2017, the TFOS DEWS II reports were published that considered the research and clinical application of dry eye tests and came up with a simple way for practices to diagnose the disease.

Wolffsohn said the DEWS reports were consensus documents that led the way for drawing out the latest evidence-based literature and turning it into something to be applied in clinical practice. Other major clinical summaries have also emerged like the International Myopia Institute white papers, and the CLEAR reports from the British Contact Lens Association.

“I find these to be useful reference documents. I’m not going to learn all of it, but sometimes a patient will ask me about scleral lenses and dry eye and I can dip into these resources and say this is the evidence we’ve got, and why we might go ahead with this approach or not,” he said.

“And of course, there are other professionals such as GPs and pharmacists who are dealing with people who report symptoms of dry eye, so by having a consensus amongst ourselves as optometrists, that helps other professions understand their role.”

“And so we are looking to find a fourth knob to help us break away from that interrelationship we currently see between efficacy and vision," he said.

In developing J&J’s prototype lens, Brennan said the company joined forces with Professor Michael Collins, from the School of Optometry and Vision Science at the Queensland University of Technology, who has developed a special apparatus that incorporated a spatial light modulator. This allows contact lens developers to test optical designs in a much more efficient manner than previously.

Another crucial element is the use of axial length and choroidal thickness to inform the lens design. It was later suggested that lenslets – much like those found in myopia control spectacle lenses – could be incorporated. Brennan and his team asked the QUT team to put a design incorporating this into its spatial light modulator.

“And they said sure, but would you’d like that with coaxial optics or non-coaxial optics? And we said, ‘say what?’.”

VF2000 NEO -

PORTABLE VISUAL FIELD ANALYZER The New Standard in Visual Field Testing Virtual Reality Visual Field device - incorporates complete Visual Field analysis.

Detailed progression analysis and the most versatile & efficient vision screening technology.

Latest technology provides the same reliability and reports as the “gold standard”.

Supplied complete with a Tablet PC – BlueTooth interface with the VF2000 NEO. Compact/Space-saving/Portable - can be used anywhere, no need for a darkened room.

Features include: Active eye tracking – enhances reliability.

Full and Fast Thresholds VF Testing plus Neuro, Kinetic, Ptosis and Estermann tests

Ph: 1800804331

Email: sales@bocinstruments.com.au

FDT Testing

Stereopsis Visual Acuity and Contrast Sensitivity Colour Testing (Ishihara, D15 and Advanced Colour Tests) Eye Mobility and Strabismus

The QUT team went on to explain how the contact lenses could bring light to a point focus, or it can be done with individual axes.

“And being the good little scientists that we are, we said, ‘let’s try both’, and the results are rather stunning," Brennan added.

During the presentation, he then pulled up a slide showing that both methods showed a reduction in axial length, but when it came to vision and contrast the non-coaxial design performed better.

This has formed the basis of the new lens and is the fourth knob that can be turned to advance myopia control soft contact lenses. Brennan said the prototype represents many firsts in soft contact lens myopia control.

“We built this from the ground up. It’s the first time a soft contact lens has been made for myopia control not based on presbyopia principles per se. We used the novel apparatus for the first time to enable systematic concept optimisation and iterative refinement of individual lens designs,” he said.

“For the first time, we’ve applied non-coaxial optics in contact lenses to break this nexus between efficacy and vision. And for the first time, we’ve used rotationally symmetric portion of a torus, rather than a sphere, for myopia control treatment. We achieved FDA device breakthrough designation, we’ve validated the design concept through clinical trials with an excellent balance between efficacy and vision ... and the resulting lenses meet all the desired properties for paediatric myopia control.”

DAY 2 Dr Kate and Dr Paul Gifford – Unanswered questions in myopia Myopia was the headline act on the second day of the clinical conference, so it was perhaps fitted that homegrown husband-and-wife myopia experts Dr Kate and Dr Paul Gifford initiated proceedings.

The topic: unanswered questions in myopia and, more specifically, looking at the “meaty topic” of the most efficacious interventions, with the value placed on axial length data and how practitioners can interpret results from studies.

Kate explained three different ways that practitioners can understand efficacy: millimetres, treatments that are going to save 1.00D, and percentages.

In terms of millimetres – treatments that have shown an absolute reduction of axial growth by at least 0.1mm/year (a measure that moves the myopic eye closer to emmetropic eye growth) – she said new myopia controlling spectacles like HOYA’s MiYOSMART and Essilor Stellest have met this criteria, alongside dual focus contact lenses like CooperVision’s MiSight 1 day, the aforementioned J&J non-coaxial ring focus contact lens design, orthokeratology (orthok), atropine (1.0%, 0.05% and 0.025%), and red light-based therapy.

On the measure of saving 1.00D (approximately 0.25mm axial length equivalent), Kate explained this was particularly important because it has been shown that saving 1.00D reduces a patient’s lifelong risk of pathology, myopic macular degeneration in particular, by around 40%.

New spectacle lens designs again met this criteria along with dual focus, non-coaxial ring focus contact lenses and orthok. Red light did too, along with atropine 1.0% and 0.05%, she said.

“CAN CORRECTED HYPEROPIA CHANGE A YOUNG CHILD’S LIFE TRAJECTORY? I THINK IT CAN, WE’VE GOT EVIDENCE POINTING IN THAT DIRECTION.” DR SUSAN COTTER KEYNOTE SPEAKER

Specsavers ANZ head of professional services Dr Joe Paul gave the latest update on myopia prevalence.

Interestingly, she showed how three treatment modalities slowed axial length by 0.21mm, 0.15mm and 0.11mm compared to the control group, alongside their respective diopters savings, 0.54D, 0.40 and 0.23D. “You’ll note how the diopters vary wildly compared to the millimetres, and that speaks to why millimetres are our better measure when it comes to research studies to compare between treatments; diopters are blunter measurement instruments,” she said.

