INSIGHT December 2021 by Prime Creative Media

INSIGHT DEC

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

Gail Spence THE ICO N RETURNS

A Sydney vitreoretinal surgeon discusses delivering the nation's first approved gene therapy.

LOCKDOWNS, VACCINES, FREEDOM AND MORE The triumphs and tribulations that defined the ophthalmic sector in 2021.

17/10/2021 7:41:41 PM

AUSSIE TEEN SEES STARS FOR THE FIRST TIME

INSIGHT DECEMBER 2021 Front cover PD.indd 1

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INSIGHT DEC

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

SURGEON DETAILS FIRST LUXTURNA GENE THERAPY ALLOWING PATIENT TO SEE STARS

The vitreoretinal surgeon who performed Australia’s first Luxturna gene therapy has described the intricacy of the procedure, while hailing the team effort that has resulted in profound vision improvements for patients, including one who reported seeing stars for the first time. Rylee Jebara, 17, and 15-year-old brother Saman, both diagnosed with Leber congenital amaurosis in the first year of life, were the first Australians to receive Luxturna. The drug is the world’s first approved gene replacement therapy for an inherited blinding eye condition and one of the first gene replacements for any human disease. Approved by the Therapeutic Goods Administration in August

2020, it is also the country’s first ‘in-vivo’ gene therapy, meaning it directly infects cells in the body. Luxturna treats children and adults with rare biallelic pathological mutations in RPE65. Associate Professor Matthew Simunovic, vitreoretinal surgeon at the Sydney Eye Hospital and Sydney Children’s Hospitals Network (SCHN) and Associate Professor at the Save Sight Institute (SSI), performed the first surgery on Rylee via a subretinal injection. He said it was an incredibly delicate procedure, with some eligible patients having paperthin retinas. To be approved to perform the surgery, he received hands-on training in the surgical methods used in the development

The Sydney team involved in delivering the historic gene therapy.

of Luxturna. One of his research interests is subretinal drug delivery and he used a modified version of a technique developed by a colleague in Oxford, UK. “The delivery of Luxturna into the correct surgical plane is the crucial part of the procedure,” he said. “It is injected via a 38-gauge Teflon-tipped cannula that punctures the retina, which is

typically thinned in this group of patients. A further difficulty is the subretinal space is a ‘potential space’: that is, it needs to be defined. If you go too deep, you risk sub-retinal haemorrhage, retinal pigment epithelial (RPE) damage and loss of treatment effect. If too shallow, the drug will end up in the vitreous cavity, with a loss of treatment effect and the potential for intraocular inflammation.” Simunovic performed the injection in two steps. First, he defined the surgical plane with an inert ‘balanced salt solution’, controlled using the foot pedal on a vitrectomy machine. On-table OCT then confirmed the solution was in the correct plane. The second step involved injecting continued page 8

COMMISSION RESPONDS TO CATARACT STANDARD CRITICS The commission responsible for developing Australia’s first Cataract Clinical Care Standard has responded to criticism over the document and says it was “perplexed” when RANZCO and the Australian Society of Ophthalmologists (ASO) changed their stance to no longer offer their endorsement. The Australian Commission on Safety and Quality in Health Care (ACSQHC) says it has been disappointed by recent coverage featuring reaction from the sector about the new standard. It comes after RANZCO and the ASO stated they would not endorse it. The college took issue with what it perceived as the inclusion of 6/12 visual acuity as a measure for cataract,

and the recommendation to offer all patients bilateral same day surgery. The ASO took aim at the consultation process, while RANZCO also stated it was “disappointed the ACSQHC have not listened to the experts”. However, the ACSQHC believes elements of the standard and its process for developing them have been “inaccurately presented” and has since “moved to clarify what the standard says, and the events regarding consultation”. Its first concern related to comments the standard promotes visual acuity of 6/12 as ”the most important determinant for surgical intervention” and “a prioritisation factor for cataract surgery”. “The standard indicates that visual

acuity is one aspect of a visual examination that should be taken into account,” CEO Adjunct Professor Debora Picone said. “The commission is not aware of any guideline that recommends against assessing visual acuity when determining the impact of cataract on visual function – it is one of several factors to consider, as stated in the standard.” Regarding criticism that same or following day second eye surgery be routinely discussed, Picone said the standard in fact recommends the timing of second-eye surgery is discussed, as appropriate to the clinical circumstances of the patient. In most cases, she said this may result in a decision to schedule continued page 8

2021 SUMMER SHOWCASE With 2021 posing yet another disruptive year for the ophthalmic market with cancelled trade events, Insight has brought together a host of Australia’s leading suppliers to showcase their 2021/22 releases. page 24

Alcon Toric IOLs lead the way in astigmatic correction ®

†1

Alcon® Toric IOLs allows you to correct even the smallest amount of astigmatism‡2-5 Most cataract surgery patients present with some level of corneal astigmatism.§6 The Alcon® Toric IOL portfolio, with cylinder powers from T2–T9, accommodate a wide range of astigmatic correction needs, from high to low.2-5 Built on the heritage of the proven AcrySof ® platform, Alcon® Toric IOLs offer exceptional performance with outstanding refractive predictability7-10 and rotational stability7-10 for you and your patients.

Based on market size and unit share from Q2 2021 compared to AMO, Zeiss, and Bausch & Lomb/Dorc in select markets. ≥0.65D of corneal astigmatism. § Refractive and keratometric data from 4540 eyes of 2415 patients.6 † ‡

References: 1. Market Scope Data. Q2 2021 in Australia and New Zealand. 2. AcrySof® IQ Toric Directions for Use. 3. Clareon® AutonoMe® Toric Directions for Use. 4. AcrySof ® IQ PanOptix® Toric Directions for Use. 5. AcrySof ® IQ Vivity ® Toric Directions for Use. 6. Ferrer-Blasco T et al. J Cataract Refract Surg 2009;35:70–75. 7. Lee BS and Chang DF. Ophthalmology 2018;125(9):1325–31. 8. Levitz L et al. Asia Pac J Ophthalmol (Phila) 2015;4(5):245–9. 9. Oshika T et al. Eur J Ophthalmol 2020;30(4):680–84. 10. Lane S et al. J Cataract Refract Surg 2019;45:501–506. ©2021 Alcon Inc. Alcon Laboratories (Australia) Pty. Ltd. ABN 88 000 740 830. Phone: 1800 224 153. New Zealand NZBN 942904703 0480 Phone: 0800 809 189. ALC1430b 09/21 ANZ-ACO-2100002

IN THIS ISSUE DEC 2021

EDITORIAL

FEATURES

THANK YOU FROM US Based in locked-down Melbourne, gratitude is a practice I started implementing in my daily routine this year. I’ve quickly learnt there is a lot to appreciate in almost any interaction, regardless of the circumstance. The times I often felt most grateful in 2021 was during the production phase of this magazine. Seeing the news and features come to life is exciting because we’re documenting the efforts of some of the most remarkable people, science and technology in this country.

PRECISE VITRECTOMY Advances in vitrectomy cutter design are leading to safer, more efficient surgeries.

PARIAH OR VISIONARY? Peter Larsen discusses his rationale bringing Specsavers to Australia and why he feels misunderstood.

This year has been one of growth for Insight. Switching to a new magazine binding, our inaugural Dry Eye Directory, increasing our readership and advertising partners, and the introduction of our popular People on the move section feature among the highlights. While there’s only a handful of people who officially produce this magazine, dig deeper and there’s many more. Each day optometrists, ophthalmologists and other ophthalmic professionals take time out of their days to share their expertise with us, and you, our readers. Many also volunteer their valuable time to write contributed columns that introduce fresh ideas and perspectives. Organisations and the individuals behind them are also another vital piece of the puzzle. Optometry Australia, RANZCO, Orthoptics Australia and the Australian Society of Ophthalmologists, among others, are always accessible and willing to contribute to debate.

USE IT OR LOSE IT How the optical sector is shaping up for the end of year health fund rush.

YEAR IN REVIEW The setbacks and breakthroughs that shaped the Australian ophthalmic sector in 2021.

EVERY ISSUE 07 UPFRONT

55 MANAGEMENT

09 NEWS THIS MONTH

56 OPTICAL DISPENSING

53 PEOPLE ON THE MOVE

57 CLASSIFIEDS/CALENDAR

54 ORTHOPTICS AUSTRALIA

58 SOAPBOX

Without this generosity and collegial mentality, we’d struggle to produce a comprehensive publication, but more importantly it helps maintain the flow of information in this advancing industry, so ultimately our readers can make informed decisions about their approach to business and/or care. Finally, we’d like to extend our gratitude to our advertisers. Many of you have stuck by us over two rocky years and offered your expertise in countless articles. And now that we’re emerging out the other side, your support has placed Insight in a strong position to begin offering even more to our readers. Bring on 2022. MYLES HUME Editor

INSIGHT December 2021 5

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Transforming data into turning points in care.

UPFRONT Just as Insight went to print, THE SAX INSTITUTE published a new analysis by Australian research institutes that found cutting cataract surgery wait times to three months over a three-year period would result in 50,679 fewer falls. This would save around $20 million, resulting in an overall cost saving of $6.6 million, once the costs of bringing forward surgeries were included. The authors have called for more high-volume surgery services, standardised referral and triage processes, fast-tracked referrals

WEIRD

when necessary, and prioritised surgery for Indigenous patients. IN OTHER NEWS, Melbourne biopharma company Opthea announced the first clinical trial sites in the Asia-Pacific region are recruiting into the OPT-302 Phase 3 trial for neovascular agerelated macular degeneration (AMD). The sites, located in Australia, are in addition to the US, Canada and Europe that are also recruiting patients. “This enables eligible patients to participate in the ShORe and COAST Phase 3 trials. We [also] anticipate opening sites in additional countries in the Asia Pacific region including South Korea and the Philippines,” Opthea CEO Dr Megan Baldwin said.

FINALLY, Vision 2020 Australia and the Fred Hollows Foundation have each shared fresh statistics demonstrating that Australian’s are jeopardising their eye health amid the pandemic. As part of World Sight Day, Vision 2020’s analysis of the latest Medicare data showed almost half a million Australians missed an eye test over the past 18 months due to the pandemic. In a separate survey, Fred Hollows found one in two Australians aged 18 to 24 reported their eyes or vision have been negatively affected by more screen time. COVID has also delayed eye check-ups for 28% of people aged 18 to 24 and 31% aged 25 to 34, mainly because of lockdowns.

STAT

WACKY

Actor Jason Momoa revealed a long list of injuries while performing stunts on the Aquaman set, including surgery for a hernia, serious rib injuries and a scratched cornea. “I messed up my eyes. I just got something in it that kind of cut it up, and then I’ve got to get surgery,” he said.

11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreative.com.au

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WONDERFUL

A legally blind Toronto home chef has a new, inclusive cooking show. Mary Mammoliti’s vision has progressively worsened with retinitis pigmentosa. With cooking providing therapeutic relief, she launched Dish with Mary that uses integrated described video. Key visual elements are incorporated into the production, making it inclusive for all viewers.

Published by:

Publisher Christine Clancy

The Ireland and Wales national rugby teams may need to change their respective green and red shirt colours when they face off to improve accessibility to the game for people with colour blindness. It also comes after affected fans had difficulty following the recent British & Irish Lions (red) series against South Africa (green). n

insightnews.com.au

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

OPTICAL EXTRAS Health funds collectively pay more than $966 million each year in member benefits for optical or eyecare services. Full report page 41.

WHAT’S ON

Complete calendar page 57.

Art Director Blake Storey Graphic Design Michelle Weston, Kerry Pert, Aisling McComiskey Subscriptions T: 03 9690 8766 subscriptions@primecreative.com.au

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11 – 12 DECEMBER

22 – 24 JANUARY

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The 14th Asia-Pacific Vitreoretina Society Congress will be held virtually, bringing the latest developments in the field.

The eighth edition of the show is taking place at the London ExCel, with around 9,500 visitors and more than 200 exhibitors expected.

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INSIGHT December 2021 7

NEWS

MORE GENE THERAPIES UNDER DEVELOPMENT continued from page 3

0.3mL of Luxturna into this sub-retinal bleb via the same puncture site; with the injection pressure controlled by the assisting vitreoretinal surgeon, Dr Gaurav Bhardwaj. “This requires clear communication and teamwork – the trick is to deliver the treatment slowly, watching for retinal stretch, which can lead to iatrogenic macula hole formation,” Simunovic added. Simunovic is part of Ocular Gene and Cell Therapies Australia (OGCTA), a new Sydney-based collaborative to accelerate the development of novel genetic therapies and offer genomic diagnosis for patients who may benefit from Luxturna and investigational therapies. It brings together experts in ocular genomics, functional investigations, investigation of novel ocular genetic and stem cell therapies, drug delivery and clinical expertise in genomic and ophthalmic diagnoses. It involves the Genetic Eye Clinic at SCHN, the Eye Genetics Research Unit and Stem Cell Medicine Group at the Children’s Medical Research Institute (CMRI), and SSI at Sydney Eye Hospital and University of Sydney. The Sydney team has now treated four people with Luxturna, including two adults in their 40s. For patients to ultimately receive Luxturna, Simunovic said it involved a significant team effort, including

identifying suitable patients and ordering the medication with a minimum 12-month lead time, through to surgery planning and follow-up. Suitable patients must also have proven mutations to both of their RPE65 genes – responsible for recycling vitamin A in the retina – and deemed likely to benefit from treatment through testing. “WHEN I STARTED “Generally, a treatment effect is noticed IN THE FIELD 20 one month following treatment,” he said. YEARS AGO, WE “Improvements following Luxturna gene therapy are probably best quantified by full-field stimulus testing (FST). The improvements correspond to – on average – a 100-fold improvement in sensitivity. This translates to improved function in real life. For example, Rylee stopped using a cane to navigate by streetlight about a month following treatment. When we caught up [recently], Rylee also reported having seen stars for the first time.”

COULDN’T EVEN OFFER THESE PEOPLE A HINT OF A GENETIC DIAGNOSIS" ROBYN JAMIESON, OGCTA AND CMRI

A MOMENTOUS MILESTONE OGCTA lead Professor Robyn Jamieson – also head of the Eye Genetics Research Unit at SCHN and CMRI, and head of Specialty of Genomic Medicine at the University of Sydney – said it was remarkable to now see gene therapies used in the real world: “When I started in the field 20 years ago, we couldn’t even offer these people a hint of a genetic diagnosis."

its important functions bringing together a multi-disciplinary panel of expert ophthalmologists, geneticists, genetic counsellors and researchers who can determine eligible Luxturna recipients, as well as other diagnoses. In some cases, patients may have a “variant of uncertain significance” – meaning the case is not clear cut. Here, the OGCTA can perform functional genomics where a blood sample is taken from the patient and grown into retinal organoids or RPE where researchers can then assess the mutation more closely and hopefully determine a diagnosis and eligibility for approved and/or pre-clinical treatments. If confirmed to have the mutation, she said they need viable photoreceptor cells to clear the next hurdle towards treatment. This is where her husband and genetic eye disease expert Professor John Grigg, also part of OGCTA, performs retinal testing to determine if the patient will benefit. The OGCTA’s activities also include developing gene and stem cell therapies, and clinical trials, with a focus on diseases groups like retinitis pigmentosa, conerod dystrophy and Usher syndrome. For Stargardt disease – a gene too large for viral vectors – the OGCTA is conducting trials for an oral therapy that works at the enzyme level, and is also looking at potential gene editing techniques. n

She said the OGCTA builds on decades of work in Sydney, with one of

'BEST PRACTICE AND CURRENT PRACTICE CAN DIFFER' continued from page 3

second-eye surgery some weeks after the first operation, which may avoid unnecessary delays for patients, particularly those for whom refractive differences may be considerable after the first-eye surgery. In others, it may be the patient’s decision to wait and see. “The standard clearly leaves this assessment to the treating clinician and suggests that they offer informed consent to the patient about the options suitable in their individual circumstances,” Picone said. The commission also responded to the ASO’s comment that it “falsely claims” to be consultative and RANZCO’s statement that it has not “listened to the experts”. Picone said the ACSQHC consulted

INSIGHT December 2021

extensively with both RANZCO and the ASO and has met with their representatives several times to discuss their feedback, including before, during and after public consultation. “Both organisations provided feedback as part of the public consultation process after which the document was revised taking all feedback into account. Changes proposed by RANZCO during public consultation to Quality Statement 4: Indications for cataract surgery, were accepted verbatim by the commission,” she said. “Both RANZCO and ASO initially endorsed the standard but withdrew endorsement some months later, despite no changes having been made in the interim and with no change in the evidence base. The commission remains perplexed as to the basis for changes in endorsement

without a change in clinical practice recommendations.”

The cataract standard is Australia’s first.

Ultimately, however, Picone said clinical care standards describe best practice care and priorities for quality improvement and don’t aim to describe current practice, “which may be in need of improvement”. “Best practice and current practice can differ, as in the case of post-operative prophylactic antibiotic eye drops, routinely prescribed by ophthalmologists against current recommendations,” she said. “Similarly, prioritisation for non-urgent elective cataract surgery based on clinical need is not currently widespread and it is surprising that ophthalmologists do not support such a model for improving equity of care.” RANZCO and the ASO said they had nothing further to add at the time of print.

NEWS XX

HOYA AND HAAG-STREIT’S NEW ALLIANCE BRINGS ONE-TWO APPROACH TO MYOPIA MANAGEMENT Ophthalmic lens manufacturer Hoya Vision Care Australia & New Zealand and ophthalmic equipment maker Haag-Streit have announced a strategic partnership focused on tackling the global rise of myopia in children.

and education to patients and parents about myopia and its progression. This, combined with Hoya’s MiyoSmart spectacle lens, launched in 2018, creates "a strong one-two approach to diagnose and manage myopia", the companies announced.

technologies and solutions we are creating a seamless approach for our eyecare professional business partners to expand their myopia management capabilities and tackle this growing problem.”

The global sales and marketing agreement creates a preferred partnership between Hoya and Haag-Streit – and its local distributor Device Technologies Australia – to provide eyecare professionals with LENSTAR Myopia by Hoya, for the diagnosis and treatment of myopia.

Hoya’s MiyoSmart lens adopts Defocus by Hoya. Incorporated Multiple Segments (D.I.M.S.) technology, which the company said it clinically proven to slow down myopia progression on average by 60% in children ages eight to 13.

In a statement, Hoya stated the alliance woukd allow eyecare professionals to establish their myopia management capabilities using LENSTAR Myopia by Hoya, which is based on the technology featured in the Lenstar 900 optical biometer and the corresponding EyeSuite myopia management software platform.

“The strategic partnership with HaagStreit aligns with one of Hoya Vision Care’s core missions to provide information and innovative solutions to our valued eyecare professionals who are on the frontlines as we globally address the rapidly growing problem of myopia in children,” Hoya Vision Care CEO Mr Alexandre Montague said.

The technology provides information

“By bringing together our organisations’

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The LENSTAR Myopia

Mr Craig Chick, managing director of Hoya Vision Care Australia & New Zealand, said the agreement creates preferred partner status between Device Technologies & Hoya Vision Care ANZ to provide diagnostics and treatment for myopia to ANZ eyecare professionals. Mr Angus Hatfield-Smith, ophthalmic diagnostics product manager at Device Technologies, said as Haag Streit’s partner, it looked forward to working with Hoya. “Partnerships such as this, where diagnostics and treatment are combined, enable improved access to technology which will contribute greatly towards improving the quality of life for sufferers of this vision disorder,” he said. n

“Joining NOC has been positive for Optiko, we have remained autonomous and the business and culture I built with my team has been maintained. We are a boutique practice, and our frames are our signature point of difference. NOC has empowered us to continue to purchase independently, including our speciality overseas suppliers and they trust us to decide on the best lens for our patients. I’m enjoying the collaboration in a bigger organisation and the support that is available.”

Start the conversation today. If you would like to understand more about joining the NOC community or are interested in an obligation free valuation, contact us in confidence. nocltd.com.au

Jason Gowie – CEO jgowie@nocltd.com.au or 0448 821 351

NEWS

3D PRINTED AUSTRALIAN-MADE FRAMES FEATURE UNIQUE HINGE DESIGN University of Canberra students are developing locally made, “hyperpersonalised” eyewear that involves 3D printing frames to the millimetre based on the wearer’s individual facial dimensions.

tension. By removing screws that traditional hinges incorporate and replacing it with a ball bearing and spring, project leaders say this allows for an even amount of pressure to be applied, requiring minimal adjustment over time.

The design initiative – known as the ID7 project – also features a unique hinge design, removing the traditional screws and replacing them with a ball bearing and spring.

“It’s really incredible the way the design students have thought outside of the box and created a totally new eyewear prototype,” Bainbridge said.

The project is a collaboration between the Faculty of Arts and Design and the Faculty of Health, seeing UC Bachelor of Design students design the frames – and the UC Optometry Clinic fit the prescription lenses. Executive Dean of the Faculty of Arts and Design Professor Jason Bainbridge said the collaboration was an example of what can be achieved when distinct areas of expertise are brought together. “The ID7 project shows just how exciting the creative outcomes can be when students from different disciplines work together,” he said. “UC is the home of creativity in Canberra, and this project further showcases that. This is one of the first projects in Australia

The frames are prodcued using SLA 3D printing.

“The future of eyewear just may have been created right here at UC.” n

– if not the world – of its kind.” The initiative aims to have consumers directly involved in their eyewear design. To create the eyewear, 3D models are created using the wearer’s specific facial dimensions. Using stereolithography (SLA) 3D printing, the frames are developed to the millimetre, eliminating the need for moulds or tooling. Once the frame components are printed, they undergo an organic dying process to match the wearers colour choices. Once complete, parts are processed ready for lens fitting by the UC eye clinic – meaning they are locally made from end-to-end. The hinge is designed to constantly be at

The hinge with a ball bearing and spring design.

COVID-19 RAPID ANTIGEN TEST NOW AVAILABLE TO EYE HEALTH PRACTICES AS SUPPLIER SECURES RIGHTS A TGA-approved, 10-minute rapid antigen test is now available for eye health practices to test staff and patients for COVID-19 – especially the unvaccinated. The test kit supplier believes they could also play a role in future industry trade shows. Good Optical Services is now the exclusive supplier to the ophthalmic industry for the CareStart COVID-19 rapid antigen test, which is registered with Australian Therapeutic goods Administration (TGA), US FDA and is CE marked. This follows extensive clinical trials out of the US demonstrating a sensitivity of 94% and specificity of 99.3%. CareStart also has independent validation data from the Doherty Institute, NSW Health (Westmead) and PathWest.

INSIGHT December 2021

sampling collects from the front area of the nose and is less invasive, reducing patient discomfort and simplifying the procedure.

With thousands of optometry practices and ophthalmology clinics unable to provide routine care for months this year, it’s hoped the tests will provide peace of mind as they welcome increased foot traffic. Mr Rick Good, of Good Optical Services, said practices could routinely test practice staff and patients. According to Good Optical Services, the CareStart rapid antigen test is the most sensitive of all TGA approved tests as validated by NSW Health. The Federal Government and AUSMAT have used it for testing of staff at Howard Springs. It’s also being used by Commonwealth Bank, Fortescue Metals Group, Lendlease, DHL and Qantas. With a result in 10 minutes, Good says it’s suitable for quick action at the point-of-care. Anterior (shallow) nasal

The tests have a sensitivity of 94%.

CareStart is manufactured by US-based Access Bio, a pioneer in rapid diagnostic testing and leading supplier of rapid malaria tests, manufacturing 130 million annually. To comply with TGA guidelines the optometrist or ophthalmologist needs to pre-register and a nominated practice staff member will need to undertake a short online course before the practice can begin to use them. All components are contained in each 20-test kit, including test devices, pre-prepared extraction vials with buffer solution and vial caps, sterile anterior nasal swabs, instructions for use and positive and negative controls. n

Gail Spence

THE ICO N RETURNS PREVIEW THE COLLECTION WWW.EYESRIGHT.COM.AU

1800 637 654

@eyesrightoptical

NEWS

OPTOMETRISTS CAN BE ACCREDITED TO NEW NATIONAL SAFETY AND QUALITY STANDARDS Federal Health Minister Mr Greg Hunt has launched new set of standards improve the care patients receive in primary health settings, including optometry practices who will be able to become accredited to the standards next year. On 12 October, the minister unveiled the Australian Commission on Safety and Quality in Health Care’s National Safety and Quality Primary and Community Healthcare Standards. They are designed to protect Australians from harm and lift the quality of healthcare patients receive in these settings. According to the commission, the new standards provide a framework that can be applied to a broad range of services such as dental practices, allied health services, incluing optometry, audiology, podiatry and physiotherapy, as well as Chinese medicine clinics, community health services and skin clinics.

“In time, Australians will have confidence that when they visit a primary or community healthcare service accredited to the standards, they are receiving safe and high-quality healthcare – no matter the type of health service they are using or where they access it." The document comprises three key standards: Clinical Governance Standard, Partnering with Consumers Standard and Clinical Safety Standard.

primary and community services.” The new standards have the support of the Australian Government chief allied health officer Dr Anne-marie Boxall.

Dr Anne-marie Boxal, chief allied health officer.

“Now is the time for healthcare services to become familiar with the new standards, ahead of voluntary independent accreditation being introduced next year. Healthcare providers may identify areas that need some attention, while many will find that they are already addressing elements described in the standards."

“Australia has had nationally consistent standards in hospitals and day procedure services for 10 years. Since then, the National Safety and Quality Health Service Standards have led to significant improvements in patient safety,” Duggan added. “In time, we expect these new standards to lead to improvements in health care provided by

The commission is developing comprehensive resources to support healthcare services to implement the new standards and to help consumers understand what the standards will mean for them.

The primary health sector is a significant part of Australia’s healthcare industry, accounting for 34%, or $63.4 billion, of Australia’s total health expenditure in 2017−18. “The [standards] will be a game changer for the health sector in Australia, by giving practitioners the tools to be even better,” commission chief medical officer Conjoint Professor Anne Duggan said.

“It is important that people feel safe when they access a healthcare service, that the care patients receive is tailored to their needs, and that they are supported to make informed decisions about their own care,” she said.

From mid-2022, healthcare services can be independently assessed and become accredited to the new standards. Over time, Australians will be able to ask their healthcare service if they are accredited and look for an accreditation certificate or badge at the healthcare service or on their website. n

Over time, Australians will be able to ask their healthcare service if they are accredited.

EDUCATION, CLINICAL CARE AND RESEARCH IN CROSSHAIRS OF NEW OPTOMETRY COLLABORATION Optometry Australia (OA) and the Australian College of Optometry (ACO) have formalised an agreement to explore collaborations and potential joint ventures that progress the profession. The two organisations have signed a memorandum of understanding (MoU) and are considering working togethering in areas of professional education, clinical research and innovation in clinical care. OA national president Mr Darrell Baker said partnerships, such as those with the ACO, enabled OA to challenge itself to find new ways of operating to support the ongoing evolution of the profession

INSIGHT December 2021

as well as how to better support members.“Optometry Australia and the ACO have always been interconnected and we believe that there are many synergies that would be highly beneficial for both our memberships, and the profession broadly, that are worth us collectively exploring,” he said. By seeking ways of working with likeminded organisations, Baker said OA would be in a stronger position to achieve the outcomes identified in Optometry 2040, the sector’s 20-year transformational roadmap, launched in December 2018. “To lead the sector towards 2040, and

to achieve the targets set in this long-term strategy, the National Board recognises that Optometry Australia must invest in the technology, education and innovation required for optometrists to take control of their future,” he said. Darrell Baker, Optometry Australia.

ACO president Mr Rodney Hodge acknowledged that preparing for the future was vital. “A key part of the ACO’s agenda is to strengthen and assist the evolution of the profession of optometry. Collaboration and facilitation, along with independent action are, and will continue to be, important for delivering the best possible outcomes.” n

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Starts 8:00 AM AEST 1/10/21. Ends 11:59 PM AEDT 31/12/21. Open to AUST & NZ residents 18+ who are Eyecare Professionals employed at Optical Retail Practices (except Luxottica and Specsavers employees) and who fulfil the entry/eligibility requirements. Order qualifying products for your chance to win an MG ZST Essence AUD$33,690 (owner of optical practice receives AUD$2,000 Mastercard Gift Card). Minor Prizes 10 x iWatch Series 6, 10 x AUD$500 Kathmandu Gift Cards & 10 x AUD$200 Rebel Sport Gift Cards. Total prize pool is AUD$49,190 (inc GST). Prize draw 3:00 PM AEDT 12/1/22 at Lvl 2 11 York St Sydney NSW 2000 Australia. Winners notified via email & published at xtractive.com.au 19/1/22. Promoter is Transitions Optical Pty Ltd. ABN 29 067 278 139. 283-287 Sir Donald Bradman Dr Brooklyn Park SA 5032 Australia. Authorised under NSW Authority No. TP/00262, ACT Permit No. TP 21/01386 & SA Permit No. T21/1260. For full T&Cs refer to xtractive.com.au. Transitions, Transitions Signature and XTRActive are registered trademarks and the Transitions logo and Transitions Light Intelligent Lenses are trademarks of Transitions Optical, Inc. used under license by Transitions Optical Limited. Light Under Control, GEN 8 and Transitions XTRActive Polarized are trademarks of Transitions Optical Limited. Drivewear is a registered trademark of Younger Mfg. Co. Photochromic performance is influenced by temperature, UV exposure, and lens material. © 2021 Transitions Optical Ltd. www.transitions.com

NEWS

BEOVU PBS-LISTED AS NOVARTIS SEEKS DME INDICATION ABROAD

OPTOMETRIST WHO ‘FELL IN LOVE WITH FLYING’ SEEKS TO COMBINE HER PASSIONS Port Macquarie optometrist Candice Pearson is one step closer to fulfilling her dream of becoming a "flying optometrist" after gaining her commercial pilot licence with the support of an $8,000 scholarship.

Almost 13,000 Australians could save thousands annually with the Pharmaceutical Benefits Scheme (PBS) listing of Beovu (brolucizumab) for neovascular agerelated macular degeneration (nAMD), the government says. Federal Health Minister Greg Hunt announced the Novartis therapy would be available via the government subsidised medicines program from 1 October after it was recommended for listing by the Pharmaceutical Benefits Advisory Committee at its March 2021 meeting.

Optometrist Candice Pearson (left). Image: Airservices Australia.

The Flight Training Scholarship from Airservices Australia and the Australian Women Pilots’ Association (AWPA) is designed to increase opportunity for more women to pursue a career in aviation by contributing to the cost of their flight training and removing what can be a financial barrier to becoming a pilot.

It will be available for patients who have not responded to first-line anti-vascular endothelial growth factor (anti-VEGF) treatment. Without PBS subsidy, the government believed around 12,800 Australians might pay more than $8,800 per year for the new treatment option.

Pearson, who has practised at Optical Superstore’s Port Macquarie store since 2017, graduated with a Bachelor of Vision Science and Master of Optometry from Queensland University of Technology in 2015.

It comes as overseas governing agencies abroad accepted regulatory paperwork for Beovu for treating diabetic macular edema (DME), with regulatory decisions expected in mid-2022 for the US and Europe.

“When I started training, I fell in love with flying and my goal now is to gain my instrument rating so I can begin work as a ‘flying optometrist’, providing eyecare services to remote and Indigenous communities,” she told Airservices Australia.

Novartis announced the US Food and Drug Administration (FDA) has accepted the company’s supplemental Biologics License Application and the European Medicines Agency has validated the type-II variation application for Beovu (brolucizumab) 6 mg for the treatment of DME.

Person said gaining her commercial pilot licence was one of the biggest achievements of her life and hopes to eventually become a pilot for the Royal Flying Doctor Service.

UNSW’s Professor Konrad Pesudovs has become the twelfth Australian to be awarded the American Academy of Optometry Foundation Glenn Fry Lecture Award in its 50-year history.

Pearson also joined Early Career Optometrists NSW/ACT, otherwise known as ECONA, Regional Engagement Subcommittee in April this year.

"Therefore, I would love to be able to help encourage online meetings to build a support network between regional members as an opportunity to share any challenges, as well as triumphs, that working in a regional area brings.” n

INSIGHT December 2021

Additionally, the Japanese Pharmaceuticals and Medical Devices Agency accepted an application for Beovu for DME. If approved, DME would be the second indication for Beovu, following its approval for neovascular age-related macular degeneration in October 2019 (FDA) and February 2020 (European Commission). Ms Jill Hopkins, senior vice president and global development unit head of ophthalmology at Novartis Pharmaceuticals, said the company looked forward to bringing a potential new option that may help to address unmet needs for DME patients. “People living with diabetes often need to manage multiple comorbidities related to diabetes and there is a significant need to provide better disease management. If approved, Beovu has the potential to provide better fluid resolution and fewer injections during the loading phase and throughout maintenance treatment,” she said. n

AUSSIE PROFESSOR RECOGNISED WITH PRESTIGIOUS AWARD

“But for now, I’m just excited to be able to combine my two passions, to help people and have fun flying across Australia while doing it,” she said.

“I find, working in a regional area myself, connection and engagement with colleagues and linking into face-toface CPD can be challenging," she told Optometry NSW/ACT.

Novartis’ Beovu could be approved for DME overseas by mid-2022.

Prof Konrad Pesudovs (right) with the late Dr Tony Adams.

research contributions.

“To see my name on the same list as all of my heroes of optometry is shocking and humbling. I’m proud of what I have achieved so far in my career and I hope I can justify this award by continuing to do useful research and by making other valuable contributions to optometry,” he said.

Pesudovs, who is currently the highest-ranked optometrist globally for citations to his research work, joined UNSW School of Optometry and Vision Science in 2020. He came to UNSW from Flinders University in South Australia where he was the Foundation Professor of Optometry, charged with establishing and leading the accreditation of a new optometry school and Masters in Optometry program between 2009 and 2017.

The Glenn Fry Lecture Award recognises a distinguished scientist or clinician for their current

UNSW credited Pesudovs with changing how practitioners practice to deliver improved outcomes. n

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NEWS

SILMO MAKING ASIA-PACIFIC COMEBACK WITH SINGAPORE TO BECOME FLAGSHIP REGIONAL EVENT After coming and going from the Australian conference calendar, the Silmo global eyewear and lifestyle trade show is set to return to the Asia-Pacific region in 2023 with the launch of a Singapore event. Silmo International, Singapore Tourism Board and MP Singapore, a marketing and event management group, have signed a Memorandum of Understanding (MOU) to officially launch Silmo Singapore. The partners said that as larger-scale business events and activities resume over the next few years, Silmo will move to Singapore from 2023, where it will be held for subsequent editions in 2024 and 2025. Silmo International president Mr Jerome Colin said Silmo Singapore was expected to become one of Asia’s leading trade shows for the optics and eyewear industry. “Singapore, being an accessible and vibrant gateway to the Southeast Asia region will be able to target significant presence from international trade sellers and visitors, from the optical and eyewear sector industry,” he said. “Like Silmo Paris, Silmo Singapore will also include quality programming to enrich visitors’ retail experience and insights on the latest innovations in the industry.” The inaugural SILMO Singapore will run

The Silmo brand is expanding into Southeast Asia.

over three days at the Suntec Singapore Convention and Exhibition Centre from 12 to 14 April 2023.

"WE ARE CONFIDENT THAT SILMO SINGAPORE WILL GROW INTO A PREMIER PLATFORM FOR INTERNATIONAL AND REGIONAL BUYERS" POH CHI CHUAN, SINGAPORE TOURISM

Silmo has had a presence in the Southeast Asian region since 2018, with the hosting of the ASEAN Optometric Congress along with an international trade show in Bangkok.

for international and regional buyers to discover the best designs, collections, and technologies in the eyewear industry,” he said. The Silmo brand launched in Australia five years ago, but only took place twice, in consecutive years. The inaugural Sydney show launched in 2017 at the newly opened $1 billion International Convention Centre at Darling Harbour. The three-day tradeshow organised by Expertise Events returned the following year (2018) at the same venue. However, SILMO Sydney and ODMA’s trade event, O-Show, took place within a week of each other, causing many exhibitors to call for a more sustainable and collaborative approach to support the entire industry. Despite this, SILMO Sydney was scheduled for July in 2019, once again at the International Convention Centre, two weeks ahead of the inaugural O=MEGA19 conference and trade event in Melbourne.

The MOU partners assert Silmo Singapore will be the Asian flagship edition of Silmo Paris. Singapore Tourism Board’s Mr Poh Chi Chuan, executive director of exhibitions and conferences, said the three-year MOU demonstrated the continued confidence in Singapore’s role as a leading business events capital.

The proximity in dates and discord among event organisers led Expertise Events to cancel the 2019 SILMO Sydney optical tradeshow.

“Given the tremendous success of Silmo Paris and our strong collaborators for this project, we are confident that Silmo Singapore will grow into a premier platform

While there were plans in place for SILMO Sydney to proceed in 2020, it did not eventuate. n

FINANCIAL HARDSHIP TAKEN INTO CONSIDERATION AS OPTOMETRY BOARD FEES RISE AGAIN The Optometry Board of Australia (OBA) has increased its annual general registration fee for a third year in a row to align with indexation and will now cost $327. The authority announced the 3% increase for 2021-22, with optometrists paying $10 more than last year (2020-21) when fees rose to $317, up from $308 in 2019-20. The fee for practitioners whose principal place of practice is New South Wales is $323. The registration fee for a non-practising optometrist is $109. There are no registration fees for students, and there is no application fee to change registration type to ‘non-practising’. Ahpra CEO Martin

INSIGHT December 2021

Fletcher said the OBA recognised the effect that the lockdowns may have had on practitioners’ practice. “We have put in place a registration and renewal fee payment plan for any practitioners who are experiencing financial hardship,” he said. Up until 2019, optometrists enjoyed a consistent fee of $300, which was first imposed in 2016-17 and frozen for two years. Prior to that, the sector saw consecutive price drops from a high of $415 in 2012-13. According to the OBA, its decision to increase the fee by indexation for the 2021–

22 period ensures it has sufficient income to carry out its duties and protect the public. “The board is committed to keeping the fee as low as possible, while meeting its regulatory obligations to protect the public,” the OBA stated. Martin Fletcher, Ahpra.

"This continues to be a challenging time for health practitioners and sincerely thanks practitioners for their important role in keeping the community safe and healthy.” Optometry was one of six disciplines to experience a 3% fee hike, along with medical ($835), occupational therapy ($119), osteopathy ($387), physiotherapy ($152) and pharmacy ($433). n

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*Darkness compared to previous Transitions XTRActive generation. Light protection from glare and UV, plus increased blue filter. 1 Based on tests on polycarbonate grey lenses; up to 10% darker than Transitions Vantage @ 23°C and up to 5% darker @ 35°C. 2 Based on tests across materials on grey lenses @ 23°C, using ISO 12312-1 standard. 3 Compared to other products in the Transitions portfolio. Based on tests across materials on grey lenses @ 23°C. Based on blue light range of 380nm-460nm. 4 Based on tests across materials on grey lenses @ 23°C, using ISO 12312-1 standard tests across materials on grey lenses @ 23°C. 5 Helps to reduce glare from artificial lighting and digital devices. 6 Clear to extra dark photochromic category. Tests across polycarbonate and 1.5 grey lenses using Transitions Optical’s standard testing method. Outdoors at 35°C achieves <18%T. Behind the windscreen at 23°C achieves between 18%T and 43%T. 7 Compared to the previous Transitions XTRActive generation across materials tested on grey lenses fading back to 70% transmission at 23°C. 8 Compared to other products in the Transitions portfolio. Blue light range of 380nm-460nm indoors measured at 23°C, behind the windscreen, outdoors at 23°C and 35°C among polycarbonate and 1.5 grey lenses in the clear to extra dark photochromic category. Transitions, XTRActive and Vantage are registered trademarks and Transitions XTRActive Polarized, Transitions Light Intelligent Lenses, and the Transitions logo are trademarks of Transitions Optical Inc. used under license by Transitions Optical Limited. ©2021 Transitions Optical Ltd. Photochromic performance and polarisation are influenced by temperature, UV exposure and lens material. www.transitions.com

NEWS

MDFA QUIZ HITS MAJOR MILESTONE Macular Disease Foundation Australia (MDFA) has reached 100,000 completions on the Check My Macula quiz – and marked A still from MDFA’s new video series. the milestone by launching a new series of educational videos to help patients learn more about eye health. One year since launching the short online quiz, the organisation says more than 100,000 Australians now know their individual risk factors for age-related macular degeneration and diabetic eye disease. Thousands of users have also downloaded vital eye health information, and many have gone on to book an eye examination through Check My Macula’s ‘find an optometrist’ search function. MDFA has celebrated the anniversary by releasing the Eye Health video series, comprising bite-sized clips that share important health advice in a simple manner. Each video is one or two minutes long, answering many of the most common questions that people ask about their eye health. “Throughout the COVID-19 pandemic, the macular disease community told us that they’re looking for short, sharp video content – and we listened,” MDFA CEO Ms Dee Hopkins says. “The Check My Macula quiz has introduced 100,000 Australians to their risk factors for macular disease and diabetic eye disease over the past 12 months. I hope the Eye Health video series can now educate even more people about how they can take care of their eyes.” The 27-video series has been supported by NSW Health and Novartis, whose funding allows MDFA to deliver education and awareness programs, as well as support services to Australians with macular disease. The video series aims to improve patients’ understanding of various macular conditions, possible treatments and preventions, lifestyle changes they can make to protect their sight, and tips to live well with vision loss. n

INSIGHT December 2021

NEW GLAUCOMA IMAGING TECH WINS ‘QUINLIVAN’ RESEARCH GRANT UNSW’s Professor Ewa Goldys from the Graduate School of Biomedical Engineering has been awarded Glaucoma Australia (GA)’s ‘Quinlivan’ Research Grant to develop a novel imaging technology for the early detection and monitoring of glaucoma. GA and patron Governor-General Mr David Hurley awarded Goldys the grant to commemorate World Sight Day on 14 October. “Our approach termed fluorescent hyperspectral imaging (fHSI) has the genuine potential to produce a paradigm shift in ophthalmic practice in a similar manner to how optical coherence tomography (OCT) became a commonplace clinical imaging tool in glaucoma management,” Goldys said. “We believe this technology will be particularly useful in the early detection of glaucoma and its subsequent monitoring.” The novel technology obtains real time monitoring of dynamic disease status by non-invasively obtaining information about retinal energy metabolism. Goldys said the research provided a scientific foundation for clinical translation by first mapping the fHSI data to pathological changes in experimental glaucoma. The next step is to obtain fHSI data in the lab-based microscopy system and then use an adapted clinical

Professor Ewa Goldys, UNSW.

fundus to image the same samples and link the results. This approach paves the way for future widespread clinical application of fHSI. A world leading biomedical engineer, Goldys and medical and data scientists with complementary skill sets, will work with internationally recognised glaucoma clinician-scientists Professor Andrew White and Professor Robert Casson, to lead the interdisciplinary project from lab to clinic. With an Australian SME providing device engineering and state-of-the-art infrastructure support from the Centre for Nanoscale BioPhotonics, Goldys believes her team is positioned to lead the world in this technology. Since 2006, GA has committed $1.4 million to support Australian glaucoma researchers across various projects. Goldys’ grant is the fourth to be awarded through the ‘Quinlivan’ Research Grants Program re-launched in 2019. n

RANZCO’S ‘THE TICK’ TO PROMOTE GREATER FEMALE INCLUSION RANZCO says it has demonstrated its commitment to gender diversity, with the launch of a new initiative endorsing events that aim for higher levels of female representation. "‘The Tick’ is an endorsement by the college that a conference or event has achieved the RANZCO target of 35% female representation. It is a visible signifier that events are as dedicated to gender diversity and inclusion as RANZCO is,” the college announced. “The Tick was developed by the RANZCO Women in Ophthalmology and has been approved for use by the RANZCO Board. Adding The Tick to an event website, program and

marketing collateral demonstrates commitment to gender equality, and diversity of thought and excellence. RANZCO's 'The Tick'. Women in Ophthalmology has also launched the RANZCO Speaker Bureau.