Kate said it was positive to see so many interventions achieve these treatment effects after two or three years of trial data. It begs the question, however, whether more than 1.00D can be saved? This can likely be achieved however a major barrier is that after two to three years when a treatment is showing effect in a study, it becomes unethical to keep progressing myopes in the control group. A way the industry has responded is through advanced modelling and, through this, it’s been shown children could save more than 2.00D with a childhood of MiSight 1 day contact lens wear.

“It means we’re getting that benefit of reducing myopic maculopathy by 40% and then another 40%, if we can save 2.00D. And research presented this year on the Stellest lens showed that it’s likely on a similar trend,” she said.

Kate also addressed the tricky issue of percentages. She said it was important to avoid comparing percentages across studies because each number belonged to that trial only. Instead, she recommended grouping them into categories: treatments that can slow progression by 50% or more (or “by at least half”), for example.

“That’s a simple message to parents to say we can’t stop progression, but we can slow it down. We then have interventions [on the second tier], which have shown in their studies of various durations, to slow progression by about a third. Now that might have been 32% or 37%, but about a third. And then we have minimally effective interventions in third place.”

In summing up, Paul said most treatments with at least 12 months of trial data show similar efficacy, with various options showing they can slow progression by at least a half. With no treatment showing clear superiority, he said the practitioner has options.

“You’re left with prescribing anything other than a single vision lenses, which we know is not a good approach, with a treatment that suits INSIGHT November 2023

49

EVENT

the child and fits your scope-of-practice. Also, by prescribing optical treatments we’re able to offer the dual benefit of treatment and vision correction, with an important factor here being full time wear,” he said.

a retrospective review from 2017-2022 of all children (under 16) visiting its practices across ANZ. Out of more than three million patient records, the company identified more than 460,000 myopic children, as per their spherical equivalent refraction calculated from their script.

Kate said highly compliant children had achieved excellent results in studies, but some questions remain when it comes to comparing treatments.

“We know that we have efficacy of a wide variety of treatments, we know there appears to be a dose response to atropine and we’re learning about different formulations. There doesn’t appear to be rebound effects with optical treatments, but there are with higher concentrations of atropine and with red light therapy,” she said.

“We’re still learning about how we can best describe efficacy and compare treatments from the research and a scientific perspective, whether that’s an absolute or a proportional effect. We’re also still learning about how long we should treat for and when we’re going to get the best treatment, and the influence ethnicity may or may not have on efficacy.”

Dr Joe Paul – Myopia prevalence in Australia Dr Joe Paul, head of professional services at Specsavers ANZ, provided the latest update on myopia prevalence rates as experienced by the company's practices in Australia and New Zealand.

He said there had been few large scale studies across the region, and various prevalence estimates have emerged from works such as the Sydney Myopia Study, SAVES study and Australia and New Zealand Child Myopia Report.

“Unfortunately, there’s very little in the way of the hard data for either of these countries,” he said.

This was the impetus for Specsavers to gauge prevalence by performing

In Australia, Specsavers found a general upwards trend of prevalence among children presenting to optometrists, increasing from 24.6% to 27.8% over the five-year period. The figures also showed the average age children are first diagnosed is also decreasing, from 14.6 years in 2017 to 13.3 years in 2022. And when looking at high myopes (greater than -6.00D), Paul showed this has increased to 3.5% in 2022.

Next, Specsavers was keen to extrapolate its findings comparing Medicare billing against ABS population data for each state to estimate prevalence across the total population in under 16 years. In this data, the estimated prevalence was 24.9% in Victoria (the highest), 20.8% in Western Australia and 10.5% in Northern Territory (the lowest).

“On average, across the country, we estimate the population prevalence of myopia among kids is 19.7%, which would mean that there’s approximately a million myopic kids in Australia. This is a chance for Australia to lead the world with a large population of kids and we are setting the standard for myopia management," he said.

“I don’t want to say this is necessarily a definitive value, it is an estimate based on Medicare billing and the ABS data and the patients we’re seeing at our practices, but it is perhaps the first national estimate of prevalence of myopia in Australia.

“Our prevalence estimate is higher than what has been reported in previous epidemiological studies, but slightly lower than the Australasia mark in Holden et al’s seminal paper and less than some surveys that have been done. Myopia’s perhaps not increasing quite as rapidly as it could be, but it is certainly on the rise.”

Revolutionising

CATARACT

TECHNOLOGY

Fast, error free Toric calculations.

Get in touch with us today for a free trial.

Schulte Holt Technology

Web: www.schulteholt.com Email: team@schulteholt.com

TECHNOLOGY

: e r u t u f e h t g in e y E

OPTOMETRISTS’ INSIGHTS ON AI Despite the myth that artificial intelligence (AI) will replace clinicians and deskill eyecare professions, optometrists hold positive attitudes toward the future use of AI to support the diagnosis of retinal disease, SHARON HO and Dr ANGELICA LY have discovered in their new study.

I

n today’s technological age, artificial intelligence (AI) represents a contemporary and innovative approach to eyecare, sparking tremendous interest due to its potential to increase efficiency, productivity, affordability, quality and accessibility. AI has chiefly been applied to image analysis, where computerised algorithms are trained to analyse clinical images and provide diagnostic and/or management recommendations. Previous research has shown these AI clinical decision support systems (CDSS) can achieve high accuracy for the detection of a number of ocular diseases including diabetic retinopathy,1-3 age-related macular degeneration, 4,5 glaucoma6 and retinopathy of prematurity.7 Despite their proven potential, AI CDSS are not widely implemented in routine clinical practice. This may be in part due to general misunderstanding and distrust toward new technology.

Along with Associate Professor Gordon Doig, we investigated this issue in our study entiled: ‘Attitudes of Optometrists toward Artificial Intelligence for the Diagnosis of Retinal Disease: A cross-sectional mail-out survey’. 8

suggests that optometrists may be more receptive to using AI CDSS in communities with relatively limited access to eyecare, such as in rural or regional communities. Meanwhile, multiple studies already exist demonstrating the reliability of diagnoses made by AI CDSS.1,3,9 Disseminating this information to optometrists may help reinforce positive attitudes toward the new technology.

In our survey, optometrists also responded positively to the potential for AI to improve diagnostic accuracy, save time, and be more cost-effective than current processes. Furthermore, they valued AI CDSS that fit well into their clinical workflow and that are easy to learn to use. These features are instrumental in driving the future use of AI and important qualities to developers for ensuring their products are well-suited to end-users.

While motivators for the adoption of AI mainly revolve around patient-centred benefits, potential barriers appear related to the rigour of validation and impact on professional autonomy from using AI CDSS.

We designed and conducted a survey of optometrists to identify their attitudes toward using AI in clinical practice to assist in diagnosing retinal disease. A total of 252 surveys were mailed to randomly selected practising optometristres across Australia, of which 133 were returned and included in the study.

On average, optometrists reported positive attitudes toward using AI as a tool to aid the diagnosis of retinal disease. They also agreed there will be an overall need for AI in primary eyecare and were excited by future increased use of AI. This is promising for the future implementation of AI CDSS into clinical practice as it suggests that optometrists’ attitudes will not be a major limiting factor.

MOTIVATORS AND BARRIERS TO FUTURE USE Understanding both what encourages clinicians to use AI and what holds them back are key in ensuring the successful implementation of AI CDSS into clinical practice.

Our survey identified several key factors for consideration. Increased patient accessibility to healthcare and more reliable diagnoses were ranked as the two most important potential benefits of using AI. This

The study was authored by researchers at the Centre for Eye Health, School of Optometry and Vision Science, UNSW Sydney - PhD candidate Sharon Ho (left), A/Prof Gordon Doig and senior lecturer Dr Angelica Ly (right).

INSIGHT November 2023

51

TECHNOLOGY

AI clinical decision support systems can achieve high accuracy for the detection of several ocular diseases using fundus images.

“ONE CLINICAL SCENARIO COULD INVOLVE USING AI DURING THE CONSULTATION TO PROVIDE A DIAGNOSTIC RECOMMENDATION AT THE POINT-OF-CARE, WHILE A DIFFERENT CLINICAL SCENARIO COULD BE TO USE AI AFTER THE CONSULTATION TO PROVIDE A SECOND OPINION ON DIAGNOSIS.” Respondents in our survey agreed that AI should be validated through higher quality randomised controlled trials rather than lower quality retrospective studies. However, the conduct of such studies has so far been limited due to resource and practical constraints. Interestingly, government approval was perceived by optometrists as the least important requirement for validating AI, being associated with neutral attitudes, indicating that this will not pose a significant barrier to the future use of AI CDSS. Perhaps one of the biggest myths relating to the use of AI is that it will replace clinicians. Other concerns have been voiced about the risk of overreliance on technology leading to automation bias, compromise of independent decision-making and deskilling of clinicians.10 Meanwhile in our survey, optometrists had mixed attitudes about whether they would limit their use of AI if it caused a neglect in their clinical skills. At the same time, they were apprehensive about “the potential [for AI] to bypass optometry and refer…based solely on the acquisition of a scan” and further asserted that “optometry is based on personable relationships…[AI] detracts from this”. This emphasises their concern for professional autonomy and value placed on the human aspect of clinical care. AI is oftentimes intended as a support system to enhance, not replace, human intelligence.11 Proactively educating optometrists on this may ease anxiety and increase awareness of the benefits of AI. Early efforts to help optometrists establish a healthy relationship with AI will ensure their potential is fully realised.

USING AI IN DIFFERENT CLINICAL SCENARIOS Clinicians will use CDSS only if sufficiently convenient to do so, and if they are used in a manner concordant with their needs and preferences.

Of particular importance is the way in which the system is integrated into the clinical workflow.

For example, one clinical scenario could involve using AI during

52

INSIGHT November 2023

the consultation to provide a diagnostic recommendation at the point-of-care, while a different clinical scenario could be to use AI after the consultation to provide a second opinion on diagnosis. An advantage of the first clinical scenario is that the result is immediately available to the optometrist who can then make an informed decision on diagnosis and management while the patient is in the chair. However, using AI in this way entails an extra step in the clinical workflow whereby CDSS that are interruptive and time-consuming will detract from their original purpose.

On the other hand, the second clinical scenario may solve the potential issue of disrupted workflow, though access to the AI-derived diagnostic recommendation is delayed.

Our survey compared these two specific clinical scenarios and found that optometrists held no significant preference for using AI during the consultation at the point-of-care or after the consultation. Future investigation is needed to better understand optometrists’ preferences for using AI to help maximise its clinical potential and ensure its successful translation into practice.

FACTORS INFLUENCING ATTITUDES TOWARD AI Finally, we also found that optometrists who used a greater number of computerised systems in the workplace had more positive attitudes toward AI. This suggests that exposure to other computer-based technologies in the workplace may encourage optometrists to have a stronger positive belief in the future use of AI. It further implies at a relationship with general innovation readiness and digital confidence, which describe whether users are receptive to and capable of innovation as well as their digital literacy and self-efficacy.12 These measures help predict the success of healthcare innovation spread and appear to drive optometrists’ positive attitudes toward AI. Other factors – optometrists’ gender, work experience, workplace location (rural vs. urban), number of patients seen daily, and level of accessibility to ophthalmology services – were not significantly associated with attitudes toward AI. Of note, there was no difference in attitudes toward AI between optometrists of different ages. This stands in contrast to the greater reluctance in accepting AI in those aged 55 years and over compared to younger members of the general public.13

STUDY CONCLUSIONS Hype or hope? Friend or foe? AI CDSS are a state-of-the-art technology with the accuracy and reliability to dramatically enhance optometric practice. Despite the myth that AI will replace clinicians and other negative preconceptions surrounding deskilling, optometrists hold positive attitudes toward the future use of AI to support the diagnosis of retinal disease. The findings of our recent survey study – described in this article and covering motivators and barriers, possible clinical scenarios, and individual factors influencing attitudes toward the use of AI CDSS by optometrists – may be applied to assist the future implementation and uptake of AI CDSS for retinal disease in clinical practice.