It is a flipbook of RANZCO Fellows and trainees who have opted to publicise their availability to speak at events. The Speaker Bureau is intended to aide event organisers in finding a broad range of speakers and can be searched by topic, gender and location. n

UNDERSTANDING FUNDING FOR LOW VISION SERVICES

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- Telstra Disability Equipment Program - Lions Visual Independence Foundation Funding Grants for ID Mate talking bar code scanner and Kapten Plus GPS device. • State-based equipment funding: NSW: NSW Spectacles Program

Funding can enable blind and low vision people access the latest technology, aids, equipment and services.

Vision Australia is keen to remind practitioners about the various funding options for blind and low vision patients, which it says can be “daunting” to remember in time poor and constrained clinical environments. “Of course, the easiest and most simple form of funding is the patient self-funding services and any equipment/aids they may require. This for most is not an option and where a referral to Vision Australia can really help,” the organisation stated. “We will ensure the patient has the best possible chance of gaining funding for which they may be eligible.” Funding can be dependent on personal circumstances, including being means tested, and includes: • National/Federal Government general funding: - National Disability Insurance scheme (NDIS) < 65 years of age - My Aged Care (MAC) >65 years of age. ensions - Centrelink and P Department of Human Services - Disability support pension - Blind pension • National equipment funding: - Job Access Workplace Modifications - Department of Veterans' Affairs (DVA) - Work Ventures

– Vision Australia, Enable NSW, Family Assistance Fund, Technical Aid to the Disabled. Victoria: Victorian Eye care Service (VES), Victorian Aids and Equipment Program, Green PC. Queensland: Green PC. Northern Terrority: Territory Independence Mobility Equipment Scheme (TIMES). ACT: ACT Low Vision Aids Scheme. All States & Territories: - Departments of Education, Catholic Education and Independent Schools - Vision Australia Equipment Funding options - Further Education Bursaries

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- Tax deductions and private health insurance rebates. • National mobility benefits and entitlements: - Centrelink: Mobility Allowance -N ational Companion Card Scheme – (enables eligible people with lifelong disability to participate at venues and activities without incurring the cost of a second ticket for their companion. Available most states at participating venues/events). • State-based mobility benefits: - Vision Impaired Travel Pass (NSW, QLD, VIC) - Access Travel pass (VIC) -T axi subsidy scheme – discounted taxis when public transport is not an option. (ACT, NSW, VIC, QLD). Visit the following links for general and further funding information: www.visionaustralia. org or www.visionaustralia.org/ referral/benefits-and-funding n

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COMPANY

SAFILO TO REDUCE PALLADIUM USE IN NEW SUSTAINABILITY DEAL Global eyewear manufacturer and distributor Safilo is continuing to progress its Safilo has made sustainability agenda, following a sustainability a priority. strategic partnership with Coventya, which develops specialty chemicals for surface finishing treatments. Safilo is now the first player in the eyewear sector to exclusively use ‘Metal X’, a new Coventya patent that reduces the use of precious metals in galvanic treatments in optical frames production by 90%. ‘Metal X’ will be introduced at Safilo’s Longarone plant in Italy, and will allow the company to significantly reduce the use of the rare metal palladium. The material will be used in Safilo’s eyewear collections produced in Italy starting with the August 2021 release. Safilo said it represented a further step in sustainable production processes initiated in recent years with nickelfree galvanic treatments. With these processes, the group said it has eliminated the use of nickel, a silverywhite metal traditionally employed in the finishing treatments of eyewear, while guaranteeing higher standards of product excellence thanks to new technologies. “The partnership with Coventya is particularly strategic for Safilo as it allows us to be the first to introduce a new and effective sustainable solution in our eyewear production processes,” Mr Fabio Roppoli, Safilo Group chief product supply office, said. “By eliminating palladium in favour of Metal X, we take a further step forward in our business strategies focused on sustainability and we are sure that this innovation will be appreciated by our customers and consumers, who are increasingly concerned about these issues.” Coventya international product manager Ms Coline Nelias added: “It was particularly significant for us to be able to create a material that offered the same qualitative and technical properties as palladium and could be used in replacement of natural precious metals.” n

INSIGHT December 2021

SPECSAVERS CANADA AIMS TO OPEN 200 STORES BY 2024 "WE'RE LOOKING FORWARD TO SHOWING CANADIANS THE VALUE OF OUR TRIED-ANDTRUE BUSINESS MODEL" BILL MOIR, SPECSAVERS CANADA

After announcing its entrance into the North American market earlier this year, Specsavers has set a goal to open 200 stores across Canada over the next three years. The world’s largest privately-owned optometry group marked its arrival in November with the acquisition of British Columbia-based, multi-store business Image Optometry. It will start by launching 16 stores in British Columbia over the next six months. The first will open in Woodgrove Centre, in Nanaimo, and Coquitlam Centre, in Coquitlam, with 14 more scheduled by March 2022. The company plans to become a market leader in Canada and reach its 200-store goal by 2024. In a statement, Specsavers said it wanted to redefine accessible eyecare for Canadians by providing value-driven prescription eyewear paired with inclusive clinical care, advanced equipment, and a network with professional expertise. "We're looking forward to showing Canadians the value of our tried-and-true business model that has allowed us to deliver on our promise of accessibility for customers for 37 years and counting," Mr Bill Moir, Specsavers Canada

Specsavers operates in more than 10 markets, arriving in Australia and New Zealand in 2008.

general manager, said. "By creating business ownership opportunities for independent optometrists, Specsavers is able to build a network that is represented in rural and urban locations and can structure operations in a way that generates high value for both optometrists and customers." Specsavers stores are owner-operated under a franchise partnership model, while providing a global, integrated supply chain with facilities across Asia, UK, Australia, Eastern Europe and North America. Founded in 1984, Specsavers now operates in more than 10 markets. The company set up in Australia in 2008 and last year celebrated its 400th store across Australia and New Zealand. n

FDA APPROVES FIRST NASAL SPRAY FOR DRY EYE DISEASE The US Food and Drug Administration (FDA) has approved the first and only nasal spray for dry eye disease (DED). Tyrvaya (varenicline solution) nasal spray 0.03 mg, from New Jersey company Oyster Point Pharma. The solution binds to cholinergic receptors to activate the trigeminal parasympathetic pathway resulting in increased production of the basal tear film. Available with a prescription in the US as of November, Tyrvaya is sold in cartons containing two multidose nasal spray bottles. Each bottle covers treatment for 15 days, administered twice daily into each nostril. “The approval of Tyrvaya Nasal Spray marks a milestone for patients and eyecare professionals by providing a new drug treatment option for the signs and symptoms of dry eye disease with a

Each bottle covers treatment for 15 days.

differentiated route of administration that is believed to leverage a nerve pathway that can be accessed within the nose,” Dr Jeffrey Nau, president and CEO of Oyster Point Pharma, said. In a study, Tyrvaya-treated patients showed statistically significant improvements in tear film production assessed using the anesthetised Schirmer's score (0-35 mm) at week four. The most common adverse reaction in 82% of patients was sneezing. n

CYLITE AND COBALT DESIGN TAKE OUT DESIGN AWARDS Australian OCT manufacturer Cylite and its partner Cobalt Design have received another award for the soon to be released Hyperparallel OCT (HP-OCT), this time by Good Design Australia.

Design with their award, the Good Design Awards Jury stated it was “a sophisticated design with a clear stepchange in innovation relative to previous generations of eye-imaging technology”.

The companies took out the ‘Best in Class’ Engineering Design and Gold Medal for Product Design during the Good Design Awards Week, which ran from 11-15 October. Cobalt Design is a Melbourne-based product development agency.

“What set this entry apart from many others was the clear expression of relative impact (four instruments in one; cost equivalence to one; ease of use and benefits compared to older technology) and that there was third party validation of the innovation (grants, early adopters),” the panel said.

This follows other recent awards, including the Premier’s Design Award, presented in 2021, and the Sir William Hudson Award – Engineers Australia’s most prestigious award – presented in 2020. The Australian Good Design Awards is said to be the country’s oldest and most prestigious international awards for design and innovation with a history dating back to 1958. In presenting Cylite and Cobalt

high demand into the future. A standout example of design excellence in this category that deserves to be recognised at the highest level in the awards.”

Cylite's Grant Friskin with the awards.

“Also impressive were the zero non-conformances. It is clear this product has been designed to a very high standard both from an engineering design and industrial design perspective. It is both visually pleasing and provides a comfortable and intuitive patient interface. Given the impact of a growing aging population around the world and eyesight being a major issue, this device will likely be in

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Mr Andrew Parkinson, Cylite’s vicepresident of engineering, said the award was a testament to the ability of Australian engineers. “Cylite and Cobalt’s team of engineers and designers have worked together, to produce world class medical technology combining cutting edge optics, electronics, software and mechanical design,” he said. Cylite’s CEO Dr Steve Frisken added: “We are also grateful to Cobalt design for their industrial design support and the wonderful look and feel of this innovative clinical diagnostic instrument. These innovations will, I believe, truly have a lasting impact on global eye health, which is a legacy that will provide ongoing pride to all those involved.” n

HEALTH INSURANCE

WILL HONEYSUCKLE HAVE A BEARING ON

? e r a c h t l a e Australian h

market power was also of concern. The final determination was handed down on 21 September, with the ACCC largely sticking by its draft decision. However, it prohibited major insurers Medibank, Bupa, HCF and HBF in Western Australia – representing 70% of the market – from joining. It also only granted authorisation for five years, rather than the 10 years sought, so it can review its impact sooner. During the consultation phase, Optometry Australia highlighted potential issues for smaller optical operators and their ability to compete with their larger counterparts who often entered low or ‘no gap’ arrangements with health funds. The ACCC stated Honeysuckle would not be negotiating agreements with individual providers in the general treatment network, including optometrists, and any changes in its buying power “were unlikely to impact the setting of prices or terms and conditions for the general treatment network”.

Following the final decision, ASO vice-president Dr Peter Sumich told Insight he regarded Honeysuckle as an induction campaign that could be built upon. "Managed care is a creeping process. Honeysuckle wanted a yard, but they got their inch. The finding was a clear rebuttal to Honeysuckle’s plans to introduce an industry wide contracting company,” he said. “They will remain contained to their own sandbox with their own products and reputation on the line. It was the best outcome we could have reasonably expected. The ACCC were ruling on competition policy, not health policy.”

Australia’s competition watchdog has delivered its final ruling allowing the formation of the Honeysuckle Health buying group, which may have implications for the ophthalmic sector.

Sumich said the ASO would join the AMA and COPS to continue pushing for a federal private health insurance (PHI) regulator.

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las, the Australian private health insurance (PHI) system has a new buying group, but whether it’s the ‘thin edge of the wedge’ for an altered Australian healthcare system remains up for debate.

Honeysuckle Health is an equal joint venture established in 2019 between Australian health fund nib and Cigna Corporation – a US-based health services giant. Honeysuckle operates independently from both entities and provides data analytics, contract negotiation, procurement and administration services for nib’s contracts with hospitals, medical specialists, GPs and allied health professionals.

“At present the PHI disregard the Health Act and are attempting to find loopholes and ways around it through intermediary processes,” he added. “Younger doctors must step up and be more vocal because it is their future health system that'll suffer if managed care evolves.”

The Honeysuckle buying group will join the Australian Health Services Alliance (AHSA) and the Australian Regional Health Group (ARHG) as the third major buying group. In its final ruling, the ACCC said Honeysuckle would provide greater choice of buying groups for smaller PHIs and increased competition between the buying groups. It would also improve access to information for smaller PHIs, through the option of a particular type of data analytics that would allow them to offer more competitive products and services.

An application lodged with the Australian Competition and Consumer Commission (ACCC) on Christmas eve last year sought authorisation for Honeysuckle to provide these services to additional PHIs and form a joint buying group, meaning it would collectively negotiate contracts with healthcare providers on behalf of other PHIs.

“Increased competition between buying groups is likely to foster greater innovation and incentivise the buying groups to provide better value to their participants,” the ACCC stated. “In turn, and in combination with the improved information available to them, smaller PHIs are likely to be able to compete more effectively with the major PHIs.”

The proposal was approved in the ACCC’s draft determination in May, but this sparked significant backlash, with 204 submissions, compared with just 30 during the initial consultation.

The ACCC also believed the buying group would benefit consumers through the Broad Clinical Partners Program (BCPP) whereby Honeysuckle signs agreements with medical specialists, so customers aren’t charged out-ofpocket costs for hospital treatment.

The Australian Society of Ophthalmologists led this opposition with the backing of the Australian Medical Association (AMA), Council of Procedural Specialists (COPS) Australia, Australian Private Hospitals Association and Medical Surgical Assistants Society of Australia. Their concern centred a perceived gradual introduction of US-style managed care in Australia, where insurers possess control over clinical care pathways through contractual agreements. The potential for the buying group to possess disproportionate

INSIGHT December 2021

“If the buying group expands to more of the smaller insurers, we consider that Honeysuckle’s BCPP likely to help reduce uncertainty for more consumers about out-of-pocket expenses for certain types of procedures. It is also likely to provide more consumers with greater access to medical procedures which attract no out-of-pocket expenses,” ACCC Commissioner Stephen Ridgeway said.

BIG FOUR REJECTED FROM JOINING During the consultation phase – in response to mounting opposition – Honeysuckle amended its original application to exclude major PHIs Medibank, Bupa, HCF and HBF from participating for hospital contracting, medical gap schemes and general treatment networks.

“YOUNGER DOCTORS MUST STEP UP AND BE MORE VOCAL BECAUSE IT IS THEIR FUTURE HEALTH SYSTEM THAT'LL SUFFER IF MANAGED CARE EVOLVES”

But it sought to provide contracting services to all PHIs, including major health funds, for the BCPP, subject to a condition that the buying group would be allowed to represent a maximum of 80% of the market. “However, we were concerned about the potential effect on competition if the buying group involving Honeysuckle Health and nib became too large and gained too much bargaining power,” Ridgeway said. “And we have accordingly imposed a condition that excludes the participation of other major health insurers. These insurers represent around 70% of the market in most states and territories.” The ACCC further stated major PHIs have the scale to develop similar ‘no gap’ experience programs on their own. CONCERNS ABOUT US-STYLE MANAGED CARE The ACCC said it carefully considered concerns about US-style managed care, but after an extensive investigation, it was not satisfied it would result in the Australian system changing to this model. The authority said it considered several healthcare regulatory restrictions and policy settings, and noted health insurers are currently engaged in similar ‘valuebased’ contracting practices, which are likely to continue in any case. “We also concluded the condition that excludes the major insurers from membership, and the shorter period of authorisation, are likely to address concerns about the long-term effects of the authorisation,” Ridgeway added.

DR PETER SUMICH ASO VICE-PRESIDENT

HONEYSUCKLE RESPONDS Honeysuckle Health CEO Mr Rhod McKensey said the entity would differ from other buying groups because it of its focus on value-based care and data science to inform decision making. “In the healthcare setting there is significant variation in costs, clinical outcomes, patient experience and provider experience with some hospitals and clinicians charging markedly more than their peers. We believe all this information should be readily available to both GPs and consumers and be used to help inform treatment options," he said. “We have no intention to ever interfere in the clinical autonomy of doctors, rather provide optional tools and services to enhance the care they already provide. Honeysuckle Health is an exciting opportunity for the healthcare system and should be judged on its actions and outcomes, not assumptions.” n

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THE

r e m m Su e s a c w sho With 2021 posing yet another disruptive year for the ophthalmic market, Insight is bringing together a host of Australia’s leading suppliers to showcase their 2021/22 releases.

Over the next nine pages, eyecare professionals will discover the latest in ophthalmic lens and equipment technology, along with in-vogue frame designs, contact lens products and other innovations. 24

INSIGHT December 2021

Summer showcase EIGHT TIMES THINNER THAN CONVENTIONAL BLISTER PACK

OAKLEY OJECTOR A CUT ABOVE An extension of the Ahyris family of Oakley eyewear styles that feature a unique design element on the frame, the universally flattering silhouette of Ojector sets it apart. In addition to the Ojector design, Oakley supplier Luxottica, says that the frame material is strong yet lightweight, with its O-Matter frame featuring a three-point fit that also helps provide all-day comfort. The eyewear is available with Prizm Lens Technology that is designed to enhance colour and contrast so the wearer can see more detail. It is also available with Oakley Authentic Prescription lenses that come laser etched with the ellipse logo on left wearing lens for proof of Oakley authenticity and quality. Product code: OO9018-0555.

Designed with the contact lens wearer in mind, Menicon’s Miru 1day Flat Pack offers wearers easy handling and cleaner, more comfortable wear. At barely 1mm thick, each foil blister pack is developed with the company’s Smart Touch Technology to reduce the likelihood of contamination of the lens inner surface, so contact lenses can be worn with confidence and comfort. “Not only does the Miru 1day Flat Pack require signiﬁcantly less force to open than a conventional blister pack, it is also eight times thinner than conventional blister pack – resulting in 80% less raw material required,” Menicon says. “The thoughtfully designed ultra-slim, lightweight packaging is easy to store taking up little space, great when travelling or for sport and comes with a convenient 30-lens storage case – made from recycled mould plastic.” It is available for single vision and toric contact lens designs. Email: mail@ menicon.com.au

Contact: 1800 637 001 (Customer Care)

HEALTHHUB FEATURES LATEST DATA AND RESEARCH

MODSTYLE UNVEILS LATEST AVANTI DESIGNS The Australian eyewear design team at Modstyle have been busy, with the summer season seeing the launch of new models across the AVANTI range, including what it describes as a gorgeous new colour way in the striking frame ‘Courtney’. The colours seen in the new colour way ‘c7’ are designed to harness the spirit of Australia. The colours featured in the acetate reflect the jewel tones found across the land of Australia with the merlot purple temples inspired our famous wine regions. With stainless steel temples, a modern twist is added to a timeless shape making it a versatile must have piece in a sophisticated eyewear collection. Frame details (pictured): ‘AVANTI Courtney c7’. Email: info@modstyle.com.au

HealthHub is a Specsavers platform dedicated to sharing updates on detection, referral and treatment progress for eye conditions, as well as highlighting the latest data and research into eye health across Australia and New Zealand. Some of the information and data shared includes advances in research, technology and treatments for eye conditions, strategies and progress in detecting eye conditions – such as glaucoma and diabetic retinopathy – case studies, and the impact COVID has had on eyecare. HealthHub also regularly features the latest information on landmark clinical trials and findings from the Centre for Eye Research Australia (CERA), Glaucoma Australia, The Fred Hollows Foundation, Diabetes Australia and Glaucoma New Zealand. With an extensive library of industry news, the company says it’s a great hub for professionals, graduates, and students. Each month a HealthHub newsletter is sent to subscribers sharing insights on eye health across the wider industry. Visit: healthhubanz.com INSIGHT December 2021 25

Summer showcase B+L BI-BLADE DUAL PORT VITRECTOMY CUTTERS Bausch + Lomb (B+L) constantly seeks new ways to put innovation into the practice, and the Bi‑Blade vitrectomy cutter – with an effective cut rate of up to 15,000 cuts per minute (CPM) – is an example of its dedication to providing a precise and efficient surgical experience, the company says. With its dual-edge blade, the Bi‑Blade vitrectomy cutter doubles the effective cut rate over single-edge vitrectomy cutters, allowing for faster procedures while potentially decreasing the risk of retinal traction, according to B+L. The cutter is exclusive to the Stellaris Elite vision enhancement system (read more on pages 34-35). “This innovative design results in increased flow efficiency compared to prior generation guillotine cutters while still providing the user a precise surgical experience,” the company states “The design also facilitates cutting without port closure, allowing the Bi-Blade to provide continuous aspiration at all times. This also reduces the need for a duty cycle while still creating a consistent flow rate with continuous holding force. This enables surgeons to confidently shave more closely to a mobile retina, perform dissections and remove intraocular tissues.” Email: customer.service@ bausch.com