Acknowledgements The authors thank co-investigator, A/Prof Gordon Doig, and all optometrists who participated in the survey.

NOTE: References to appear in the online version of this article.

DISPENSING

WHEN SPECS DON’T DO THE TRICK – PART 1 SPECTACLES ARE AN EFFECTIVE SOLUTION FOR REFRACTIVE ERRORS, BUT THEY MAY NOT BE ENOUGH FOR PEOPLE WITH LOW VISION. CONNIE ANGELI DISCUSSES OPTIONS TO IMPROVE THE LIVES OF THIS PATIENT COHORT.

L CONNIE ANGELI “BY COLLABORATING WITH LOW VISION SPECIALISTS AND EXPLORING THE LATEST TECHNOLOGIES, WE CAN CONTINUE TO ENHANCE THE VISION AND INDEPENDENCE OF INDIVIDUALS WITH LOW VISION.”

ow vision is a condition where individuals experience significant visual impairment that cannot be fully corrected with conventional eyeglasses, contact lenses, or medical treatments. For individuals with low vision, spectacles or traditional eyeglasses may not always provide sufficient visual improvement to perform everyday tasks effectively. While spectacles can help in some cases, there are situations where they are not enough to meet the unique visual needs of people with low vision depending on the severity and nature of the visual impairment. Here, I will explore the limitations of spectacles for patients with low vision and alternative solutions to enhance their visual capabilities which work alone or in addition to conventional eyeglasses.

LIMITATIONS OF SPECS IN LOW VISION Magnification insufficiency: Spectacles are intended to correct refractive errors such as astigmatism, near sightedness, and farsightedness.

While these devices can improve vision, they don’t provide sufficient magnification for people with low vision. To read, write, and perform other necessary tasks, patients with impaired vision frequently require higher magnification levels. Standard eyeglasses might not be able to offer enough enlargement for these tasks.

Limited field of view: Low vision often affects the peripheral vision or central vision, resulting in restricted field of view. Spectacles can’t make your field of vision wider. As a result, even when wearing eyeglasses, patients may have trouble navigating their surroundings, spotting obstacles, or identifying people.

Insufficient contrast enhancement: Low contrast sensitivity is a common symptom of low vision, which makes it challenging to differentiate items apart from their surroundings. Even while certain eyeglasses may include coatings or tints to improve contrast, they might not be sufficient for people with low vision.

Inability to address specific eye conditions: Certain eye conditions leading to low vision, such as macular degeneration or retinitis pigmentosa, cannot be effectively corrected with standard spectacles.

These conditions involve damage to specific parts of the retina, which cannot be fully compensated for with regular eyeglasses.

LOW VISION SOLUTIONS Magnifiers: A key component of visual assistance for people with limited vision is magnification. Various magnifiers are available, including handheld magnifiers, desktop magnifiers, and wearable magnifiers. These devices offer higher levels of enlargement, making it easier for patients to read books, newspapers, and labels, as well as perform other tasks requiring adequate near vision.

Telescopic devices: To improve distance vision, telescopic lenses and other accessories are used. They can be useful for things like TV watching, distant face recognition, and taking in outdoor events. Depending on the patient’s demands, telescopic glasses may be prescribed for monocular (one eye) or binocular (both eyes) use.

CCTVs are electronic magnifying devices that reflect enlarged images from a camera onto a screen.

Closed-circuit televisions (CCTVs): CCTVs are electronic magnifying devices that reflect enlarged images from a camera onto a screen. For tasks requiring constant magnification, like reading, writing, and other activities, they are especially helpful. CCTVs offer a variety of customisable options, including text-to-speech functionality, contrast adjustments, and adjustable magnification levels.

Electronic devices and apps: Numerous electronic tools and smartphone apps have been created to help people with limited vision thanks to technological advancements. These might include mobile devices with built-in accessibility features, handheld electronic magnifiers, and specialised solutions that can recognise objects in real time or convert text to speech.

Prismatic devices: Prisms can be integrated into glasses to shift the image and expand the visual field for individuals with restricted peripheral vision.

Prismatic glasses can be beneficial for those with conditions like hemianopia, where half of the visual field is lost in one or both eyes.

Training and Rehabilitation: Low vision individuals may need training and rehabilitation to fully utilise their equipment, even with the most innovative visual aids. The best way to use visual aids and modify daily routines to maximise independence can be learned through the assistance of low vision specialists, occupational therapists, and mobility and orientation specialists.

While spectacles are a common and effective solution for refractive errors, they may not be sufficient for individuals with low vision. The limitations of standard eyeglasses can significantly impact the quality of life for those with visual impairments.

Fortunately, a wide range of alternative solutions and assistive devices is available to help patients with low vision overcome these challenges.

The field of low vision rehabilitation continues to advance, offering hope and empowerment to those affected. By collaborating with low vision specialists and exploring the latest technologies, we can continue to enhance the vision and independence of individuals with low vision, enabling them to lead more fulfilling lives.

ABOUT THE AUTHOR: CONNIE ANGELI has more than 34 years of experience as an optical dispenser, practice manager, educator, and assistive technology solution provider. She is Human Ware’s National Sales Manager for Australia and New Zealand and an Advisory Board Member for Optical Dispensers Australia.

INSIGHT November 2023

53

DIABETIC RETINOPATHY IN INDIGENOUS AUSTRALIANS THERE IS LIMITED EVIDENCE ON EFFECTIVE CARE MODELS FOR DIABETIC RETINOPATHY IN INDIGENOUS AUSTRALIANS, SO ROSAMOND GILDEN CONDUCTED HER OWN STUDY TO FIGURE OUT THE BEST APPROACH.

I ROSAMOND GILDEN “THERE IS A NEED TO SUPPORT ADDITIONAL RESEARCH ON THESE BEST-PRACTICE FEATURES TO RECEIVE INDIGENOUS-LED FEEDBACK AND NEW INPUT INTO CARE MODELS.”

n Australia, Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Indigenous Australians) are three times more likely to have diabetes than non-Indigenous Australians and have a higher rate of diabetes-related vision impairment (5.5%) compared to their non-Indigenous counterparts (1.5%).

Despite this, there has been limited evidence about suitable treatment models or clinical guidelines to provide appropriate and best-practice care to Indigenous Australians.

As part of my six-month Masters of Public Health project conducted in February 2020, I investigated what best-practice features are required to ensure that Indigenous Australians with diabetic retinopathy (DR) have better treatment outcomes.

As the COVID-19 pandemic commenced during the time of my project, I was limited in my research approach and participant options.

A practical way forward was to interview ophthalmologists who were regularly providing DR care to Indigenous Australians. A total of eight ophthalmologists were recruited that represented varied geographic settings (urban, regional and remote) and jurisdictions in Australia.

From the interviews, seven best-practice features were identified.

These are outlined in table 1.

A limitation of this study was that it did not capture views and perspectives of Aboriginal Medical Service staff and community end-users. Further research

KEY FEATURES OF BEST-PRACTICE MODELS (1) Cultural safety

Services are provided within a culturally safe and appropriate environment, as considered by community

(2) Affordability and accessibility

There are no cost or financial barriers to patients to receive care with services publicly funded or subsidised to a level that is effectively publicly funded

(3) Partnerships between all providers across the continuum of care

Relationships between providers are important to support integrating and linking of patients in the pathway of care and developing and monitoring of treatment ‘systems’ that meet patient need (e.g. partnerships between Aboriginal Medical Services, optometrists, ophthalmologists, hospitals, Aboriginal Health Liaison Officers etc)

(4) Timeliness

Refers to: • Patients referred for DR treatment within appropriate time frame • Patients receiving DR screening on regular basis • Travel time and distance to receive care needs to be as close to home as possible

(5) Integration with primary care

Primary care providers understand and are engaged in the pathway of eyecare throughout (i.e. by providing diabetic retinopathy screening) and understand, support and monitor referral pathways to secondary and tertiary care

(6) Clarity of guidelines

Clinicians refer to and follow the established guidelines so as to provide consistent and agreed standards of care

(7) Clinician attitude and motivation

54

INSIGHT November 2023

Ophthalmologists involved are willing and committed to improving diabetic retinopathy outcomes for Indigenous client

Table 1: Seven best-practice features Rosamond Gilden identified when caring for Indigenous Australians with diabetic retinopathy after interviews with eight ophthalmologists.

is warranted to expand on these findings and include these perpectives.

However, in the meantime, the best-practice features identified in this study have started to address a gap in the research on equity in DR treatment in Australia.

The challenge now for the eye health sector based on this research is therefore two-fold when considering the future of DR treatment in Indigenous communities.

Firstly, there is a need to support additional research on these best-practice features to receive Indigenous-led feedback and new input into care models. Once this is completed, the second challenge is to integrate all of the findings into policy and funding models going forward to ensure a truly accessible and culturally safe DR program of treatment is provided to Indigenous Australians.

Aboriginal and Torres Strait Islander peoples are three times more likely to have diabetes than non-Indigenous Australians.

EXPLANATION AND DETAILS

This will require collaboration and commitment from all levels of government, advocacy bodies, workforce agencies, Indigenous eye

health organisations, research bodies and the peak bodies of Aboriginal and Torrest Strait Islander health.

NOTE: To read the full article, ‘Identifying best-practice features of diabetic retinopathy treatment models for Aboriginal and Torres Strait Islander Australians’, visit: onlinelibrary.wiley.com/ doi/full/10.1111/ajr.12949.

ROSAMOND GILDEN is an Orthoptist and Regional Coordinator for DR-NET, South Pacific Region.

DR-NET is a large network of programs delivering DR screening and treatment in low- and middle-income countries. Her role includes coordination, stakeholder engagement, data collection and capacity building for DR in the South Pacific region. She is also a member of DR-NET’s steering committee.

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

MANAGEMENT

‘AGAINST MY BETTER JUDGMENT’: PRESCRIBING FOR LOVED ONES WHEN A FRIEND OR RELATIVE COMES SEEKING TREATMENT, THERE IS AN IMPORTANT BOUNDARY TO ESTABLISH FOR THE PRACTITIONER. DR PATRICK CLANCY DISCUSSES WHAT IS AT STAKE FOR ALL INVOLVED.

O

phthalmologist Dr K was phoned at midnight by a family member desperate for pain relief. They had run out of their medication and could not get an after-hours appointment. Dr K felt compelled to help.

PATRICK CLANCY

“CONSIDER, FOR EXAMPLE, YOU WERE TREATING A FAMILY MEMBER WHO ASKED YOU NOT TO MAKE A RECORD OF A PRESCRIPTION OR EYE CONDITION THAT MAY AFFECT THEIR ABILITY TO DRIVE.”

Dr Patrick Clancy advises having a plan to respond to requests from family and friends.

Five years later, Dr K faced criminal charges and findings of professional misconduct over prescribing and administering Schedule 8 medications for eight patients, including close family members.

Dr K’s story illustrates the reasons codes of conduct warn doctors and optometrists in Australia to try to avoid providing care to anyone with whom you have a close personal relationship.