PRODESIGN DENMARK MARKS MILESTONE WITH NEW CAPSULE COLLECTION ProDesign Denmark – locally distributed by Eyes Right Optical – is celebrating its upcoming 50th anniversary. To celebrate, it is paying homage to some of its most iconic eyewear models by launching a new capsule collection: ICONS. The Danish design team has taken on the challenge in redesigning these eyewear ICONs from the past. The first release in the ICONS series pays homage to Gail Spence and her iconic collaboration with ProDesign in the 1980s. The original Gail Spence series was a huge success and was worn by many celebrities. They are a true ICON in the world of eyewear, the company says. The design team at ProDesign Denmark were honoured to work with Spence on this exciting re-design of her iconic eyewear. Made in Italy, the collection features a re-design of the original 1980s Gail Spence ‘no. One’ along with two new exclusive Gail Spence shapes in both optical and sun. Eyes Right Optical says it is thrilled to bring these exquisite frames to the Australian and New Zealand market. Frame details (pictured): ‘ProDesign Denmark Gail Twelve 9914 3521’. Email: sales@eyesright.com.au

COMPACT TOUCH – THREE-IN-ONE ULTRASOUND SYSTEM Compact in design and definitive in diagnosis, the new A/B/P ultrasound platform from Quantel Medical/Ellex is designed to transform views of even the finest ocular structures, enabling users to visualise, diagnose and treat more Diabetic Retinal Detachment. © Adil El Maftouhi accurately and efficiently. – Hôpital des XV-XX (Paris, France). Centre According to its Ophthalmologique Rabelais (Lyon, France). manufacturer, its Compact Touch platform benefits from a new generation 15 MHz B probe with a resolution increased by 30%. Small in size, this probe benefits from excellent ergonomics to facilitate its handling and use. Coupled with the exclusive technology of biometry in B-mode, the user can automatically measure the axial length from a B-mode image, a technique essential for patients with long myopic eye associated with staphylomas. “Ultrasound biometry is the only technology that allows measurements in all eye types, including when patients present a dense cataract,” the company states. “With the immersion technique, the axial length measurement accuracy is 0.03mm. The patented A-scan Probeam, exclusive to Quantel Medical, generates a laser beam that offers a fixation point to the patient facilitating: this aids the measurement while

INSIGHT December 2021

increasing ease of acquisition. The IOL calculation function allows comparison between different IOL types and calculation formulae. A total of 12 calculation formulae is available including postrefractive surgery formulae. The IOL implant calculation is The Compact Touch platform. completed at 0.25D.” For glaucoma diagnosis and refractive surgery, Compact Touch offers several measuring modes and corneal maps with an accuracy of ± 5 microns, allowing physicians to adjust intraocular pressure (IOP) through built-in IOP correction tables, Ellex says. A connected ultrasound platform, the new Compact Touch can now import and export images and patient reports to the PACS through a fully integrated DICOM interface. To further increase the working ergonomics around the patient, its sleek design makes the system easily transportable to fit in any working environment or examination room. Email: salesadmin@ellex.com

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VIEW THESE MODELS AND MORE AT WWW.EYESRIGHT.COM.AU

Summer showcase ACCESSORIES COMBINE FASHION WITH FUNCTIONALITY

SWAROVSKI: OPENING EYES TO THE CRYSTAL LIFESTYLE Following a successful global rebrand this past spring, Swarovski is poised to expand beyond the boundaries of one specific category. In Collection II, its newest iteration, creative director Ms Giovanna Engelbert plays with wonders beyond jewellery to fully fulfill the brand’s promise of a crystal lifestyle. A part of this broader offering, Swarovski reinvigorates its eyewear offering with new pieces informed by key jewellery families. With the MICRO PAVÉ, SK0340 (pictured), Swarovski says these oval pavé crystal sunglasses are a modern twist on a wardrobe essential. Meticulously crafted frames, available in a variety of colorways for maximum self-expression. Whether worn for daytime adornment, or at sunset for cocktail hour, these sunglasses are sure to become a go-to pair for wearers. The Swarovski Eyewear collection is available by contacting your local Marcolin sales representative.

With glasses cases now considered as much a fashion statement as handbags, clutches or wallets, Good Optical Services has introduced the Sorella Double Take case. The collection has been split into two styles – Milan and Glam – and seeks to combine contemporary design, fashion and functionality – with each case able to carry two pairs of glasses that can double as a clutch bag. The Milan collection is oval-shaped and available in red, black and brown leather with plain black or animal print lining. It was inspired by the styles of Melbourne and Milan where Good Optical Services sourced a manufacturer skilled in handmade craftmanship and a range of top grain leathers. Sorella Glam is a round-shaped collection that adopts a glamourous, luxury approach; available in a luxe rose gold, silver or black – all with a soft grey suede fabric lining. Separately, the company has a rectangular Quad Case for travelling, which can hold four pairs of glasses or can store jewellery in one half and glasses on the other. Finally, Good Optical is supplying OptiPets – creative and collectible eyeglass holders. Originally introduced to spice up storefronts and frame counters, they have become popular with consumers, particularly kids and pet owners, and could be an ideal Christmas gift. Email: goodopt@ozemail.com.au

Email: customerservice.au@marcolin.com

THREE-IN-ONE LENS TECH WITH SERENGETI SUNGLASSES With the 1970s spirit flowing through its veins, the Serengeti Amboy embodies the DNA, philosophy and expertise of Serengeti. Its distributor, Sunglass Collective, says the iconic shape combined with classic colours is a must have this summer. Amboy’s handcrafted Mazzuchelli acetate and premium stainless-steel frame is not only eye catching, but will also stand up to the rigors of an adventurous wearer. “For decades, Serengeti has been making the most technically advanced eyewear one can find,” Sunglass Collective states. “Specifically, each pair of Serengeti sunglasses come equipped with three-in-one lens technology: photochromic, spectral control and polarisation technologies allow you to see the world at its finest. Combined with unique hardened, ultralightweight mineral lenses; it’s no wonder Serengeti are known globally as ‘the most advanced lenses'.” Also available on the Serengeti RX Program and in a range of colours, Amboy is the perfect choice for those unwilling to compromise on quality. Frame details (pictured): ‘Serengeti AMBOY SS530001’. Email: info@sunglassco.com.au

INSIGHT December 2021

BLUE LIGHT PROPERTIES BUILT INTO LENS MATERIAL Zeiss Vision Care has introduced a new generation of blue light blocking lenses called Zeiss BluePro, as patients seek greater eye protection from digital devices, modern LED light exposure and during outdoor activities. In its latest design, the company has incorporated the blue light blocking properties into the lens material itself. This is said to overcome common disadvantages in many blue light blocking solutions, including irritating reflections on the lens surface. Compared to the current blue light coating DuraVision BlueProtect from Zeiss, the reflections of digital blue light are reduced by up to 50%. As a result, Zeiss says the BluePro lens design offers excellent lens clarity and can block up to 40% of the potentially harmful and irritating blue light in the wavelength between 400 and 455nm, which it says has known links to digital eye strain. BluePro lenses also come standard with Zeiss DuraVision Platinum UV, offering full UV protection up to 400nm. Email: elmarie.pretorius@ zeiss.com

MULTI-MODALITY YAG/SLT LASER

1. Shah CP, Heier JS. YAG Laser vitreolysis vs. sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmol. 2017;135(9):918-923 2. Gus Guzzard, LiGHT Study 2019

EXCEPTIONAL VISUAL EXPERIENCE, UNPARALLELED ACCURACY Tango Reflex™ has a CE Mark (Conformité Européenne) for the indications of Laser Vitreolysis, Posterior Membranectomy, Premium Capsulotomy, Laser Iridotomy and Selective Laser Trabeculoplasty (SLT).

A clinically proven safe and effective primary option to manage symptomatic floaters1 Ellex Australia: Tel: +61 8 7074 8200 salesadmin@ellex.com

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First-line therapy for effective, safe, proven glaucoma treatment2

Summer showcase ISABEL MARANT EMBODIES ‘SOPHISTICATED PARISIAN AESTHETIC’ The ISABEL MARANT Eyewear collection is designed, produced and distributed in partnership with Safilo. According to Safilo, the brand embodies an effortless yet sophisticated Parisian aesthetic, coming to life in the eyewear collection with a cool edge in the classic silhouettes and re-interpreted with unexpected touches, as well as in the colour pallete ranging from timeless colours to playful combination and bold patterns. Discover the collection and get in touch with your local territory manager or contact the Safilo corporate office.

NEW TRANSITIONS XTRACTIVE LENS RANGE Transitions Optical has launched two new technologies in its extra dark photochromic lens range: Transitions XTRActive new generation and Transitions XTRActive Polarized. Both lenses are clear indoors, extra dark outdoors, and they darken in the car. They filter blue light and block 100% UVA and UVB. According to the company, Transitions XTRActive Polarized is designed for wearers frequently exposed to bright light and reflected glare. Indoors the lens is clear and unpolarised. Featuring dynamic polarisation, the lens polarises as it darkens outdoors. Transitions XTRActive new generation is designed for wearers frequently exposed to bright light and those that are light sensitive. It is the only photochromic lens to attain category 3 lens darkness at 35°C and only photochromic lens to achieve category 2 lens darkness in the car. It is also 35% faster to fade back to clear compared with the previous generation. Read more at: www. XTRActive.com.au. Email: info@transitions.com.au

Email: sales.order@safilo.com

ZEISS SYSTEMS STREAMLINE GLAUCOMA MANAGEMENT In an ageing population with an increased disease burden, clinicians are seeking ways to manage glaucoma patients routinely presenting in already busy practices. One of these clinicians, Dr Jed Lusthaus, a glaucoma specialist at Sydney Eye Hospital and director of Eyehaus, is tackling these challenges by using an integrated, multi-modality approach to overlay and associate raw data from diagnostic Dr Jed Lusthaus,Sydney Eye Hospital & Eyehaus. devices when managing his patients. Presented on a single screen and within seconds, ZEISS FORUM Glaucoma Workplace turns raw data from the CIRRUS OCT, HFA3 and CLARUS ultra-widefield camera into an interactive progression analysis tool for both clinicians and patients. “All of the test results are displayed on one screen and this gives me an immediate indication whether the patient’s glaucoma is stable,” Lusthaus says. “Previously, I had to physically flick through reams of paper to assess the visual field of each eye and now all the information I need can be obtained with the click of a mouse.” The Structure-Function Guided Progression Analysis (SF-GPA) screens show specifically when and where progression in OCT and perimetry have been detected. Lusthaus believes it is essential to have as much historical data as possible when managing chronic eye diseases, stating that “organisation and clear presentation of the data is crucial to enable appropriate clinical decision-making. Glaucoma Workplace provides the flexibility of viewing individual data points as well as progression analyses from multiple imaging modalities”. The regular surveillance of

INSIGHT December 2021

The Glaucoma Workplace presents data from several devices on a single screen.

patients is a critical part of glaucoma management, but this has been disrupted by the COVID-19 pandemic. “For some patients, an extended period of time between reviews has been proven to be acceptable, while other patients’ glaucoma has progressed more rapidly. When patients return to my clinic, Glaucoma Workplace provides me with a seamless solution for quickly assessing glaucoma stability that cuts down my consultation time significantly and improves the workflow of my practice.” Email: med.au@zeiss.com

Summer showcase FOREVER WARRANTY, FOREVER COVERED Since 1979, Le Specs has become renowned globally for its iconic and affordable eyewear collections at an affordable price, according to Sunshades Eyewear who designs, manufactures and distributes the brand globally. With a reputation as the ultimate summer accessory, Le Specs has developed an international cult following and become a true trendsetter in the global fashion market. “Since introducing optical and blue light collections more recently, Le Specs has truly become the goto eyewear brand,” Sunshades Eyewear says. “With a passion and focus on quality and value, Le Specs are now offering a lifetime warranty on all Le Specs sunglasses and optical frames purchased between 1 October 2021 and 31 December 2021. The Le Specs Forever Lifetime Warranty covers defects in materials, workmanship and accidental damage. Cover applies to all instances, from loose screws to accidentally sitting on your favourite pair of Le Specs, allowing the peace of mind that purchases can last forever.” To find out more, head to www.lespecs.com/forever or contact Sunshades Eyewear. Email: customerservice@sunshadeseyewear.com.au

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

NUPOLAR POLARISED LENSES Younger Optics says a far reaching reputation and consistent reliability has positioned NuPolar as the polarised lens of choice for eyecare professionals globally, along with a wide range of colours, styles and materials. Trusted to deliver long lasting quality and value for money, the company says eyecare professionals can be confident patients will be satisfied with NuPolar. Colours remain consistent and don’t fade over time, excellent film adhesion eliminates delamination problems and heat stability means the lenses will not fade or delaminate when left in hot cars. “NuPolar comes in a choice of styles to suit patient lifestyle and personal style: solid tint (five colours), gradient tint (three colours), mirror finish (three colours) and photochromic technology (NuPolar Infinite and Transitions Drivewear)." Younger Optics has a large range of point-of-sale materials and demonstration lenses available for practices to order on its website. Learn more about the range, where to buy and to order materials at www.youngeroptics.com.au. Email: Craig.Johnston@youngeroptics.com.au

OPHTHALMIC SURGERY

y m o t c e r it v e is c e r p more

IN PURSUIT OF

Vitrectomy cutters are the fundamental tool for vitreoretinal surgeons. South Australian retinal specialist DR STEWART LAKE discusses one of the latest advances in the field and how it’s leading to safer, more efficient surgeries.

ince vitrectomy cutters were pioneered in the 1970s, manufacturers have sought to improve their safety and efficiency with smaller gauge size and increased cutting speeds, while also attempting to maintain consistent flow rates. Other components such as the port geometry and blade design have also undergone significant modifications. This tricky balancing act is one that South Australian ophthalmologist Dr Stewart Lake has followed closely over his near-two-decade career as a vitreoretinal surgeon with a keen interest in new surgical technology. Lake, who splits his time between public work at Flinders Medical Centre and privately at the three-site practice Eyemedics, says vitrectomy cutters have advanced significantly over time. Now, surgeons can perform vitrectomies with more precision, predictability and efficiency. Vitrectomy involves removing the vitreous humour to allow surgeons to perform other procedures that cannot be done with the fluid vitreous in its place. The clear jelly-like substance is composed of more than 99% water, as well as collagen fibres, proteins and hyaluronan. In the early part of his career, Lake recalls vitrectomy cutters were 20-gauge, with the larger incisions requiring sutures, leading to slower recovery and more postoperative pain. Over time, instrument size reduced to 23, 25 and 27 gauge, with some early trade-off in the rigidity of the cutter, making them more difficult to control. “In recent years however, the instrumentation has improved in two areas, the smaller gauge instruments have improved in their rigidity making them more acceptable, and manufacturers have increased the cut rates to help

INSIGHT December 2021

reduce tissue handling issues including traction on the retina,” he says.

Conventional systems have largely featured a single opening cutter design that cuts in one direction. Although surgeons have welcomed increased cutting speeds to allow for more precision – particularly when shaving near the retina – this can somewhat paradoxically lead to slower overall operating times due to slower flow rates to remove the vitreous. In other words, the aspiration port isn’t open for as long.

Dr Stewart Lake, vitreoretinal surgeon at Flinders Medical Centre and Eyemedics.

“So, the aim has been to make the gauge smaller, increase the cut rate to reduce the chance of complications, but also maintain the flow rate so that you are not slowing down the operation time,” Lake says, noting that longer surgical times can lead to patient discomfort and affect visualisation, while also increasing the risk of a complication occurring. Adopting a system that addresses these key issues was the impetus for Flinders Medical Centre to acquire the latest in vitrectomy cutting technology from Bausch + Lomb (B+L). Last year, the hospital added the Bi-Blade dual port vitrectomy cutter to its two existing Stellaris Elite vision enhancement systems, allowing Lake and his colleagues to perform more predictable and efficient vitrectomies on their patients. At Flinders Medical Centre, these include Indigenous patients flown in from the Northern Territory for retinal surgery, many with complex diabetic eye disease. According to B+L, the Bi-Blade – available in 27, 25 and more recently 23 gauges – is a significant advance over conventional cutters. While single-port cutters cut only in the forward direction, the Bi-Blade’s dual-edge blade cuts in both the forward and backward directions, performing two cuts per cycle.

This offers an effective 15,000 cuts per minute (cpm) rate. The design also means cutting is performed with less port closure time, allowing the system to provide more continuous aspiration. This ultimately results in increased flow efficiency and control compared to prior generation guillotine cutters, B+L states. “Previously, with the traditional technology, we used a cutter that had a single opening and as the cut rates increased, this also meant the port was closed for a slightly greater proportion of the cycle,” Lake says. “But the design of the Bi-Blade essentially has two openings, or two blades, so for each cycle you get double the number of cuts. That maintains higher opening time, which maintains flow, and improves the efficiency of the surgery, but also keeps traction low by not dragging hard on the retina.” COMPLEX CASES With conventional cutters, Lake says he was more previously inclined to opt for the larger 23 gauge, only using 25 sparingly. However, he believes the 25-gauge Bi-Blade performance in terms of efficiency and rigidity is superior to the 23-gauge single port cutter. Using a smaller gauge is better for several reasons, the obvious being the smaller incision. Although surgeons perform self-sealing pars plana sclerotomies to prevent leakage, wound healing involves vitreous incarceration (where vitreous is trapped within a wound or incision site), which can lead to discomfort and affect vision. “With a smaller gauge, we have a smaller opening, which means faster healing, therefore the patient has less hypotony when the eye is soft, and therefore faster recovery,” he explains. Further, in patients with diabetic eye disease with fibrotic bands, he says the smaller gauge allows the surgeon to tunnel in and trim closer to the retina. It has other advantages in cases that require shaving at the vitreous base – an area of strong adhesion where in the past surgeons needed to limit traction on the retina by using lower aspiration rates. “When you’re shaving at the vitreous base, with older cutters, you are having to do other things to make the system safer that make it less efficient. This is usually done by dropping the vacuum – you still want to go close to retina, but to do that safely with a non-Bi-Blade system, you have to reduce aspiration so you are putting less force on the retina. However, if you’re reducing aspiration you are effectively being less productive compared to a Bi-Blade cutter where you can cut more efficiently close to the retina.” Additionally, in retinal detachments, he says the rigidity of the Bi-Blade – even in smaller gauges – allows for more controlled access to the peripheral retina towards the front of the eye.

“The Stellaris offers full dual linear capabilities, where you have dual, simultaneous, independent control of vacuum and cut rate. I can move the foot pedal up and down to control one, and then side-to-side to control the other," he says. “It means I can increase the suction rate and keep the cut rate low, or vice versa – that is quite a major advance for several different conditions, particularly macula holes where you want to aspirate without cutting to pull the posterior vitreous off the retina, whereas with other machines you have to keep kicking the cut rate on and off. “With diabetic eye disease it’s also ideal because you’d want a high cut rate and low suction – because you want to shave and not consume a lot of tissue – the foot pedal makes this easy to control.” The Stellaris Elite system also has colour filters (yellow, green and amber) that can be used as augmentation or an alternative to intraoperative dyes. Bi-Blade procedure packs are exclusive

Although he only uses this Bausch + Lomb’s Stellaris Elite vision occasionally, Lake says it’s nice to enhancement system. have up his sleeve for macula work by helping to visualise the vitreous and scar tissue, as well as while performing epiretinal membrane peels. LOOKING AHEAD

While the Bi-Blade is B+L’s most advanced vitrectomy cutter in Australia, the company is poised to launch a new generation vitrector called the Vitesse hypersonic vitrectomy system. Lake is among a handful of surgeons trialling the device globally, which uses an ultrasonic vitrectomy probe to liquefy and then aspirate vitreous at the edge of the port. Without a guillotine-like mechanism, this also means its port is open 100% of the time. “It’s exciting technology, and globally surgeons are helping to explore and optimise the settings to make it work most efficiently,” Lake adds. n

“Then in the opposite direction, where you’re working on the back of the eye for conditions such as macula holes or epiretinal membranes, or more severe diabetic eye diseases, it gives you that nice efficient, stable system, so it works well in both settings.” AN INNOVATIVE FOOT PEDAL B+L’s Bi-Blade procedure packs are exclusive to its latest vision enhancement system called the Stellaris Elite. Flinders Medical Centre have had the system installed before introducing the Bi-Blade, so it was a relatively minor adjustment to the operating room, requiring a minimal learning curve. The Stellaris Elite is a combined surgical platform, which offers both cataract and retina capabilities. Lake says a key feature of the platform is what B+L calls a dual linear foot pedal, which is unique. When performing a vitrectomy, he says it allows him to independently adjust both the aspiration and cutting rates with his foot, without having to move away for manual adjustments. Other systems have less flexibility in control.

The Bi-Blade’s dual-edge blade (top) cuts forward and back, performing two cuts per cycle. Cutting is performed with less port closure time for more continuous aspiration.

INSIGHT December 2021 35

PHARMACEUTICALS

a r t n a m e e r f preservative-

HONOURING THE

Dr Hartley Atkinson and his wife Marree founded AFT Pharmaceuticals.