LACK OF OBJECTIVITY AND PROFESSIONAL DISTANCE It can be difficult to maintain objectivity if your role as a friend, partner or carer conflicts with your professional responsibilities.

In some states and territories it is mandatory to do so.

INACCURATE DIAGNOSIS OR INAPPROPRIATE CARE Doctors in similar situations have found a close relationship can compromise patient care in other ways.

Your knowledge of the patient may lead you to make assumptions. Or it can You may feel pressured to provide treatment you would not ordinarily consider be awkward to take a complete history, ask sensitive questions or conduct an to be in the patient’s best interests. examination. In some cases, this has led to With hindsight, Dr K acknowledged that in diagnostic error or inappropriate care. his desire to help he may have put patients FAILURE TO RECORD PRESCRIBING at risk by continuing to prescribe outside Like other practitioners in his situation, his area of expertise.

Dr K considered this informal prescribing He knew he should stop but felt separate from his professional role and “compelled by his sense of compassion” responsibilities. He failed to comply with his and acknowledged that it was only legal and professional obligations to keep “by the grace of God, no one had been appropriate records of his prescribing. harmed”. Other cases where doctors have felt pressured to prescribe drugs of dependence have ended in patient deaths.

LEGAL AND PROFESSIONAL OBLIGATIONS Under the code of conduct, doctors must not prescribe Schedule 8 medications, other drugs of dependence or psychotropic medications to family members. In South Australia, except in a verifiable emergency, prescribing Schedule 8 medications for family members is also against the law.

Doctors are also required to obtain relevant state and territory authorities or permits when prescribing drugs of dependence, something which Dr K failed to do.

Doctors can now also check Real Time Prescription Monitoring (RTPM) systems before prescribing drugs of dependence.

Even for lower-risk treatments and prescriptions, failing to comply with reporting obligations can lead to ethical dilemmas and potential harm.

Consider, for example, you were treating a family member who asked you not to make a record of a prescription or eye condition that may affect their ability to drive.

DISCONTINUITY OF CARE Dr K did not inform the patients’ other treating practitioners of his prescribing. He made no plans to hand over care, nor did he conduct any further investigations or follow-up.

The tribunal highlighted this not only put patients at risk. It also breached his professional obligations to colleagues, putting them in the position of making treatment decisions without a full picture of the patient’s care.

IS TREATING FAMILY OR FRIENDS EVER APPROPRIATE? In most cases, providing care to family or friends is avoidable. It is important to manage treatment requests from family members carefully. Have a policy in place or consider in advance how you will respond to these requests.

If faced with an emergency, you can provide care until another practitioner becomes available.

And if you find yourself in a situation where one-off treatment is unavoidable, ensure this does not lead to providing ongoing or regular treatment for anyone close to you.

The following tips can help manage prescribing requests from family or friends: • S et boundaries and expectations about the treatment you will provide • B e clear which medications you are authorised to prescribe • A void informal consultations. If you need to treat family or friends, try to do so in a practice setting where you have time to make considered clinical decisions • A lways keep a medical record of any treatment provided • A rrange follow-up if required ommunicate with the individual’s • C treating practitioners about treatment you have provided.

ABOUT THE AUTHOR: DR PATRICK CLANCY, MBBS FRACGP MHlth&MedLaw is a Senior Medical Advisor – Advocacy, Education and Research at Avant.

INSIGHT November 2023

55

SOAPBOX

MYOPIA – MORE THAN CLINICAL ACUMEN

BY MATT OERDING Myopia management has become a central focus in eye care, dominating discussions at conferences worldwide.

This emphasis is well-founded, given projections that predict nearly half of the global population will be myopic by 2050. Today, we possess the tools and evidence to slow or halt myopia progression in children.

Yet, our experience at Treehouse Eyes, operating in over 70 locations dedicated to myopia management, suggests that the clinical aspect is not the greatest challenge. The true hurdles lie in marketing, practice implementation, and effective communication. Practices that master these elements can establish a thriving myopia management specialty.

The reality is that parents often lack awareness of the treatments available to slow or stop their child’s myopia progression. Most don’t proactively seek treatment, assuming that glasses or contact lenses are sufficient for correcting blurry distance vision. Thus, the first step is to create awareness and generate interest in myopia management. This article will focus on two critical components: marketing (for creating awareness) and patient communication (for generating desire and action).

In marketing, two fundamental steps are essential. First, ensure your practice website prominently features myopia management information in a consumer-friendly format. Second, maintain an active presence on social media platforms. These elements help parents find your practice if they are actively seeking myopia treatment and remind them that you

56

INSIGHT November 2023

offer this service if they aren’t actively searching. Avoid the common mistake of creating a clinical and technical myopia management page on your website. Most parents aren’t interested in the intricate details; they want to know that you can halt their child’s vision deterioration.

Think of orthodontists, whose websites emphasise straightening teeth to improve smiles rather than explaining the technical aspects of braces. Additionally, your website should include a clear call to action, typically encouraging visitors to schedule an appointment.

Social media is a trusted source of information today. Your practice should, at minimum, maintain active Facebook and Instagram accounts and post regularly about myopia management. Video content is shown to be five to 10 times more engaging, so consider sharing team videos and, if possible, testimonials from parents with children undergoing treatment. Aim for weekly posts and assign a social media savvy staff member to manage this task.

Once the foundation is in place, it’s marketing that drives consultations. Two marketing investments offer a favourable return on investment if executed correctly: Pay Per Click (PPC): These ads appear on search engines like Google.

Target specific keywords like “myopia management” or “childhood myopia” instead of generic phrases like “eye exam.” Be patient, as optimising your PPC efforts can take two to three months to yield results.

Paid Social: These are paid ads inserted into social media feeds. They allow precise targeting, such as reaching parents aged 30-50 with school-age children within a specific radius of your practice. Collaborate with a marketing agency to craft a simple message, run ads, and continually optimise them.