Ophthalmic products are a significant contributor to AFT Pharmaceuticals’ bottom line. Combined with an unmet need for preservative-free products, the company is highly motivated to expand its pipeline, says CEO and founder DR HARTLEY ATKINSON.

ince its inception in 1997, New Zealand-born company AFT Pharmaceuticals has established itself as one of the major players in the Australasian pharmaceutical market, often perceived as punching above its weight against the offshore multinationals.

broader [ophthalmic] range, but we have decided to focus our portfolio and make preservative-free our mantra.”

An example is its eyecare portfolio of preservative-free eye drops, which has elevated the company into the number two spot in the eye lubricants segment – with 25% market share – and pharmacy data showing its HYLO-Forte eye drop is the best-selling product by value.

Until now, AFT’s ophthalmic portfolio has largely focused on products for a complete dry eye care regime, with heat packs, wipes and lubricants. However, the range is set to take on another dimension in 2022.

AFT was famously started by Dr Hartley Atkinson and his wife Marree out of their family garage in Auckland 24 years ago. While it now counts itself among the multinationals with 98 employees and subsidiaries in Auckland, Sydney, Kuala Lumpur, Singapore and Ireland, Atkinson says it remains nimble enough to swiftly respond to consumer trends and overseas innovations. The company’s eyecare portfolio is no exception, with a full pipeline containing new therapies for glaucoma and bacterial eye infections, as well as a ciclosporin for dry eye. Importantly, they fit with the company’s preservativefree approach, which is its differentiator in response to evidence that preservatives – often benzalkonium chloride – can aggravate the eye. The ASX and NZX-listed company’s current ophthalmic portfolio is distributed to Australian optometrists and ophthalmologists by Melbourne-based supplier Good Optical Services. It has now grown to seven products out of 65 proprietary and licensed drugs in Australia, accounting for around 25% of the company’s overall revenue.

AN EXPANDING PORTFOLIO

The first of these will be a product called Ocuzo, which is a chloramphenicol 5mg/mL pharmacist-only preservative-free 10mL eye drop that will launch in the first quarter. It’s an antibiotic for bacterial eye infections. Bacterial conjunctivitis is an infection involving the mucous membrane of the surface of the eye. There is a comparative product already available, but it’s not preservative-free, indicating a significant unmet need for patients, Atkinson says. “We have registered Ocuzo and are preparing for the launch at the moment, so watch this space,” he says. “It’s a significant market with around 600,000 packs of chloramphenicol sold in Australia annually for minor ocular bacterial infections. The thinking behind this was if you have an already irritated eye from a bacterial infection, it would be an advantage to have a preservative-free version where you are not looking to cause any additional irritation from a preservative.”

“Most companies have found the past 12 months challenging given the current ongoing pandemic, but we were pleased last year to grow sales again by finishing the 2021 financial year with $113 million in revenue, up from $105 million,” Atkinson says.

The other major launch slated for next year features two prescription glaucoma therapies under the umbrella brand Vizo PF. The first to launch will be dual agent dorzolamide + timolol variant, which will become the market’s only preservative-free version. The company is current evaluating the launch date for a bimatoprost 300 micrograms/mL solo agent eye drop for which there are already other preservative-free options, however these aren’t available in a multidose bottle.

“I think if it hadn’t been for the pandemic, we would have had greater growth. We see good potential to keep growing, especially our Australian market, to well over $100 million (currently $68 million), and the eyecare products continuing to be a quarter of that. Some companies arguably have a

“Once again, it’s the same logic, a disease like glaucoma is a long-term condition that doesn’t go away. Eyecare professionals have told us they would like the option of a preservative-free product because some patients do have some irritation from preservatives in current treatments,” Atkinson explains.

INSIGHT December 2021

“THE MAJORITY OF PATIENTS DO HAVE A DEGREE OF EVAPORATIVE DRY EYE AND THE NOVATEARS PRODUCTS SPECIALLY ADDRESS THAT”

Since last speaking with Insight a year ago, AFT has introduced NovaTears + Omega-3, a line extension of the popular NovaTears eye drop for evaporative dry eye and meibomian gland dysfunction, that itself arrived in 2018 from the German firm Novaliq. Launched in November 2020, NovaTears+ Omega-3 combines perfluorohexyloctane and concentrated Omega-3 fatty acids of algae origin. It has been developed based on research suggesting deficiencies of Omega-3 tear film lipids may be a driver for chronic ocular surface inflammation in dry eye disease. Essential fatty acids (EFAs) – like Omega-3 – are required for healthy metabolic processes, but humans cannot produce these and must acquire them through supplementation or dietary sources. “The majority of patients do have a degree of evaporative dry eye and the NovaTears products specially address that,” Atkinson says, noting the NovaTears products have been a major factor in propelling AFT into the number two position in the lubrication eyecare category. “NovaTears + Omega-3 is looking at the patient with evaporative dry eye, but also degree of irritation, as well as redness of the eye and eye lid – and this is a reasonable-sized sub-category of dry eye.” An added benefit of AFT’s products is its multi-dose containers, which the company says deliver accurate drop sizes to the eye, minimising drop wastage sometimes seen in unit dose products. Multi-dose containers – as opposed to single-use ampoules – also result in less plastic waste. Atkinson says the company is launching a new packaging initiative in its dry eye products, but in a different way. AFT’s dry eye portfolio is built around a “heat, clean and hydrate” message that emerged from the DEWS II work. This is reflected in its Opti-Soothe heat mask, Opti-Soothe eye lid wipes and eye drops comprising the two NovaTears products, HYLO-Forte and HYLO-Fresh. Atkinson says eyecare professionals are increasingly promoting the importance of a holistic dry eye regime to patients. This has similarities to the dental profession that drastically improved oral hygiene over recent decades by promoting a preventative approach around brushing, flossing, fluoride and regular check-ups. To underpin this approach, AFT will be packaging a combination of its products so patients can purchase a complete dry eye regime in the one box. With most patients having the evaporative form of the disease, the company is beginning with NovaTears, combined with the OptiSoothe heat mask, and Opti-Soothe wipes.

DR HARTLEY ATKINSON CEO AND FOUNDER Launched last year, NovaTears + Omega-3 is a line extension of the NovaTears eye drop for evaporative dry eye and meibomian gland dysfunction.

“We think this is an important add-on, having the eyecare pack containing a three-step plan, which is also easier than going to your optometrist and pharmacist and having to navigate your way around two to three items,” Atkinson says, noting there will be a cost saving for purchasing the bundled pack. “By not being a huge company compared to some of our competitors, it means we can remain quite nimble – we find things that our customers tell us will be helpful and respond.” A NEW CICLOSPORIN While AFT has reported success with the NovaTears range to date, its relationship with the manufacturer Novaliq may go deeper yet, with the company putting significant resources behind a ciclosporin eye drop, currently in the clinical development phase. The therapy is called CyclASol, which is a topical anti-inflammatory and immunomodulating ophthalmic drug solution, containing 0.1% cyclosporine A for dry eye. The formulation contains the company’s EyeSol technology that also underpins the NovaTears products. As a result, Novaliq says the drug increases residual time on the ocular surface and enables a high bio-availability in the target tissues to exploit the potential of cyclosporine A. It has also touted fast onset of action within two weeks. “Certainly, the NovaTears base is particularly good at dissolving lipid soluble molecules that are not easily dissolved in an aqueous media,” Atkinson says. “Combining this with a ciclosporin is an interesting prospect. There is already impressive clinical data available and it looks robust in terms of the end points. This is something we are also working on for the Australian market and could be really exciting long term.” The CyclASol program is in late-stage development with three completed clinical trials. The US Food and Drug Administration has stated that the second registrational trial, ESSENCE-2, is expected to complete the clinical development phase, Novaliq reported. OTHER INITIATIVES Elsewhere, AFT has used its eyecare business to contribute to charitable causes in Australia and across the world. Closest to home were the 2020/21 bushfires in Western Australia where firefighters from Murdoch Fire Station in Perth were donated HYLO-Fresh and HYLO-Forte eye drops and NovaTears to relieve irritation from the heat and smoke. Each year the company also seeks to reduce health inequalities in developing nations. Typical beneficiaries are the AusViet Charity Foundation and Eyes4Everest. With AusViet, in Phu Tho, Vietnam, in August 2019 AFT provided 500 boxes of HYLO-Fresh and 200 boxes of Cromo-Fresh allergy drops. For Eyes4Everest, a charity delivering eyecare to Himalayan communities founded in 2013 by Sydney optometrist Mr Shaun Chang, AFT has previously donated 50 boxes of HYLO-Forte drops for a population that suffers from a high prevalence of dry eye syndrome.

AFT’s Australian revenue rose 11% to $68 million in FY21, with ophthalmic products accounting for around a quarter.

Although efforts have been hampered due to the pandemic, Atkinson says it’s important the company continues to have a social impact. n

INSIGHT December 2021 37

PROFILE

Peter Larsen

BREAKING THE MOULD: UNDERSTANDING

In a wide-ranging interview, PETER LARSEN details his rationale for bringing Specsavers to Australia, as well as the opposition he’s faced trying to change optometry’s ‘belief systems’. He also discusses his new roles at Topcon and the Centre for Eye Research Australia.

hroughout his career Australian optometrist-turned-global company executive Mr Peter Larsen has felt misunderstood. Labelled a pariah, a mad scientist, as well as a visionary, he even resorted to practising presentations to his teenage daughter en route to her weekend soccer matches to ensure his message was decipherable. But, as he has found, it’s part of the deal when trying to fuilfil his mission to make Australian optometry more competitive – hence offering more accessible eyecare – while changing ingrained beliefs around the profession’s role in the eye health ecosystem.

In a career spanning 34 years, Larsen has worked in high volume practices in the UK seeing 30 patients a day, operated the wholesale contact lens business Aspect Vision that was sold to CooperVision, and spearheaded Specsavers’ rapid Australian entrance. His fingerprints can also be found on the Oculo e-referral platform, a $40 million Specsavers-wide OCT rollout and world-first benchmarking system for optometrists, KeepSight and an improved relationship between ophthalmology and optometry. There’s also the additional 50,000 people detected for glaucoma who he says otherwise wouldn’t have been, if it wasn’t for the systems he helped build. “Data repositories, benchmarking, understanding of outcomes that lead to actions: that language in our industry is fairly rudimentary, where it has been all about how many pairs of glasses you sell and how many sight tests you do, so it has been a massive journey,” he says. “There wouldn’t be many people with my background, breadth of

INSIGHT December 2021

experience and insight – and sometimes the language I use isn’t easily understood because of that. I’m amazed people in the industry often still can’t understand it, while outsiders can.” Earlier this year, Larsen entered the next phase of his career as president of Topcon Medical Systems in North America and vicepresident of business development for Topcon Healthcare Solutions. He’s performing both roles from his home near Geelong in Victoria, while heading up the Centre for Eye Research Australia (CERA)’s new Health Services Research unit. As far back as 2001, he recalls feeling like an outlier when he owned the independent Melbourne practice Andrew Gaddes Pty Ltd, which he took over from his father. He says he embraced technology much earlier than others, installing a digital retinal camera and a Heidelberg Retinal Tomograph (HRT) 2, and performing scans on every patient. “There were very few optometry practices with digital retinal cameras back then and there were very few Heidelbergs in the country generally – it was globally exceptional, however, for an optometrist to utilise both in a routine eye examination at that time. People were shaking their heads and asking what I was doing with a piece of kit only hospitals and glaucoma specialists should have,” he recalls. “But six months later I knew I was picking up the 50% undiagnosed glaucoma. People also didn’t understand I’d developed close relationships with my local specialist and in particular my glaucoma specialist, Associate Professor Julian Rait, who helped my team

through interpreting the results and ensuring we weren’t referring false-positives. We found there was variation between the optometrists, so we held regular meetings and discussed the need for visual fields so we were only sending those with structure and an associated functional loss.” After 12 months, Larsen formed the belief this was the methodology to improve eye health outcomes, but still his assertions fell on deaf ears. That was until around 2012 when he was asked to develop the professional side of the Specsavers business in Australia where he was able to embed his model on a national scale – but more on that later. SELLING TO SPECSAVERS Larsen is arguably best known for leading Specsavers’ 2007 entrance into the Australian market – a role that made him famous or infamous, depending who you ask. In 2004, he founded the Optovision buying group with Mr Charles Hornor, the current communications director for Specsavers ANZ, with more than 250 independents joining in the first six months. Optovision had only been in operation for two years when the opportunity arose for a discussion with Specsavers co-founder Mr Doug Perkins about finally introducing the brand into Australia via a part-purchase of Optovision. Initially, a supply chain would be set up and tested with Optovision members before assessing the potential for a full retail model. Within months of the supply chain launch, there was significant interest among independents to convert their stores to the Specsavers banner under a franchise model. “Before talking to Specsavers it had dawned on us that the scale you can achieve with local buying-group consolidation at that time was limited; the gap between what the global players were paying for product versus an independent buying group in Australia was massive, so we knew that Specsavers’ arrival would give participating optometrists a chance to more than match up with the big players and provide more affordable care,” he says.

independently diagnosing and managing glaucoma.

“I had one of most successful independent stores in the country, I was doing very well, but I felt uncomfortable with an expensive supply chain and the consequent prices we were having to charge our customers and knew the industry was vulnerable. The Specsavers deal was absolutely critical to change the paradigm for business-minded independents and for patients.

Larsen was also a member of the CERA board, so he had formed relationships with the ophthalmological world. Eventually, he worked with RANZCO to sign an exclusive Memorandum of Understanding seeing RANZCO work with Specsavers and others to produce referral guidelines for several diseases – starting with glaucoma – and Specsavers adopting these across its stores.

“Many in optometry disagreed and I was very unpopular for a while because people thought I turned against the industry, but in my mind I’m very comfortable. If we hadn’t made the move, we would have had Big W or Walmart enter the market and marginalise optometry – optometrists wouldn’t have had some level of control over their businesses. And, of course, Specsavers has been an unqualified success in this country, introducing a customer-focussed business that is also great for owners.” TECHNOLOGY AND BENCHMARKING After leading Specsavers as managing director through that growth phase – including the famous 100 stores in 100-odd days – Larsen was asked to lead the professional services side of the business in 2012. While this role traditionally focuses on recruitment and training, he wanted to have a more meaningful impact. He was still convinced of the need for the model from his independent practice more than a decade earlier, so he set about using his influence in Specsavers to draw up a blueprint centred around technology and collaborating with medicine. At the time, the relationship between optometry and ophthalmology was fractious due to RANZCO and the Australian Society of Ophthalmologists taking the Optometry Board of Australia to court over guidelines that would have seen therapeutically endorsed optometrists

Peter Larsen (right) with Specsavers co-founder Doug Perkins outside one of the first independents that converted to Specsavers in 2008.

“It annoyed a lot of people that a commercial operator like Specsavers would have an agreement with the college, but I am an optometrist without a professional ego; I believed it was fundamental to first establish the referral rules and then proactively play by them – to be ambitious beyond that is counterproductive,” he says. “I was able to be honest about the 50% undiagnosed glaucoma and say this is a problem that optometry – and ophthalmology – has; having those frank conversations means you’re not shutting doors. That’s a different conversation to the one optometry generally has with ophthalmology. Today, I believe it’s still one of the few clinical pathways agreed between optometry and ophthalmology globally.” Larsen says the next necessary component to underpin this collaboration was a consistent and secure communications system. Hence Oculo was born, a platform sharing clinical imaging, referrals, and other clinical correspondence securely and instantly between healthcare professionals. (Oculo was sold to Finnish company Revenio in March, valued at AU$18.5 million). In his role with CERA, Larsen supported co-founders Professor Jonathan Crowston and Dr Kate Taylor in its development. After some initial trepidation on usage and implementation costs, Specsavers got behind it and Larsen conducted a pilot. “Unless we systemise and measure, then you have to assume there’s a spectrum out there and the quality isn’t what you think,” he explains.

INSIGHT December 2021 39

PROFILE

“TOGETHER WITH MY COLLEAGUES AT SPECSAVERS, I’VE HAD A SUBSTANTIAL IMPACT ON GLAUCOMA IN THIS COUNTRY, AND STILL IT HASN’T BEEN WELL UNDERSTOOD A LOT OF THE TIME.” PETER LARSEN

He continues: “Normally when optometrists purchase a piece of kit, the first question is how can I get my money back, and yes we have got improved Medicare utilisation, but I think it’s still the only OCT rollout in optometry whose primary purpose was to drive out improved, measurable clinical outcomes. Peter Larsen (far right), at the KeepSight launch with (from left) former MP and former president of Diabetes Australia Judi Moylan, Federal Health Minister Greg Hunt, then Vision 2020 Australia CEO Judith Abbott and Diabetes Australia CEO Professor Greg Johnston.

“We managed to implement it across Specsavers with the support of store partners, and that gave us the important technology piece needed to conduct and measure referral rates per optometrist.” The next puzzle piece required a reporting system for all Specsavers optometrists to ensure individual optometrist referrals were aligning with disease prevalence rates. Known as benchmarking, the concept had been discussed within the industry for years but had never been clearly described. The reports provide weekly summaries so optometrists can understand their practice compared to the practice average, regional optometric norms and national benchmarks. In designing the reports, Larsen took inspiration from the Australian primary schools Naplan tests and added a traffic light system. “I thought this was an inoffensive method, if it’s being sent to parents then you can send something similar to optometrists. And while many were worried about sending benchmark reports, we pressed on and sent them to 800-odd optometrists and only had one complaint,” he explains. Larsen says it created an environment for self-directed training and professional development for optometrists to improve patient outcomes. “Most corporates will measure glasses sales, sight test numbers and experience, but I strongly felt we needed to start giving our optometrists insight into their clinical performance, otherwise they’re unaware. And I believe it’s still the only reporting going to individual optometrists anywhere in the world on their diagnostic rates.” With these systems in place, Larsen says this confirmed his belief optometrists were missing 50% of glaucoma. This provided the impetus, in 2016, for the commencement of the well-known $40 million-plus OCT rollout to every Specsavers store, with scans performed on every patient without an out-of-pocket fee. Larsen selected the Topcon Maestro as the most user-friendly, automated instrument that could also capture the macula and optic nerve in the same shot, but again people doubted his decision.

“In the over 50 population, 2-3% have glaucoma with estimates around 150,000 were undiagnosed. Subsequent to the implementation of benchmarking and OCT across Specsavers, by the time I moved out of the Australian business in 2019, there had been over 50,000 people detected with glaucoma who otherwise wouldn’t have been. "If you look at the PBS medications data, since 2016 glaucoma therapies have shot up. I’m not a practising clinician anymore, but I know the original insights of my experience with technology some 16 years ago, together with my colleagues at Specsavers, I’ve had a substantial impact on glaucoma in this country, and still it hasn’t been well understood a lot of the time.” Of course, Larsen says it is critical to understand that commercial outcomes are a priority. It is a unique grasp of store operations and the people involved that has enabled a parallel positive impact in store profitability. “Benchmarking and change management experience are rare qualities in allied health,” he adds. NEW HORIZONS In 2019, Larsen moved from Melbourne to take up a newly established role as group eye health strategy director. In that role, he was based at Specsavers headquarters in Guernsey, UK, to implement the Australian and New Zealand model in Specsavers’ other markets. Less than a year into this role, the pandemic forced his return to Australia where other opportunities awaited. One of those was for Topcon Medical Systems. Larsen is now responsible for the company’s ophthalmic equipment business in the North American market. Alongside this, for Topcon Healthcare Solutions, he is seeking business opportunities with key customers and stakeholders globally. He says it has been fascinating to have a bird’s eye view of the global market, which has reinforced his belief that Australian optometry needs to come together to tackle the big issues like diabetic eye disease through initiatives like KeepSight. Elsewhere, as an honorary principal investigator for CERA and head of the Health Services unit, he’s exploring solutions that drive better coordination between the eyecare system. Initially, this is focused on how optometrists communicate with The Royal Victorian Eye and Ear Hospital.

“I was thinking, we’re responsible for 3.5 million examinations a year, and so we have to build something into a customer journey in a busy store that will create consistent outcomes,” he says.

“The hypothesis is that it should enable the hospital to make better decisions and triage more effectively to guide the appropriate utilisation of resources; it sounds simple, but hospitals are complex,” he says.

“To test the concept, I put two Maestro OCTs into my own Specsavers store in Eastland (Victoria), measured referrals before and after and proved it worked, then installed them in another six stores over a threemonth period and then rolled it out.”

“In my mind, referrals coming from optometry in an electronic format with set data fields is the methodology that should drive better outcomes, but it’s about making this inclusive, the last thing we need is an exclusive system solving problems on a smaller scale.” n

INSIGHT December 2021

RETAIL

USE IT OR LOSE IT: MAXIMISING THE

health fund rush Optometry practices across the country are gearing up for a busy Christmas period, with pent up demand to make this period even busier than usual for some. Insight finds out how the sector is gearing up as patients race to use their health fund benefits.

fter a challenging 2021 for many practice owners, the potential for optical retail to flourish towards the end of the year increases with Christmas, summer holidays – and the 31 December expiration date for many health funds entitlements. The rush to claim health fund benefits before the end of the year – often known as ‘use it or lose it’ – presents an ideal opportunity for patients to purchase a spare pair of glasses, stock up on contact lenses before the holiday season or replace prescription sunglasses. Typically, most health funds have a yearly or annual limit on claiming for optical or eyecare services, and within this, individual per person limits and, in some cases, membership limits also apply in addition to the individual per person limits. A yearly or annual limit generally means that if a policyholder hasn’t claimed up to their yearly limit, it doesn’t ‘roll over’ to the next year – it

“AT THIS TIME OF THE YEAR, LENS LABS OFFER PROMOTIONS, ESPECIALLY FOR A SECOND PAIR OF LENSES. PRACTITIONERS CAN LEVERAGE THIS” STEVEN JOHNSTON PROVISION

INSIGHT December 2021 41

RETAIL

helps even out the traffic flow for the proceeding months,” Johnston says.

“HEALTH INSURANCE DATA REINFORCES THIS POINT REGARDING OPTICAL EXTRAS SPENDING, SHOWING A 20-30% UPLIFT”

“Giving patients a heads-up used to be done in November and December. Then it was extended to October, and now it’s happening in September, to make sure practices don’t get over-run with high demand. It’s tailored to these times, a clear message to patients that now is the time to start thinking about health fund benefits.

CHARLES HORNOR SPECSAVERS

“For some, as soon as 1 January rolls around, they want to get in and use their health fund entitlements at the beginning of the year. They may purchase specs before Christmas, and then come back in January for prescription sunglasses using their entitlements. This creates two bites of the cherry and spreads retail spending,” he says.

resets on 1 January. The annual limits on optical cover depend on each health fund’s policy, with most offering anywhere from $100 to $400 per person, per year. However, some providers also have a ‘rollover feature’ that lets the policyholder’s benefits accumulate from one calendar year to the next up to a maximum amount. Whether patients spend-up in December, wait until January – or not at all – depends somewhat on location, and how that has been affected by COVID lockdowns and business restrictions this year. Insight speaks with industry leaders, suppliers, and those at the coal face about what they’re expecting as the clock runs down on 2021. BUSIER THAN BEFORE – BUT NOT NECESSARILY

Over the years, Johnston says he’s also found patients fall into different rhythms.

“Also, at this time of the year, lens labs offer promotions, especially for a second pair of lenses. Practitioners can leverage this to present patients with an opportunity to get a second pair of prescription specs or sunglasses.” Specsavers director of professional communications across Australia and New Zealand Mr Charles Hornor echoes similar sentiments. For optical retailers in Australia, he says November, December, and January will always be the busiest months of the year – and all the more so this year because of the enormous backlog of re-scheduled eye tests, not to mention those with private health insurance wanting to make use of their annual optical extras cover.

With more than 30 years management experience across a diverse range of industries – and the last 10 years at the helm of ProVision – CEO Steven Johnston is familiar with the seasonal ebb and flow of optical retail. “I think the best way that our data illustrates the seasonal importance of November and December is when we index these months against the average and establish that they are typically 12% above an average month, whereas virtually every other month is usually within a few percentage points of that average,” he says. When he spoke with Insight in October, Johnston says orders were starting to build in preparation for November and December. “Most of our suppliers have indicated that they are in fairly good shape for stock, despite supply chain constraints – but ProVision practices don’t need to sit on any additional inventory if they use ProSupply.” Despite his confidence, Johnston says location will largely determine whether there is an end-of-year rush on optical retail and patient’s wanting to use benefits before they expire. “It’s a tale of two different circumstances. In Queensland, which is not in lockdown, it’s almost business as usual. For practices in New South Wales and Victoria, depending on restrictions, they don’t need to beat the drum of ‘use it or lose it’ because they’ll have pent-up demand from weeks of limited operations,” he says. Patients naturally want to get value out of their health fund entitlements and ProVision wants to help members prepare for that, he says. During his decade leading the organisation, communication with patients about maximising health fund benefits is also being actioned sooner rather than later. “We have hundreds of different resources for members to send out accurate messages to patients with private health cover concerning their optical benefits. That’s already started for some practices; it started in September. Sending messages to patients in September

INSIGHT December 2021

KEY STATISTICS • Optical is the second largest area of expenditure (behind dental) by private health insurers under general treatment (extras) cover. • 17% of ancillary claims expenditure annually by PHIs are for optical or eyecare. • Optical is the second highest modality or allied health treatment service type that private health funds pay for, making up 13% of total allied health treatment services paid annually. • Health funds collectively pay more than $966 million each year in member benefits for optical or eyecare services, covering over 12.7 million services annually. • The average health fund benefit paid per optical service is $76. • At 30 June, 54.3% of the Australian population were covered by a general treatment policy with optical or eyecare coverage. Source: Australian Prudential Regulation Authority (APRA)

Hornor says this is also borne out in Medicare’s own data which shows a typical uplift of around 7% in November and December billings compared with other months of the year.

“MANY WILL ORDER TWO JOBS; ONE FOR THIS YEAR AND THE OTHER TO BE SUPPLIED IN JANUARY”

“Similarly, publicly available private health insurance data reinforces this point regarding optical extras spending, showing a 20-30% uplift in the months of November and December,” Hornor explains. “This is well understood by the industry as a whole and makes perfect sense – for most health fund members, their cover and benefits renew at the end of the year. Therefore, across the industry you see an increase in people in November and December visiting optometrists to utilise their annual benefits that they haven’t yet used that year.” Hornor also agrees there can be a retail buzz at the beginning of the year. “In January, there is also a noticeable uplift in customers making appointments as their optical extras cover benefits reset, with those customers wishing to utilise these benefits as soon as they become available,” Hornor says. “Specsavers spends a significant amount of time throughout the year preparing for this period to ensure product availability and a seamless customer experience across all of its stores. This year we believe it will be busier than ever before.” Optical dispenser Mr Eddie Moore, who purchased Masons Eyecare in Kempsey, NSW, with optometrist Ben Baily in 2006, says October is a reasonably busy month. “We send out health fund letters mid-October and have done them this early for the past two years. It creates good early end-of-year sales for us. In November, we follow-up with an SMS to our health fund patients who are yet to utilise their fund, and this creates an even larger bounce in November,” Moore says. “I suspect this quarter this year to be quieter than last year – which was particularly good – as there is less money being handed out by government in the form of JobKeeper.” He says Masons Eyecare, which offers a two-year frame guarantee and an afterpay service, has reduced its stock levels. “We get a lot of patients utilising their health funds and many will order two jobs; one for this year and the other to be supplied in January," Moore says. “We don’t typically stock up and in fact COVID has given us plenty of time to review our stock quantities and scale down our holding somewhat. We carry an extensive range of sunglasses, and this helps enormously for second pair sales.” Optometrist Ms Nicole de la Perrelle owns Coral Sea Eyecare in Port Douglas. She says December is traditionally one of their quietest months as most people head back south for the summer. “Typically, the practice sees a few last-minute health fund claims in the last week of December but nothing ground-breaking. Although we have not had any serious lockdown up here during the pandemic, most local businesses are finding it very difficult to stay afloat,” de la Perrelle says. “As Port Douglas is a tourist town, there is little spare money for luxuries like health funds and new spectacles. Unless the Queensland border opens, things are looking very bleak for our little town. “I suspect next year things will change as tourism returns, but probably not in time for this Christmas. Consequently, we will not be adding extra stock until we see a return of domestic and international flights to Far North Queensland.”

EDDIE MOORE MASON’S EYECARE

TAKE STOCK Ms Lisa Wymond, national brands manager and a director of Eyes Right Optical, Modstyle and Sunglass Collective, says the companies have spoken to many practices around Australia who are anticipating being extremely busy at the end of the year. She says this is because of the usual end of year ‘use it or lose it’ health fund rush, and also COVID restrictions easing and states coming out of hard lockdowns. “The patients that may have delayed their usual eye test for some months are now wanting to book in before the end of the year. Practices are gearing up for a very busy December and are making sure they are well stocked with the latest eyewear to delight their patients,” she says. “Our three companies, Eyes Right Optical, Modstyle and Sunglass Collective are anticipating an increased demand on all product ranges, and we have invested heavily to make sure stock is available to meet demand. “We have catered for this surge in demand by increasing our already large stock holding of all brands, including our luxury ranges, here at our state-of-the-art warehouse in Melbourne. This means we can fill our customers’ orders immediately and the practice receives their order within one to two days of placing it. “Service reliability, support and strong supplier partnerships are crucial for a successful practice to provide beautiful, high quality eyewear and prompt patient delivery.” While in October, Melbourne earned the unwanted world record for time spent in COVID-19 lockdown, unsurprisingly it is having an impact on consumer trends. “Being in lockdown, we have seen more lifestyle factors influencing a shift in buying habits of eyewear. Examples of this are an increase in exercise, cycling, reading, hobbies, TV watching and being outdoors more,” Wymond says. She says asking patients about their lifestyle can often lead to multiple pairs of eyewear prescribed to the same patient. “We call it the patients’ ‘frame wardrobe’. You have different shoes for different outfits and activities, we treat eyewear in the same way. Having multiple pairs of eyewear is not only practical, it allows patients to express their individual personality and have the appropriate eyewear tailored for their lifestyle needs,” she says. “Stock replenishment of best sellers is crucial for practices, particularly at this time of year. After the busy period it is an ideal time for practices to use their sales data to assess every brand and evaluate which brands are working for them. “It would be worth expanding on these existing ranges that are doing very well. This will not only increase sales for the practice

INSIGHT December 2021 43

RETAIL

13% of total allied health treatment services paid by private health funds on an annual basis. APRA’s data shows health funds currently collectively pay over $966 million each year in member benefits for optical or eyecare services, covering over 12.7 million services annually. The average health fund benefit paid per optical service is currently around $76. As at 30 June 2021, over 13.95 million Australians (54.3% of the Australian population) were covered by a general treatment policy with optical or eyecare coverage. Dr Rachel David, CEO of peak industry body Private Healthcare Australia (PHA), says the latest APRA data shows in the 12 months to June 2021 growth in membership in both general treatment and hospital policies has stabilised, demonstrating that consumers recognise the value of private health insurance. “Almost 14 million Australians choose to have PHI for the choice and peace of mind it provides. In the year to June 2021, there was an increase in general treatment coverage of 2.6% (up 352,000 to 13.95 million) and hospital cover increased by 2.2% (up 245,000 to 11.44 million),” David says. The APRA data (June quarter) confirmed members were also using their PHI at pre-COVID-19 levels. Health funds paid $22 billion in benefits on behalf of their members in the year to June 2021. “Under lockdown restrictions which came into effect in July 2021, all patients attending allied health appointments had to be classified as ‘urgent’ to receive face-to-face treatment," David says.

Eyes Right Optical’s Mark and Lisa Wymond have invested heavily to make sure stock is available to meet demand.

overall, it will also build a stronger relationship with the supplier. “Every time you buy from a local Australian optical supplier, you are supporting the Australian optical industry and there is someone on the other end of that order who is extremely grateful for your support.” STATISTICALLY SPEAKING In August, the Australian Prudential Regulation Authority (APRA) released its quarterly private health insurance (PHI) publications for the June 2021 quarter.

"For the month of July 2021, optical treatments were at 76% as a result of COVID restrictions. As restrictions ease, health funds anticipate a rapid increase in the number of members seeking allied health treatments." She says health funds are committed to providing ongoing financial support for members and ensuring the affordability of PHI into the future. Since March 2020 to the end of August 2021, there has been more than 172,000 financial hardship member applications approved by the private health insurance sector, with a cumulative estimated total value of over $172.5 million. Last year, the industry returned more than $500 million to members through the pandemic crisis. Whether or not this will be repeated this year remains to be seen. n

The publications provide industry aggregate summaries of key financial and membership statistics for the private health insurance industry. In the year to 30 June 2021, industry profitability improved, driven by stronger insurance profits and investment income for the year. APRA said the PHI industry’s commitment not to profit from COVID-19 has seen some PHIs announce their intention to return surplus funds to their policyholders while others are continuing to monitor experience and exploring options. All private health funds provide benefits for optical or eyecare services. According to APRA data, optical is the second largest area of expenditure (behind dental) by private health insurers under general treatment (extras) cover. One in six (17%) of ancillary claims expenditure annually by private health insurers are for optical or eyecare. Optical is also the second highest modality or allied health treatment service type that private health funds pay for, making up

INSIGHT December 2021

“AS RESTRICTIONS EASE, HEALTH FUNDS ANTICIPATE A RAPID INCREASE IN THE NUMBER OF MEMBERS SEEKING ALLIED HEALTH” DR RACHEL DAVID PRIVATE HEALTHCARE AUSTRALIA

FEATURE XX

MARCH

JUNE

ECPs start receiving vaccine. Optometry Australia reacts to Fair Works’ decision on pay awards coverage.

MAY

JANUARY Nine people from sector recognised in Australia Day Honours, including A/Prof Anne Brooks.

SEPTEMBER

RMIT University axes Certificate IV in Optical Dispensing. Uncontrollable Sydney COVID outbreak takes grip.

ACCC authorises Honeysuckle buying group but imposes a condition affecting four big health funds.

AUGUST

Australia’s first trials of investigational gene therapy for dry AMD commence at CERA.

Nation’s first Cataract Clinical Care Standard released. Lengthy Victoria lockdown begins.

OCTOBER Sydney and Victorian optometrists open up for routine care after threemonth shut down.

Year in Review From lockdowns and vaccines to major acquisitions and breakthrough technology, Insight reflects on the major developments across the Australian and global ophthalmic sector in 2021.

hen Insight compiled a similar report last year reflecting on the major events of 2020, it ran with the headline: “2020 – a year like no other.”

At the time, Victoria was emerging from its back-breaking winter lockdown, business was rebounding, and the summer months were in full swing. There was a palpable sense of hope and positivity; the fact that many could face yet another year of turmoil seemed unimaginable. But COVID-19 and the Delta strain brought all-new problems, with the impact of extended lockdowns continuing to dominate headlines throughout 2021 in the most populous states of NSW and Victoria. Thankfully, this time there are vaccines, strangely bringing a similar sense of hope felt at the end of 2020.

COVID-19 wasn’t the only topic making news, however, with major product launches, business deals, personnel changes and breakthrough research shaping some of the biggest moments in the Australian ophthalmic sector in 2021. EXPANSION AND ACQUISITION Despite optometrists being unable to offer routine care for several months across NSW and Victoria, some of the country’s largest players forged ahead with their expansion plans. Specsavers entered Alice Springs, Mt Isa, Parkes and South Melbourne, and launched another program to expand existing stores.

Optical chain Oscar Wylee opened its 100th retail store, with 27 of those locations added to its network across Australia and New Zealand this year. Both Specsavers and Oscar Wylee also broke into the Canadian market, with Specsavers announcing it will launch its first 16 practices from November 2021, with ambitions to open 200 stores by 2024. Oscar Wylee opened its first store in Alberta in August and was planning to establish four further locations in Halifax, Calgary and Toronto. Back on home soil, National Optical Care (NOC) launched a new division of its business, offering independent optometry practices new subscription-based buying group and managed services opportunities, called Optical Growth Partners. NOC also unveiled new acquisitions, taking its portfolio to 17, while Healthia – which acquired The Optical Company for $43 million last year – grew its network to 45. George & Matilda Eyecare added two Queensland practices, with several more to be announced soon. In March, London-based global private equity advisory firm Apax Funds reached an agreement to acquire ophthalmic lens manufacturer Rodenstock Group, reportedly worth AU$2.3 billion. In other global news, EssilorLuxottica completed the acquisition of optical retail giant GrandVision in a 7.3 billion euro (AU$11.2 b) deal in July, adding 7,000 stores across 40 countries, as well as 37,000 employees. Glaukos agreed to settle with Ivantis over a patent infringement lawsuit regarding the latter’s Hydrus Microstent. Ivantis was ordered to pay Glaukos US$60 million (AU$83 m), as well as an ongoing royalty. EDUCATION AND EMPLOYMENT RMIT University announced the closure of its Certificate IV in Optical

INSIGHT December 2021 45

FEATURE

Dispensing, with final students completing their training in June, ending a 52-year history of educating and training Australian optical dispensers. While RMIT reported student numbers had been consistently low in recent years, other trainers experienced a surge in enrolments after the Federal Government announced a wage subsidy of up to $28,000 per employee as part of its COVID-19 economic recovery – a program that has been expanded multiple times. New figures revealed optometry graduates have among the highest rates of full-time employment compared with other sectors, sparking debate over future workforce supply that will increase once the first set of graduates emerge from optometry schools in WA and Canberra. According to Quality Indicators for Learning and Teaching (QILT), in 2020 around 95% of optometry graduates were employed in full-time work, with a median salary ranging between $80,000 to $85,000. Speaking of salaries, Insight analysed tax office data showing ophthalmologist are the second highest paid specialty (behind neurosurgeons), with an average taxable income of $524,800. For optometrists the average income was $94,800, health practice managers $74,956, orthoptists $62,417, optical mechanics $60,666 and optical dispensers $41,783. OPHTHALMIC THERAPIES AND EQUIPMENT The TGA approval of the Luxturna gene therapy was a major moment in 2020, and in 2021 it was confirmed that at least four patients with RPE65 mutations had received it. The first were a pair of Sydney teenage siblings with Leber congenital amaurosis, marking the next revolution in ophthalmic medicine. The therapy was delivered as part of a new Sydney-based collaborative called Ocular Gene and Cell Therapies Australia (OGCTA), which has also treated two adults in their 40s with the therapy. Another major feat was meant to take place Queensland in October when the first official iteration of the homegrown Cylite HyperparallelOCT (HP-OCT) was to be showcased to the local market. Although this did not transpire due to COVID, it was exciting to learn the instrument is ready, with the company planning to get the device in the hands of optometrists and ophthalmologists in 2022. Preservative-free dry eye therapy Cationorm was listed on the Pharmaceutical Benefits Scheme (PBS) in Australia from 1 August, followed by Ikervis in September, becoming Australia’s first listed disease modifying ciclosporin eye drop for severe keratitis in adults with dry eye disease. Both therapies are in-licensed in Australia by pharmaceutical company Seqirus, a new player to the Australian ophthalmic market, and a subsidiary of Melbourne biotechnology company CSL that was contracted to manufacture the AstraZeneca COVID-19 vaccine. In June, Glaukos announced it had secured Therapeutic Goods Administration (TGA) approval for the Preserflo MicroShunt, offering late-stage glaucoma patients a more elegant surgical alternative to conventional filtration procedures. Glaukos is planning a full commercial launch in Australia in mid-2022. Earlier in the year, the Australian government disclosed it spent more than $610 million on anti-VEGF treatments from July 2019 to June 2020. In total, the government spent $392 million (not including rebates) on aflibercept (Eylea) to cover 315,200 prescriptions, making it the most expensive PBS treatment. For ranibizumab (Lucentis), which ranked seventh by cost, it paid $218 million for 190,126 injections. This came as another anti-VEGF was listed on the PBS in October. Beovu, from Novartis, can be subsidised for patients who have not responded to first-line anti-VEGF therapy, and could prevent 12,800 Australians from more than $8,800 per year.

INSIGHT December 2021

MDFA patron Ita Buttrose delivers her National Press Club address in Canberra in May, pleading with the government not to slash the Medicare rebate for anti-VEGF injections.

KEY DECISIONS AND POLICIES In the most-read report on Insight’s website this year, the Fair Work Commission handed down a long-awaited decision regarding pay awards coverage for optometry practices. The saga began more than two years ago when a note was discovered the Fair Work Ombudsman (FWO) website stating the Health Professionals and Support Services (HPSS) Award was applicable to optometrists and staff such as optical dispensers and administration employees. OA had two major concerns, the first being that it could lead to underpayment claims if front-of-house staff were being paid under a retail award. Fair Work later indicated there would be no penalties if staff passed the ‘better off overall test’, but OA still held concerns about optometrists – traditionally an award-free profession – being classified under an award, potentially driving down wages. OA CEO Ms Lyn Brodie said Fair Work’s ultimate decision to neither exclude optometrists from the HPSS Award, nor include them on the List of Common Health Professionals in Schedule B of the Award, meant things were slightly unclear. Ultimately, however, it meant the status quo was maintained – a win for the sector. Elsewhere, the Australian Society of Ophthalmologists (ASO) spearheaded a challenge against the introduction of “US-style managed care” following an interim decision in July to allow a new buying group to collectively negotiate contracts with healthcare providers. In its final decision, the Australian Competition and Consumer Commission authorised Honeysuckle and nib health funds to form and operate the Honeysuckle Health Buying Group, but it imposed a condition that major insurers Medibank, Bupa, HCF and HBF in Western Australia couldn’t join. After several years in development, the nation’s first Cataract Clinical Care Standard caused a stir when it launched in August. It failed to win the full support of RANZCO and the ASO, with the college citing two major issues with the finalised document. It didn’t agree with the inclusion of 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery, however the Australian Commission on Safety and Quality in Health Care has challenged these interpreations. However, RANZCO was supportive of a new continuing professional development (CPD) framework for ophthalmologists, set to come into effect in January 2023. Three core changes to the CPD registration standard include CPD Homes and Professional

Development Plans for all doctors, and a requirement to conduct different types of CPD. In May, Macular Disease Foundation Australia (MDFA) patron Ms Ita Buttrose used a National Press Club address in Canberra to warn that many older Australians will no longer be able to afford antiVEGF treatments if the Federal Government adopts a MBS Review Taskforce recommendation to slash the Medicare Benefits Schedule (MBS) fee from $310 with a rebate of around $250, to a $96 fee with a rebate of around $75. She said economic modelling commissioned by MDFA predicts the proposed rebate cut will result in out-of-pocket costs increasing from $1,900 to $3,900 a year on average – double for patients needing injections in both eyes. This translates to an additional 47,000 Australians experiencing severe vision loss and blindness within the next five years if a Medicare rebate cut for intravitreal injections is given the green light. Staunch in its view that expanded scope is the only way to tackle longstanding eye health issues, in July OA released a new policy platform, ‘Working Together for Better Eye Care’, to remind the government, vision sector and consumers about Australia’s serious eye health challenges, and to recommend practical ways they can be tackled. Oral therapeutics, intravitreal injections and telehealth MBS items are among six areas OA is calling for change so the nation’s “seriously under-utilised” optometric workforce can combat urgent issues looming over the eyecare sector.