Both investments can start small and scale over time. Understand that they take time to optimise and generate results, so be patient; these are long-term investments.

Effective communication is vital to spark interest once parents are aware of myopia management. Providing excessive technical details or showing uncertainty during recommendations can quickly

blunt interest. Effective communication is needed at several critical points in the patient journey: Initial Contact: Respond promptly to inquiries with simple, parent-friendly answers. The goal is to secure a consultation, so avoid delving into clinical specifics. Be ready to address basic questions about cost, types of treatment, and insurance coverage.

Pre-Test: Start the education process early. When measuring axial length, explain its significance. Use language like: “Your child’s eye is growing too long from front to back. We measure this, and it’s why they have blurry distance vision.”

Consultation: Communicate risk factors for myopia progression, use tools like the BHVI calculator to project progression, and make a strong treatment recommendation. Parents expect you to be the expert; avoid presenting multiple options. If needed, have a staff member discuss fees.

Follow-Up: Many parents need time to discuss treatment with their partners or families. Develop a clear follow-up process. Ideally, a staff member should reach out to parents who don’t commit to treatment and answer questions. Parents, especially those with busy schedules, may need two- to-three weeks.

Our obligation is to offer treatment to every child at risk of myopic progression. Clinical acumen is essential but insufficient. In this evolving field, practices must plan to raise awareness and generate interest.

These are skills that many practices lack, but by partnering with others can accelerate the integration of myopia management into your practice.

Name: Matt Oerding Affiliations: Co-founder and CEO, Treehouse Eyes; past Board Chair of Global Myopia Awareness Coalition Location: Boulder, Colorado, US Years in industry: 22

THE TRUE HURDLES LIE IN MARKETING, PRACTICE IMPLEMENTATION, AND EFFECTIVE COMMUNICATION. PRACTICES THAT MASTER THESE ELEMENTS CAN ESTABLISH A THRIVING MYOPIA MANAGEMENT SPECIALTY.

2023/24 CALENDAR NOVEMBER 2023

ANZGS CONGRESS 23

JANUARY 2024

HONG KONG INTERNATIONAL OPTIC FAIR

Hong Kong 8 – 10 November hktdc.com/event/hkopticalfair/en

OPTI2024

Munich, Germany 12 – 14 January opti.de/en

Istanbul, Turkey 23 – 26 November silmoistanbul.com/en

San Vigilio, Italy 13 – 20 January skiconf.com

DECEMBER 2023

SINGAPOREMALAYSIA JOINT MEETING IN OPHTHALMOLOGY

ASIA PACIFIC TELEOPHTHALMOLOGY SOCIETY CONGRESS

Pattaya, Thailand 2 – 3 December 2023.asiateleophth.org

THE 16TH CONGRESS OF THE ASIA-PACIFIC VITREO-RETINA SOCIETY (APVRS) 2023 Hong Kong 8 – 10 December 2023.apvrs.org

Potential to Earn in Excess of 220k - Designate Partnership in Wagga Wagga, NSW! Specsavers Wagga Wagga have an exciting opportunity for an experienced Optometrist looking to take the next step in their career. No upfront cost and opportunity to try partnership before committing long term.

Specsavers Wagga Wagga has 4 Optical test rooms and 1

AUSTRALIAN VISION CONVENTION (AVC)

ASIA-PACIFIC ACADEMY OF OPHTHALMOLOGY (APAO) CONGRESS

Bali, Indonesia.

22 – 25 February 2024.apaophth.org

Singapore 19 – 21 January sophth-sinmal2024.com

FEBRUARY 2024 MIDO EYEWEAR SHOW

dedicated Audiology room with a varied patient demographic and a welcoming and supportive team. You will be partnered with an experienced Specsavers Retail Partner and have access to our Pathway and Partnership development program for duration of time in role. Interested in partnership? Why not try before you buy!

Optometrist opportunity – Specsavers Invercargill, NZ Seeking a talented optometrist to join our extraordinary team at Specsavers Invercargill. We offer cutting-edge technology, a friendly environment, and a commitment to professional growth. Embrace the relaxed pace of life and enjoy a perfect work-life balance. Explore stunning coastal views and enjoy a fantastic outdoor lifestyle. Don’t miss this incredible opportunity to be part of Specsavers Invercargill.

Graduate Opportunities Still deciding on where to start your optometry career?

Specsavers continue to be the largest employer of Graduate Optometrists across Australia

SILMO SINGAPORE

Singapore 24 – 26 April silmosingapore.com/

London, UK 24 – 26 February 100percentoptical.com

MAY 2024 ARVO 2024

Washington, US 5 – 9 May arvo.org

MARCH 2024 SKI CONFERENCES FOR EYECARE PRACTITIONERS

Milan, Italy 3 – 5 February mido.com

Gold Coast, Australia 6 – 7 April optometryqldnt.org.au

100% OPTICAL

Furano, Japan 3 – 10 March skiconf.com

OSHOW24

Sydney, Australia 17 – 18 May o-show.com.au

WAVE 2024

Fremantle, Australia 16 – 17 March admin@optometrywa.org.au

All Specsavers stores now with OCT Optometrist opportunity – Specsavers Armidale, NSW Specsavers Armidale are seeking a full-time optometrist to join the team! Enjoy a flexible roster providing extra-long weekends for the ultimate work/life balance.

This 2 test-room store comes with market leading equipment including OCT and involves working with an experienced retail team dedicated to delivering first-class customer service. The beautiful region of Armidale provides the perfect spot to live and work – affordable and high standard of living with ample to enjoy such as waterfalls, gorges, national parks, vineyards and culture. An attractive salary is on offer with $40k of bonuses in your first 2 years!

APRIL 2024

Hobart, Australia 16 – 19 February anzgsconference.com

SKI CONFERENCES FOR EYECARE PRACTITIONERS

SILMO INSTANBUL

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

and New Zealand with our industry leading two-year Graduate Program and we have a number of exciting opportunities across regional Australia.