KEY EVENTS AND TRADE SHOWS Two major events in the eyecare sector were impacted by the ongoing pandemic. Organisers cancelled O=MEGA21 scheduled for September 2-4 in Melbourne, stating that it would have been unwise to postpone due to ongoing uncertainty surrounding COVID-19 lockdowns across Australia. However, the CPD educational component proceeded virtually on the same dates as part of a relaunched Southern Regional Congress (SRC). RANZCO postponed its 52nd Annual Scientific Congress, to give ophthalmologists and other attendees the best chance at meeting at a face-to-face event. Taking place at the Brisbane Convention & Exhibition Centre, it was originally scheduled for 19-23 November 2021, but COVID-19 lockdowns across the country prompted the RANZCO Board to formulate a new plan. The event will now run 25 February to 1 March 2022. The official 2022 congress booked for 3-8 November in Perth will go ahead as planned. PEOPLE AND LEADERSHIP There were several high-profile personnel changes throughout the year. Zeiss appointed former managing director of Carl Zeiss Vision South Africa Ms Gail Giordani to head its vision care business in Australia and New Zealand, relocating to Adelaide and taking over from Ms Hilke Fitzsimons who was promoted into a global role.

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FEATURE

OPHTHALMIC SURGERY The first corneal allogenic intrastromal ring segment (CAIRS) surgery in Australia was performed at the Queensland Eye Institute (QEI) in June, paving the way to better sight for keratoconus patients. Ophthalmologist Dr David Gunn conducted the procedure that overcomes higher complications rates associated with current synthetic corneal implants by using donor tissue instead. In another first, also in Queensland, OKKO Eye Specialist Centre become the first in Australia to offer the CAPSULaser procedure, enabling surgeons to perform highly accurate and consistent capsulotomies in less than one-third of a second.

Melbourne ophthalmologist Dr Tom Edwards (centre), with the team that delivered the investigational GT005 gene therapy for dry AMD as part of the CERA trial in March.

The impact of COVID-19 lockdowns on ophthalmic surgery wait lists is expected to be eye-watering in 2022, particularly in eastern states. However, RANZCO joined specialist medical colleges to support the temporary postponement of all non-urgent elective surgery in areas of high prevalence of COVID-19 infection. VACCINATION AND COVID

Vision 2020 Australia appointed former Aged and Community Services Australia head Ms Patricia Sparrow as its new CEO. Sparrow commenced in the role in September, taking over from Ms Judith Abbott who is assuming the role of CEO at Carers Victoria.

In February, it was reported that Australian optometrists and ophthalmologists, their support staff and students and trainees on placement would be eligible to receive a COVID-19 vaccine as part of the second wave of a national rollout strategy, commencing 22 March.

The Australian College of Optometry (ACO) announced Mr Pete Haydon has been appointed CEO, resigning from his position at the helm of Optometry Victoria South Australia after seven years. Haydon replaced Ms Maureen O’Keefe who resigned as CEO in July after eight years, but has retained leadership roles at Vision 2020 Australia.

As the Delta variant spread and vaccination rates stagnated, optometrists were approved to prepare and administer COVID-19 vaccines in Victoria as the state government worked to supercharge the jab rollout. At the Federal level, optometrists later featured among 12 regulated health professions that authorities approved to expand the nation’s COVID-19 response workforce, joining other allied health professionals.

EyeQ Optometrists announced its CEO Mr Ray Fortescue will chair a new joint-committee, overseeing the operations of the EyeQ Optometrists/National Optical Care Alliance. Former EyeQ chief business development officer Ms Lily Wegrzynowski transitioned into a new role as general manager eyecare and professional services as part of the alliance. Sydney’s Professor Stephanie Watson was recognised this year as one of the world’s top 100 female ophthalmologists. She was the only Australian to make the 2021 Power List of the Top 100 Women in Ophthalmology, a first-of-its-kind list released by The Ophthalmologist magazine.

More recently, states have imposed mandates requiring eyecare professionals and their staff to be fully vaccinated. Limitations have also been imposed on patients who aren’t vaccinated. AUSTRALIAN RESEARCH In March, Australia’s first clinical trials of an investigational gene therapy for dry age-related macular degeneration (AMD) commenced at the Centre for Eye Research Australia (CERA).

Nine people from the ophthalmic sector featured in the Australia Day 2021 Honours List for their service to ophthalmology and eyecare.

CERA’s principal investigator of retinal gene therapy research and vitreoretinal surgeon Dr Tom Edwards performed the first surgeries to administer Gyroscope Therapeutics’ gene therapy, GT005, to patients at The Royal Victorian Eye and Ear Hospital in Melbourne.

Those to receive a member of the order (AM) were ophthalmologists Associate Professor Anne Brooks from East Melbourne, Dr John Crompton from North Adelaide, Dr Tom Playfair from Woollahra, Dr Richard Stawell from Hawthorn and Dr Kevin Vandeleur from Brisbane, as well as former Orthoptics Australia president Mrs Marion Rivers from Gisborne South.

Australian researchers have also led the development of a promising new genetic test for glaucoma that can potentially identify 15-times more people at high risk of glaucoma than an existing genetic test. Those involved in the work are also launching a spin-off company to develop an accredited test for use in clinical trials, with recruitment expected to begin in 2022.

Ophthalmologists Dr Henry Lew from Caulfield North, Dr John Willoughby from Gawler, and Mr Larry Kornhauser, a founding member of Keratoconus Australia and president since 2000, received a medal of the order of Australia (OAM).

Prominent Melbourne retinal disease researcher Professor Robyn Guymer shared her enthusiasm for the Phase 3 results of a trial she was involved in, investigating pegcetacoplan, which she says is the only intervention shown to significantly slow the growth of lesions in dry AMD.

A further four eyecare professionals received Queen’s Birthday Honours, including Associate Professor Heather Mack, who was made a Member in the General Division (AM), Bellevue Hill eye doctor Dr Michael Newman, who was awarded a Medal in the General Division (OAM), South Australian optometrist Associate Professor Anthony (Tony) Phillips (AM), and NSW’s Ms Shayne Brown (AM) for her service to orthoptics.

US-based Apellis Pharmaceuticals told Insight it now plans to discuss the results with regulatory authorities worldwide, including the TGA.

Sadly, the sector lost three legends this year with the passing of Emeritus Professor Barry Cole, Dr Tony Adams and Professor Peter Swann.

INSIGHT December 2021

Overseas, a Hong Kong study highlighting a significant decrease in the time schoolchildren have been able to spend outdoors and a sharp increase in screen time was the latest to join mounting evidence that a rise in childhood myopia may be linked to the coronavirus pandemic. The research follows a similar Chinese study published last year that found myopia prevalence was three times higher in six-year-olds during the COVID-19 pandemic, giving rise to the term “quarantine myopia”. n

BUSINESS

e h t o t g n i S ti ck script ON SUCCESSION PLANNING

Most independent practice owners want to place their business in the safe hands of a new owner who can take their established practice and move it forward. But first, they need a succession plan – and a buyer.

chance meeting at a succession planning seminar at a conference three-and-a-half-years ago altered the course of two optometrists’ business careers, with the result exceeding expectations. Mr Mark Leverett describes selling his practice of 40-plus years to an independent optometrist as the best decision he could have made. Leverett and Kindler Optometrists is an independent practice established by optometrist Frank Kindler in 1966 in the leafy northeastern Melbourne enclave of Greensborough. In 1977, Leverett – then a recent optometry graduate from the University of Melbourne – joined the practice and became a partner in the business in 1978. When Kindler retired 10 years later, Leverett became sole principal. “Frank was a fantastic mentor, and we got on really well. We were in partnership for five years until he retired,” Leverett says. His experiences with Kindler, a man he admired, taught him a valuable lesson about business partnership. “He was in retirement mode, and I was in practice growth mode. We had different agendas, which could be frustrating at times. Decisions took forever to be made. I wanted to invest in new equipment, but Frank wanted to save money for his retirement,” Leverett recalls. “It was liberating when I took ownership. I was happy to not have a

partner, and I owned my own mistakes. As a result, until I had a firm desire to exit the practice, I decided that I wouldn’t take on a partner." Although the business’s succession conformed to a traditional model of employee-turned-partner-turned-owner, Leverett says it wasn’t the exit strategy Frank Kindler had in mind. “Frank retired prematurely due to ill health. It could’ve been a 20year partnership but was only five.” Leverett also learnt another valuable lesson when he purchased the practice: "When I bought Frank out, I changed the practice name and it was a disaster. Patients didn’t realise it was the same practice. The name of a practice carries goodwill – there is no benefit in changing the name." As his career progressed and the years passed, it reached a point where he had to consider his own exit strategy, with the shoe now firmly on the other foot. “I didn’t want to use the same strategy I used to enter into practice ownership – I didn’t want a 10-year transition period to pass the practice to a new owner,” he says. “I left my exit strategy fairly late.” To help guide his belated strategy, Leverett, who has been a member of ProVision since its inception – he was a founding member of the group – attended a seminar at the Southern Regional Congress

INSIGHT December 2021 49

BUSINESS

Leverett and Kindler Optometrists in Greensborough, Melbourne.

(SRC) on succession planning, hosted by Optometry Finance Australia managing director Mr Paul McKinley. He was discussing exit strategies and how to finance them, as well as the challenges of opening a greenfield practice compared to buying into equity in an existing practice. This was a topic familiar to Leverett who knew from experience that it’s better to buy equity. “I opened a greenfield practice in The Pines shopping centre in East Doncaster 17 years ago. I opened from scratch with the support of ProVision, when I was on ProVision’s board of directors,” he says. At that point in time, Leverett owned two Leverett and Kindler practice locations – in Collingwood and Greensborough – and had purchased another existing practice in Eltham. He sold the Collingwood practice when he opened The Pines. “The practice in The Pines ran for five years. It was growing slowly, to the point I needed to employ another optometrist, but the landlord wanted to increase rent and it wasn’t worth the effort, so I closed it,” he says. McKinley and Leverett openly shared their views about greenfield versus existing practices among the audience at the succession planning session. “Paul said, ‘I have to agree with you, that if you can, you are better off buying an existing practice’. Unbeknown to me, Amelia was sitting behind me – she was thinking about opening a greenfield practice,” Leverett says. He also shared with the audience that he was thinking about selling his practice. “Amelia contacted me shortly after."

INSIGHT December 2021

OPPORTUNITY KNOCKS Optometrist Amelia Jiao, the incumbent owner of Leverett and Kindler Optometrists, graduated 10 years ago – in 2001 – from the University of Melbourne. Qualified in therapeutics, she worked as a locum optometrist for several years but ultimately wanted to own her own practice. With this goal in mind, Jiao completed a Master of Optometry at UNSW, where she cultivated a special interest in behavioural optometry and orthokeratology, and an MBA at Melbourne Business School. Jiao was pursuing a path to open a greenfield practice when she met Leverett, then owner of Leverett and Kindler. She began working in the practice a few days a week, amid early discussions about ownership. As both saw an opportunity to realise their respective goals – Jiao to own a practice, and Leverett to sell – their plans converged. The pair implemented a three-year handover, which is now complete. “It took a while to find a practice fit. I approached Mark, knowing he had many years’ experience in the industry,” Jiao explains. “I essentially walked in cold to an established practice when I started working at Leverett and Kindler. But now, after three years, I know the patients by name, and have built rapport with them. Part of the transition in ownership from Mark to myself was about retaining the culture of the practice and keeping the feel of the patient experience the same.” As the practice owner, Jiao manages a team of 13 staff, and Leverett continues to work in the practice. Her business administration skills have come to the fore, although running a small business in the allied health sector is a different orientation to an MBA, she says. Jiao plans to continue the practice’s strong patient-focus.

“There is a lot of goodwill in the practice – the duty of care to the patient comes first, and I want to continue that. Frank Kindler founded the business [in 1966] and Mark was the second-generation owner. I want to continue the legacy and value of the business, so I’m keeping the name,” she says.

"I HAD A LIST OF ATTRIBUTES I WAS LOOKING FOR IN A NEW OWNER THAT MAY HAVE SEEMED UNATTAINABLE"

Jiao’s special interest in behavioural optometry and orthokeratology has also injected fresh ideas into the practice. “Mark saw my clinical skills as a potential opportunity for growth when he looked for a business partner. He wanted someone to add children’s vision services and we’ve built more clinical space to accommodate that. We’ve also added a designated kids frame range which could be seen as a controversial decision businesswise, but we want to build that specialty and niche around children’s eyecare,” she says. START WITH THE END IN MIND ProVision’s CEO Steven Johnston and business services manager Mark Corduff are in solid agreement on a key part of implementing a successful succession plan. “You have to start your business with the end in mind,” Johnston says. “You have to think about how you set up your business entity structure, whether that be as a trust, sole trader, private company, et cetera. This can affect bringing a partner, family member or employee into the business in five, 10 or 20 years’ time.”

MARK LEVERETT FORMER PRACTICE OWNER

McConnell began working with Lewis in 1997, became a partner in 2002, and took over the practice as a sole owner in 2015, with Lewis continuing to practice there. Johnston says transition is an important aspect of succession planning discussed early and explicitly. “Ninety percent of inexperienced buyers want the owner to stay on, to mentor and assist, and provide continuity for patients and that same level of patient care. It’s a distinguishing feature," Johnston says.

Corduff’s advice to sellers is to be well-organised ahead of seeking a buyer.

"Whereas an experienced buyer may not, and their business decisions have the potential to upset the original owner. That’s why we advocate for values alignment between the buyer and seller."

“This includes practice management and presentation including up-to-date fit out and equipment, financials, and a long-term lease, ideally a five-year lease plus an additional five-year option,” he says.

Despite the best laid plans, sometimes potential sales come unstuck because buyers are ill-prepared, don’t seek finance in time, or have unrealistic expectations of how long a sale will take.

“Anytime, COVID or not, a person buying a business wants certainty and to avoid risks, such as a short-term lease or a demolition clause, which can be the case in some shopping centres. “Buyers look for growth over the last three years. Owners selling their business need to demonstrate growth potential. Buyers want a clean sale. Younger buyers are not looking for a ‘renovator's delight’.” Having identified a need for optometrists to have access to succession planning expertise in one place, ProVision created SuccessionPro. Corduff says the resource aims to arm optometrists with information so they can have a conversation with ProVision that prompts thought and consideration as to how best to manage their exit. ProVision has helped guide several successful business transitions for optometrists including Mr Norm Russo, a founding partner at Russo Optometry, Ms Majella O’Connor, former owner of Ocean Eyes Optometrists, and Mr Peter Lewis, former owner of Lewis and McConnell Optometrist in Mount Waverley. In line with a typical transition model, optometrist Mr Stewart

"MARK SAW MY CLINICAL SKILLS AS A POTENTIAL OPPORTUNITY FOR GROWTH WHEN HE LOOKED FOR A BUSINESS PARTNER" AMELIA JIAO CURRENT PRACTICE OWNER

Negotiating staff as part of a deal can also derail plans. “How staff are treated, especially long-term staff and long-service benefits, can be a point of contention. Who takes on the obligations? The buyer or seller? It can be a sticking point,” Johnston says. Corduff says negotiating perceived value can also be challenging but it’s ProVision’s role to set expectations for both parties. “It’s relatively straight forward to value goodwill in business, but equipment and stock can be a challenge.” Johnston adds: “Selling out to a consolidator is not the only choice. We only recommend opening a greenfield with a well-considered business plan. Be prepared to pay for goodwill and a platform from which to grow.” UNCERTAINTY ON BOTH SIDES OF THE TABLE Eyecare Plus national business development manager Mr Philip Rose understands buyers and sellers are both putting a lot on the line, which is only heightened in the current COVID climate. “Succession planning is a delicate matter and at the moment, almost everything is on pause,” he says. “Owners wishing to sell are finding it difficult to find a buyer that’s committed, and to find an agreed price point. Buyers usually take an average of the last three years’ profit and loss figures, but owners are resisting that, because it’s currently not a fair reflection of the value of their business, as the last two years’ figures have been directly affected by forced closures during COVID lockdowns.” This can create disagreement on price and perceived value. Rose says some owners are reluctant to sell in 2021 because they don’t want to drop their price, which could be by as much as 30%. Instead, owners are biding their time. “Many owners are saying, ‘I’ll wait’. If a buyer and seller can’t agree on pricing, it’s a stalemate. It’s made more difficult because we

INSIGHT December 2021 51

BUSINESS

currently don’t have enough vaccinations to lift restrictions and reopen retail and business,” Rose says. “Even if a patient or customer just wants to buy a pair of sunglasses from their optometrist, they can’t in all areas because of the health restrictions. How can a seller achieve a fair price in these conditions? It’s like a stalemate, they’re in limbo.”

"BUYERS WANT A CLEAN SALE. YOUNGER BUYERS ARE NOT LOOKING FOR A ‘RENOVATOR'S DELIGHT'"

Rose says there is hesitancy around value-finding for buyers and sellers.

MARK CORDUFF PROVISION

“This issue is relevant and current. How do you determine the value or purchase price in a period of continued business disruption due to COVID-19? The value of optical equipment and stock is relatively fixed but the goodwill component is not fixed," he explains. "As an owner, do you ignore the last two years profit and loss when determining your sale price? Or do you take the last five years average?,” Rose says, explaining the quandary buyers and sellers are facing. “And who determines this? How much influence do banks and accountants have in determining a practice’s dollar value? Owners are saying, ‘If I sell now, I’m selling cheap’, and buyers are saying, ‘I can’t buy at the price you’re asking because the profit and loss figures don’t support that price'." In his view, standard succession planning ‘rules’ don’t apply in the current economy. “From a financial point of view, appetite for risk is low. There is uncertainty on both sides of the table. “Optometrists sometimes forget the buyer is unemotional – the buyer’s accountant looks at the numbers and they’re even more unemotional. They’re looking at the figures in black and white, they’re evaluating actual performance. “Determining value depends on what 2022 will look like. What will retail look like? I think we can expect retail to come back with compulsory masks, with regionally-targeted lockdowns, and a limit on how many patients can enter a practice, as per 2021,” Rose says. He anticipates economic activity will pick up towards the end of the year, especially with the ‘use it or lose it’ period associated with unclaimed optical health fund benefits, Christmas and summer holidays, and hopes succession planning can resume successfully in 2022. One element of succession planning that hasn’t been affected by the turbulence of the pandemic is the strategy behind transitioning a practice from one owner to the next. “The transition process is not affected and remains, for a flexible period, a central component of any good succession plan, for a flexible period. Mentoring is important, not just in a full-time capacity – it can be just two to three days a week, for the former owner to guide the new owner and remain a face in the practice,” Rose says.

"OPTOMETRISTS SOMETIMES FORGET THE BUYER IS UNEMOTIONAL" PHILIP ROSE EYECARE PLUS

INSIGHT December 2021

UNEXPECTED SUCCESS While the advice is overwhelmingly in favour of laying out a five to 10 year exit plan, Leverett was intent on a quick exit strategy, and had started to consider his options. He had been approached by consolidators and corporates six to 12 months before meeting Jiao. They were professional in their approach and presented attractive offers. Because of exclusivity agreements, he had been in discussions for a period of more than 12 months. “They [consolidators and corporates] could accommodate what I wanted, which was a three-year handover, not five or 10, but it was pivotal that I stay on in the business,” Leverett says. “They were not interested in a walk-in, walk-out sale. There was very little appetite for that.” But there was pressure to make a decision. “I had discussions with the team at ProVision. It’s good to speak to as many people as you can, and get as much advice as you can,” he says. Ultimately, Leverett turned down the offers when the opportunity to implement a succession plan with Jiao started to materialise. They both had some mutual friends in the profession, and their informal background checks were positive. The business agreement that eventually transpired between them was exactly what he wanted. “Although it came about completely out of the blue, it was the ideal scenario. Amelia presented with the right skill set, the right culture, in the right timeframe,” he says, explaining that a three-year transition ensued. “Amelia had not run a practice before, so for the first 12 months, she was observing. Then she began to take over more and more, and by the third year she was running the business, with my mentorship and support. I’m happy to take a backseat.” He is currently working in the practice four days a week and has no input into the running of the practice. He also has no plans for retirement at this stage. While it has proven to be a successful succession, Leverett admits it was an ambitious plan, and was advised he may need to be prepared to compromise. “Once I made the decision to sell, I wanted it done and dusted in a few short years. I guess I wanted a lot, and I had a list of attributes I was looking for in a new owner that may have seemed unattainable,” he says. “I was looking for an optometrist who had the same patientcentric culture as me, strong in financial and business management skills, somebody with strong administration skills, and a special interest or behavioural optometry background to generate a new generation of patients." n

CAREER

People

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

MONICA JONG JOINS JOHNSON & JOHNSON VISION IN MYOPIA ROLE Dr Monica Jong has joined Johnson & Johnson (JnJ) Vision as the global director of professional education for myopia. The appointment has seen her depart the International Myopia Institute, an organisation she led since its inception in 2015 as its executive director. “I am humbled to be given this incredible opportunity to work with the team of experts at JnJ, and all stakeholders to ensure every child with myopia has access to the latest evidencebased eyecare,” she wrote on Linkedin.

OPTOMETRY AUSTRALIA BOLSTERS COMMS TEAM Jenna McGowan has joined Optometry Australia to support its member and consumer communications and engagement with a focus on written, visual, digital and broadcast storytelling across the organisation’s channels. She was previously national media and communications manager with the Australian Institute of Architects and prior to this spent five years in London where she worked in communications roles for the British Lung Foundation and two PR agencies.

SUPPORTING OPTOMETRY MEMBER ENGAGEMENT Optometry Australia has appointed Trixie Do as its community engagement officer, member and consumer, also seeing her support the organisation’s member and consumer communications and engagement across the organisation’s channels. She was previously an optical dispenser where she worked seven years part-time for OPSM and, from 2020, she was also a part-time communications officer with youth not-for-profit Oaktree.

ANNA HEALY COMES TO EYEWEAR SUPPLIER WITH RARE EXPERIENCE Anna Healy recently joined Safilo as the senior trade marketing specialist for Australia and New Zealand. She brings a wealth of knowledge, with a rare combination of experience in both optical wholesale and retail sales and marketing. “I am thrilled to be joining Safilo and contributing to the promotion of the brand portfolio during a period of strong growth. Interestingly, it is the company with which my grandfather first started our family wholesale business,” she said.

ORTHOPTICS AUSTRALIA APPOINTS NEW EXECUTIVE OFFICER Orthoptics Australia has appointed Jane Cowan as its new executive officer. She comes to the role with a degree in public policy and experience across a wide variety of portfolios including, Indigenous affairs, disability services and information and communication technology. Jane said she was excited to contribute to the vision of striving for excellence in eye healthcare.

STAFF RESHUFFLE AT BAUSCH + LOMB SEES NEW REGIONAL BUSINESS MANAGER Claire Hooper-Lewis has taken on a new role with Bausch + Lomb Surgical as the regional business manager for Victoria/Tasmania, South Australia/ Northern Territory and Western Australia. During the past 10 years she has worked in various roles at Bausch + Lomb, having moved from Wales, UK. “I am incredibly fortunate and proud to work for a company which has provided me great development opportunities, all the time remaining in WA,” she said.

Do you have career news to share? Email editor Myles Hume at myles.hume@primecreative.com.au to be featured. INSIGHT December 2021 53

MORE THAN GUIDE DOGS GUIDE DOGS’ SERVICES EXTEND BEYOND WHAT ITS NAME SUGGESTS, TO ALSO INCLUDE ORTHOPTIC SERVICES. ORTHOPTIST KATE CLARK DESCRIBES THE DIFFERENCE SHE HAS MADE IN ONE CLIENT’S LIFE.

F KATE CLARK

"CHRIS (CLIENT) EXPLAINED THAT HE OFTEN HAD TO WAIT FOR A WEEK FOR SOMEONE TO VISIT TO ASSIST HIM TO READ HIS MAIL"

or more than 60 years Guide Dogs has provided vital support for people with low vision or blindness.

Since then, Guide Dogs’ services have expanded far beyond just Guide Dogs, to helping people with low vison or blindness move with confidence, achieve the ordinary and the extraordinary, connect with their community and feel better physically and emotionally – no matter their level of vision.

In fact, despite being best known for its much-loved namesake, more than 70% of the supports and services offered by Guide Dogs are non-dog related. Guide Dogs supports people with low vision or blindness at every stage of their journey, through a variety of services that can be adapted to meet individual needs. Clients come to Guide Dogs Victoria wanting to explore new services that will help reach their individual goals, ranging from orthoptic services, technology solutions, occupational therapy, peer support, and cane and guide dog training. GUIDE DOGS VIC ORTHOPTIC SERVICES Orthoptists are often the first port of call for Guide Dogs Victoria clients, using our knowledge, training and experience to provide tailored low vision supports to people of all ages. An orthoptic functional vision assessment can provide clients, family members, friends, carers, and other health professionals with valuable information about a person's remaining vision. This can be particularly helpful for those who are very young, non-verbal or have additional disabilities. I am one of Guide Dogs Victoria’s low vision orthoptists. I work with clients of all ages and find the work exciting and extremely rewarding, in this ever-evolving field of orthoptic practice. Increasing independence and quality of life for clients is at the forefront of every service we provide. In low vision orthoptic practice no two days are the same. Every person is different, their vision, their personality, lifestyle and low vision goals. Every day I meet new people and have the privilege and opportunity to contribute to their daily independence and quality of life.

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Guide Dogs Victoria specialist Kate Clark with client Chris who has low vision.

An important part of our practice includes keeping up to date with changes in low vision aids and assistive technology (including accessibility options for mainstream devices) and availability and changes in individualised funding. This is vital as these are constantly evolving and being knowledgeable allows us to provide clients with the most suitable and up to date options. CHRIS' STORY Some of my recent work has involved working with Guide Dogs Client chris who is living with severe low vision. Prior to working with him, Chris was unable to read any form of hard copy print which greatly affected his independence. Chris explained that he often had to wait for a week for someone to visit to assist him to read his mail. "My independence was heavily impacted by the changes to my vision,” he said. “I found it difficult to perform even the simplest reading tasks like reading my mail from the council or food packaging and expiry dates. Being able to read was so important to retaining my quality of life and staying active but I needed assistance to find the right product available to assist me.” To understand Chris' level of functional vision, I conducted an assessment to help to determine: • W hat he could see and how best to utilise his remaining vision. • W hat strategies and low vision aids

would best help him with his goals. • H ow best Chris could manage visual fatigue when reading or conducting tasks. The assessment results enabled me to recommend the best strategies and low vision aids to help Chris achieve his goals, such as reading his mail, identifying food expiry dates and reading menus when eating out. For Chris, a small, portable electronic magnifier was recommended. Chris was both delighted and very emotional saying: "This magnifier is going to make a world of difference to me. I can read my mail again without waiting a week for someone to read it to me and not paying bills because I don't know when they are due. "I will be able to know what I am buying at the shops instead of coming home with the wrong products. I can even go to the library and sit and read the newspaper if I want. I would never have dreamed I could do that.” To know more about Guide Dogs' services, visit www.guidedogs.com.au n ABOUT THE AUTHOR: KATE CLARK is a Guide Dogs Victoria specialist who has worked in low vision for eight years after many years in clinical practice. She works with clients of all ages to provide orthoptic services to people with low vision or blindness. 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

CLINICAL IMAGES AND PATIENT CARE SHARING AN IMAGE OF AN UNUSUAL PRESENTATION WITH A COLLEAGUE MAY BE VALUABLE IN THE DIAGNOSTIC PROCESS. BUT AVANT’S RUANNE BRELL SAYS IT'S VITAL TO TREAT IMAGES LIKE ANY OTHER HEALTH INFORMATION.

our-year-old K is brought into the regional hospital’s ED complaining of severe photophobia. Her eyelid is swollen. Her father says they were in the shopping centre when K screamed in pain. He didn’t believe K had been stung. RUANNE BRELL

"AN UNUSUAL INJURY OR CONDITION, THE TIME AND LOCATION, OR THE PERSON WHO TOOK THE IMAGE, MIGHT ALLOW SOMEONE TO IDENTIFY THE PATIENT"

the patient’s clinical record, delete it from your device. How can you use the image? Clinical images are health information. As with any other health record or information, you are bound by the requirements of the privacy legislation in your state or territory and your duty of confidentiality.

The resident remembers reading about eye injuries from hand sanitiser and wonders if this might be the cause. She quickly takes some photos of the injured eye on her phone and contacts the nearest ophthalmology clinic for advice. K recovers, but the resident is concerned about the risk to other children. She writes a post for a community Facebook page and uploads the photos. She doesn’t mention any names or seek permission to share the photos. Several people ask K’s father about the injury after seeing the post. He contacts the hospital*. IMAGES AND PATIENT CARE Images can be valuable in supporting patient care but before you take and/or share them, it’s important to understand your obligations and ask yourself some key questions. Will a photograph help? Smartphones make it very easy to take photos, almost without thinking. Nevertheless, in your professional capacity, always consider whether an image will help with treatment or diagnosis. Has the patient consented? Having decided that an image will assist in treatment, you need consent from the patient, or their parent or guardian. Explain: why you want to take the image; how the image will be used; who will have access to it. Do you need consent in writing? Consent can be written or verbal. Ask the patient, or their guardian, to sign a consent form if your hospital or practice policy requires this. For verbal consent, this should be documented in the patient’s medical records. No matter how you obtain consent, ensure it’s for the specific purpose/s

In the scenario above, taking images for the purpose of treating the injury, and sharing them with specialist colleagues for the same purpose, is permissible under privacy legislation.

Clinical images are health information and are bound by the requirements of state and territory privacy legislation.

for which you want to use the image. If it’s for non-clinical purposes, such as education or research, discuss this with the patient and ensure it’s included in your notes of the discussion. Store the completed consent form, or document any verbal consent, in the patient record along with the images. Could the image be identifiable? It’s safest to assume any image could be identified so ensure you seek permission to capture and use it. Even if the image doesn’t include the patient’s face or name, they may be recognisable from pieces of information, particularly in combination. An unusual injury or condition, the time and location, or the person who took the image, might allow someone to identify the patient. Have you made sure the image is secure? Follow any hospital or practice policies about which device you can use to take the image and which platforms to share images. If using your own device, check the security settings, particularly as some default settings can lead to inadvertent privacy breaches (i.e. an automatic upload to a cloud service). Once you have saved the image to

However, it’s not permissible to use the image for another purpose without specific consent from the patient or their guardian, even if you think it is de-identified. USING CLINICAL IMAGES SAFELY Clinical images are valuable for diagnosis and to improve care. Developments in technology have increased the ease and speed with which they can be used in clinical treatment. The key is to remember clinical images are health information and assume the patient could be identified. For this reason, ensure you seek patient consent and follow privacy, security, and storage requirements. *Scenario based on Avant claims experience. It has been de-identified and certain facts have been altered to illustrate the legal issues involved. It doesn’t reflect any individual matter. Disclaimer: This article is intended to provide commentary and general information. It does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. n

RUANNE BRELL is a senior legal advisor in the Advocacy, Education and Research team at Avant with over 15 years’ experience in health and medical law. She also provides advice to Avant’s members via its Medico-legal Advisory Service.

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DISPENSING

MYOPIA LENS FITTING REQUIREMENTS – PART 2 IN THE SECOND PART OF HIS SERIES ON THE DISPENSER’S ROLE IN MYOPIA MANAGEMENT, GRANT HANNAFORD COVERS THE UNIQUE FITTING DEMANDS OF NEW AND AVAILABLE SPECTACLE LENS OPTIONS.

ens developers are taking strong interest in spectacle lenses designed to slow myopic progression in children. Following from part one of this article, we will assess some of the fitting requirements of these treatments. GRANT HANNAFORD

"THERE ARE SEVERAL MAIN FAMILIES OF LENSES USED IN MYOPIA: BIFOCALS, PROGRESSIVE STYLE LENSES, AND LENSES USING RADIAL AREAS OF DEFOCUS"

The optometrist will consider the full range of diagnostic data when selecting a lens for myopia management, from family history, risk factors, biometry and binocular function (among many others). There will be well defined reasons for a given lens selection, so even if cosmetically the lens chosen isn’t the one the patient prefers, it’s important to remember this is a treatment process, so the appearance is not a consideration, only the outcomes. As mentioned in the previous article, there are several main families of lenses used in myopia: bifocals, progressive style lenses, and lenses using radial areas of defocus such as in the DIMS and HALT style designs. Progressive and bifocal lenses should be familiar to all practitioners in terms of fitting requirements, although there may be specific height demands placed by the optometrist for bifocals, such as segs set to lower pupil. Avoid the temptation to manipulate the fitting heights for progressive power lenses as the designs are relying on specific placement to be effective. Arbitrarily shifting heights to gain a perceived increase in distance or near vision will undo the benefits of the design. Lenses that attempt to manipulate peripheral retinal defocus (i.e. DIMS and HALT concepts) utilise lenslets arranged on the lens surface to present the eye with areas of defocus (Figure 1, available in the online version of this article). Figure 2 above shows some configurations for these lenslets or ‘dots’ of additional plus power. They provide a defocus or treatment zone as shown in blue which create areas or volumes of defocus to stimulate a response in the growth of the eye. The design on the far right does not use lenslets, instead it has a smooth treatment zone. In all cases the lenses have a central area containing the

INSIGHT December 2021

Figure 2 – Some peripheral defocus lens designs (treatment zones in blue, distance prescription in white).

Figure 3 – Fitting requirements as dictated by the lens treatment zones.

patient’s full distance prescription.

treatment zone. Choose frames with:

Fitting these lenses comes with their own demands. Despite being referred to as ‘highly aspheric’, the design cannot be treated as a single vision aspheric lens. The central zone of distance vision must be placed so it’s centre corresponds with direct line of sight, i.e. fit at pupil height, allowing an equal amount of the central distance section to be viewed in all directions from level gaze. Consequently, it’s desirable to have pantoscopic tilt and wrap angles minimised for these fittings to avoid oblique astigmatism and other angular aberrations. Due to production constraints, there are limitations on available lens blank sizes. Lower powers are available in large blanks (often up to 75mm) however these can shrink to 60mm blanks in higher power and cylinder combinations. Be aware of the MSU when looking at frames as this can preclude certain frame choices.

• A dequate depth to incorporate as much of the treatment zone as possible.

Finally, it’s important to realise that while these lenses may help slow axial length growth and the attendant myopic progression, there is currently no mechanism for the reversal of myopia. This is important to keep in mind when discussing the prescribed treatment options with patients and their parents. Be wary of over promising results and always do the follow up to ensure compliance with the treatment protocols. n

Frame selection will drive the success of the lens designs. Figure 3 shows a poorly centred eye (left), resulting in the blank size being inadequate and the treatment zone (blue dots) being cut off. Better centration (right) allows incorporation of the blank size and the entire

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

• G ood vertical centration to avoid vertically asymmetric treatment zones. • M inimal horizontal decentration. • F latter fitting (tilt as low as reasonably possible and wrap close to zero).

2021 CALENDAR

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

DECEMBER 2021

FEBRUARY 2022

MARCH 2022

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

MIDO EYEWEAR SHOW DIGITAL EDITION

COPENHAGEN SPECS

BARCELONA SPECS

Copenhagen, Denmark 5 – 6 March copenhagenspecs.dk

Barcelona, Spain 7 – 8 May info@barcelonaspecs.com

Virtual 11 – 12 December 2021.apvrs.org

Milan, Italy 12 – 14 February mido.com

VISION EXPO EAST RANZCO ANNUAL SCIENTIFIC CONGRESS

JANUARY 2022

Brisbane, Australia 25 February – 1 March ranzco.edu

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

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

MAY 2022

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

APRIL 2022

10TH SUPER SUNDAY CONFERENCE Sydney, Australia 22 May optometry.org.au

OSHOW2022

77TH ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE

AUSTRALIAN VISION CONVENTION (AVC)

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

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

Sydney, Australia 27 – 28 May marketing@odma.com.au

SPECSAVERS – YOUR CAREER, NO LIMITS All

Specsa Graduate opportunities - NSW ve stores rs now Are you a final year student looking to secure your first role as a Graduate Optometrist? Specsavers with O CT has provided a solid career development path for optometrists, offering great rates of pay with a patient-focused environment. By joining us as an optometrist, you can be certain that you will have everything at your disposal to help improve health outcomes for your patients. If you like the idea of building your career and delivering exceptional clinical care within a growing team, then reach out to the Graduate Recruitment team.

Optometrist opportunities in Tasmania – offering up to $150K To support our stores during continued growth, Specsavers are looking to expand our optometry team across Tasmania. We have full and part time roles available with flexible rosters and supportive and welcoming teams. You will have the opportunity to work with market leading specialist equipment – including OCT and access to excellent opportunities for professional development. Extremely generous salary package on offer including relocation support if required.

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

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

marie.stewart@specsavers.com or 0408 084 134

SRS – Full time opportunity – Specsavers Grafton Looking for a sea change or a break from the hustle and bustle of the city? Specsavers Grafton are looking for a community focused optometrist to join their team. You will work alongside an experienced and supportive team that provide affordable and exceptional clinical eye care to their community. We have an attractive package including relocation on offer.

WA, SA, NSW & ACT optometrist enquiries: Madeleine Curran – Recruitment Consultant

Specsavers Recruitment Services – Locum Specsavers Recruitment Services welcome our newest member, Dean Nguyen. Supporting the NSW & ACT locum portfolio along with Cindy Marshall – Team Leader (SA/WA), Matthew Cooney (QLD/NT) and Crystal Kunnikorn (Vic/TAS), Dean will facilitate all locum requirements within the ever-growing Specsavers network. With more than 20,000 locum placements each year, we welcome all optometrists interested in a locum career to reach out. The team will assist you to secure placements, advise on opportunities all across the country and assist in planning your roster.

cindy.marshall@specsavers.com or 0450 609 872

Specsavers Morwell – Optometrist and Optical Dispenser/ Retailer Partnership Opportunities Available! We are looking for a passionate, energetic, and experienced team of professionals to become JVPs at Specsavers brand-new store soon opening in Morwell. Situated 150kms east of Melbourne in the heart of the La Trobe Valley, Morwell is known as the Garden Town with roses characterising many of its gardens. Town residents have access to the large Mid Valley Shopping Centre located on the eastern side of the town. With market rate salary + share of the store profits, this is an opportunity not to be missed.

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

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

apac.graduateteam@specsavers.com

SOAPBOX

SAME DAY BILATERAL CATARACT SURGERY

BY CHAMEEN SAMARAWICKRAMA

ataracts are the commonest operation in the world. With modern day surgical techniques, it’s also the safest. And better yet, advances in lens technology mean some patients may enjoy the best vision of their entire life post-surgery. This technological revolution has meant cataract surgery is more than avoiding blindness – rather, in many ways it’s about optimising vision. Today, we aim to deliver patients crystal clear vision in the activities they enjoy most, and some may even be totally free from glasses altogether. As such, many opt for surgery earlier so they can enjoy improved quality of life, younger and for longer. If we’re moving towards optimising quality of life, doesn’t it make sense to offer same day bilateral cataract surgery? It is much more convenient for patients, with less time off work, only a single trip to hospital, is often more cost effective and has a faster time course to full recovery. The main arguments against same day surgery focus on the risk of infection, but that risk has been effectively mitigated by using completely separate equipment between eyes. Well, we finally have a good answer to this question, and it’s got nothing to do

INSIGHT December 2021

with infection. It’s all about vision. Data from the IRIS Registry, a huge multicentre eye disease clinical registry based in America with over 3 million patients recruited, has shone a light on this controversy.1 In their report of 1.8 million patients split between immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS), ISBCS or same day bilateral cataract surgery was associated with worse visual outcomes. Let’s drill into this. The authors broke the DSBCS group into an early group, where the second eye was operated within 14 days, and a late group, where the second eye was operated within three months. After adjusting for confounders, the best performing group was the early delayed, followed by the late delayed, while the same day bilateral surgery group came in last. It should be noted the size of the difference was small. On average the same day group performed worse by three to four letters in uncorrected vision, despite having better presurgical vision, compared to the delayed groups. Further, the proportion who achieved uncorrected 6/6 vision in the second eye was worse in the same day group (21%) compared to the delayed group (24.2%). What does this mean? Delaying surgery between eyes, even by a couple

of weeks, on average gave better outcomes than having both cataracts operated on the same day. The likely reason is the delay allows the surgeon the opportunity to check the performance of the first eye, and if necessary, adjust the second eye for better results. The differences are small, but when it comes to vision we are aiming for better and better outcomes, and it is these incremental small improvements that add up to make sizable differences over time. If your vision is 6/5, the difference is probably not overly noticeable. However, if your vision is 6/12, this small difference affects your ability to drive without glasses. Saying that, I do believe there is a role for same day cataract surgery. In cases where anaesthetic may be risky, or intellectual disability where the goal is to reduce the number of trips to hospital, it makes sense. Some healthy patients may choose to have same day cataract surgery because it fits with their life and requirements better. However, these patients should have a thorough informed consent so they understand what they are choosing, and a proper understanding of both options available. We should take a step back and put it all in perspective. Ultimately, much of this refractive error is correctable with glasses, contact lenses or laser eye surgery, so all is not lost. However, many patients are opting for early cataract surgery to get the best vision they can at an earlier age and enduring extra procedures is not ideal. In my mind, this is good evidence that modern day routine practice should be delayed sequential cataract surgery. Ultimately our goal as ophthalmologists should be to offer our patients the best vision they can achieve, and sometimes that may involve telling them not to rush things. n References can be found in the online version of this article at www. insightnews.com Name: A/Prof Chameen Samarawickrama Qualifications: BSc(Med) MBBS PhD FRANZCO Business: Nexus Eye Care Location: Blacktown and Norwest, NSW Years in profession: 11

WE FINALLY HAVE A GOOD ANSWER TO THIS QUESTION, AND IT’S GOT NOTHING TO DO WITH INFECTION. IT’S ALL ABOUT VISION.

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