Avail of our ‘Go With A Friend’ bonus, Sign On Bonus’, as well as a generous regional salary and relocation package.

Fly In, Fly out Locum Opportunities across Australia Are you an experienced Optometrist looking to combine work and travel? If so, We are offering unbeatable opportunities across our Australia store network.

Working as a locum with Specsavers means you will receive great rates, have access to market leading technology and work with excellent Optometrists and retail staff. We will organise and cover the cost of your travel including car hire, flights and accommodation. If you’re passionate on delivering professional and outstanding eye care, and you would like to explore Specsavers fly in fly out opportunities around Australia, get in touch now.

Specsavers YOUR CAREER, NO LIMITS

LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership opportunities enquiries: Kimberley Forbes on +61 (0) 429 566 846 or E kimberley.forbes@specsavers.com Australia Optometrist employment enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134 Locum employment enquiries: Matthew Cooney matthew.cooney@specsavers.com or 0447 276 483 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries: apac.graduateteam@specsavers.com

Visit spectrum-anz.com

CAREER

People ON THE MOVE

Insight's monthly bulletin to keep the Australian ophthalmic sector updated on new appointments and personnel changes, nationally and globally.

OV/SA CEO MOVING ON AMID ‘INTEGRATION’ WITH NATIONAL BODY

NEW WORLD COUNCIL OF OPTOMETRY PRESIDENT ELECTED

AUSSIE PROFESSOR ENDS WORLD COUNCIL OF OPTOMETRY PRESIDENTIAL TERM

Optometry Victoria South Australia (OV/SA) CEO Ms Ilsa Hampton is stepping down from the role. Following a decision from OV/SA members for an integration with Optometry Australia, OV/SA no longer requires its own CEO. “I have greatly enjoyed my time at OV/SA, working with a wonderful team, getting to know optometry and our partners in eye health. Apart from the hundreds of individual conversations I have had with our members from Mildura to the Fleurieu Peninsula and many places in between, in such a short time there have been many highlights,” she said.

Dr Sandra Block from the US will serve as the World Council of Optometry (WCO) president for the 2023-2025 term, replacing Australian Professor Peter Hendicott. She has served in various positions on the WCO Board since 2015 and is a Professor at Illinois College of Optometry. “WCO is stronger than ever, leading the profession to be a part of the solution to effect change and improve access to quality, affordable, and equitable eyecare,” she said. The UK’s Dr Cindy Tromans is now the WCO President-Elect for the 2023-2025 term.

With Professor Peter Hendicott’s tenure ending as president of the World Council of Optometry, he will now continue to serve the WCO Board of Directors for the next two years as the Immediate Past President.

“It has been an honour to serve as president of the World Council of Optometry over the past two years, and I would like to sincerely thank all my colleagues in optometry worldwide for entrusting me with the role,” he said. “Particular thanks must go to Professor Sandy Block for her valued teamwork, input, and support. I look forward to WCO’s continued success under her presidency.”

LEADERSHIP CHANGE FOR RANZCO SCIENTIFIC PROGRAM COMMITTEE

DR ADRIAN FUNG TO CO-CHAIR COLLEGE’S SCIENTIFIC PROGRAM COMMITTEE

MONDOTTICA ANNOUNCES KEY ADDITION TO SALES TEAM

Dr Clare Fraser, Associate Professor of Neuro-ophthalmology at the Save Sight Institute, The University of Sydney, will become Co-Chair of the RANZCO Scientific Program Committee from 2024. The committee organises the academic content of the annual RANZCO Scientific Congress, which will be held in Adelaide next year. The current Chair is Dr Elsie Chan.

Professor Adrian Fung will Co-Chair the RANZCO Scientific Program Committee alongside Dr Clare Fraser next year. As part of organising the congress academic program, the role includes calling for and selecting invited speakers, courses, symposia, abstracts, papers, posters films and chairs. Fung is a Clinical Professor at the Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital and Discipline of Clinical Ophthalmology and Eye Health, University of Sydney. He is also the organiser of the Ophthalmology Updates! conference.

Mondottica Australia has welcomed new Victoria/South Australia/Tasmania Sales Representative Ms Julia (Jules) Thompson to its team. She joined the company 2 October 2023, with extensive optometry experience having been the dispenser/practice manager at Bill Cutler Optometrists for the past 10 years. Ranges carried will be Benetton, Christian Lacroix, Joules, Mako, Moleskine, Pepe Jeans, Sandro, Scotch & Soda, Ripcurl, Ted Baker and Taylor Morris.

DO YOU HAVE CAREER NEWS TO SHARE? EMAIL EDITOR MYLES HUME AT MYLES.HUME@PRIMECREATIVE.COM.AU TO BE FEATURED. 58

INSIGHT November 2023

Join the CooperVision Academy™ Education and knowledge on demand

• Designed to help optometrists, practice managers, optical dispensers and assistants, and optometry students develop their communication, clinical and technical skills, and learn more about CooperVision® products • Offers an array of training and resources constantly updated to reflect the latest knowledge and best practice

Register now Go to https://academy.coopervision.net.au/au or scan the QR code. Enrolment in the CooperVision Academy™ is free-of-charge for all those working in the optical industry.

CooperVision® is a registered trademark of the Cooper Companies, Inc. and its subsidiaries. EMVCOO0962 ©2023 CooperVision.

COO0962_InSight_FPC_FA_PR.indd 1

26/9/2023 1:15 pm

Join the OPSM team. We have the scale and resources to help you personalise your position and choose your career path based on your goals.

NOVEMBER 2023

CUSTOMISE YOUR ROLE TO YOUR CAREER ASPIRATIONS

Accelerate your career aspirations with OPSM. Visit opsm.com.au/careers today.

WWW.INSIGHTNEWS.COM.AU