Apr 2016

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OTs tackle low vision<br />

Collaboration<br />

between the<br />

occupational<br />

therapy (OT) community<br />

and an advocacy group<br />

has resulted in several<br />

public awareness<br />

projects and a developing<br />

curriculum for OT<br />

students to specialise in<br />

low vision care.<br />

The development began<br />

a few years ago when<br />

Dr Mary Butler, Otago<br />

Polytechnic principal<br />

lecturer, put some<br />

third-year students<br />

in-touch with the Visual<br />

Impairment Charitable<br />

Trust Aotearoa (VICTA) to develop ideas for projects<br />

to help that community. Around the same time<br />

Associate Professor Gordon Sanderson from<br />

Otago University encouraged Dr Butler to develop<br />

a curriculum for postgraduate OT students to<br />

concentrate on that area.<br />

Occupational therapists are interested in<br />

function and practical ways to improve lives,<br />

says Dr Butler. Low vision is a central field in OT<br />

practice overseas, but in New Zealand, there are<br />

opportunities for OTs to become more involved in<br />

helping low vision patients to navigate life in spite<br />

of their visual problems and to work far more<br />

closely with optometrists.<br />

“I’m very much trying to create a space where<br />

the profession will say, ‘we can do this’, and to<br />

encourage OTs to work closely with optometrists.<br />

I’m encountering too many old neighbours and<br />

clients who are unnecessarily disabled by visual<br />

impairment,” says Dr Butler.<br />

“Too often they are told by their ophthalmologist<br />

that there is nothing that can be done. This is<br />

not true. There are many things that OTs can do<br />

by problem solving everyday functions such as<br />

cooking, community mobility and remaining active.<br />

We tend to use the simplest equipment or none at<br />

all to bring about these outcomes.”<br />

Projects arising from student collaboration with<br />

VICTA include the development of high visibility<br />

canes and wristbands for low vision pedestrians to<br />

make drivers aware of their presence on the street.<br />

“The whole question of road safety was a big<br />

issue from the time we started the group,” says Dr<br />

Lynley Hood, founding trustee of VICTA.<br />

The Trust actually began as the Dunedin Visually<br />

Impairment group, a lively cadre of elderly people<br />

diagnosed with various problems that will lead to<br />

permanent sight loss. When it became clear their<br />

issues were of national significance, particularly in<br />

regard to the ageing population, Dr Hood and her<br />

cohort established the Trust.<br />

“If you’re no longer allowed to drive, even if<br />

you get half-priced taxi fares with a disability<br />

allowance, getting around becomes very<br />

expensive. Buses are the better option,” says Dr<br />

Hood. “But if you catch the bus, you still have to<br />

cross the road. (Low vision people) don’t have<br />

white canes or guide dogs, so motorists don’t<br />

know that they can’t see them properly. So, one<br />

of the first suggestions was high visibility walking<br />

sticks. They are a hit with bus drivers.”<br />

Still from video promoting the use of high visibility sticks and wristbands from OTs<br />

collaboration with VICTA<br />

VICTA worked with a local fabricator to develop<br />

four high visibility walking sticks, made from<br />

carbon fibre with high contrast colours sure to be<br />

visible from blocks away. Go Bus and Richies now<br />

train drivers to recognise high visibility canes and<br />

wrist bands thanks to VICTA’s efforts. While one of<br />

Dr Butler’s third year OT students, Keri McMullan,<br />

helped produce a video promoting the service,<br />

which VICTA intends to use to promote visibility<br />

canes around the country for World Sight Day in<br />

October.<br />

McMullan was also responsible for a video<br />

promoting the use of iPads among low vision<br />

recipients and, according to Dr Butler, a third<br />

video promoting safe use of mobility scooters is in<br />

the works.<br />

“I applied for a small amount of funding to help<br />

promote what occupational therapy can do for<br />

people with low vision,” says Dr Butler. “We have<br />

been running student placements, making videos,<br />

creating Facebook pages, setting up an equipment<br />

library, running iPad classes for people with low<br />

vision and workshops for OTs. Lynley and VICTA have<br />

been very important in helping us to get traction<br />

and the profession is now coming on board.”<br />

A postgraduate paper in vision rehabilitation will<br />

be rolled out at Otago Polytechnic in the second<br />

semester of the <strong>2016</strong> academic year. Dr Butler says<br />

this has been brewing for some time.<br />

“It came about in a number different ways. My<br />

main area is brain injury and a few years ago I had<br />

a master’s student doing work on neurological<br />

vision impairment. She was working for the Blind<br />

Foundation, but she pointed out that people with<br />

neurological vision impairment and other kinds of<br />

low vision did not qualify for help from this service.<br />

At about the same time, Lynley and Gordon were<br />

setting up VICTA, which draws together 20-30 with<br />

low vision every month who are passionate and<br />

increasingly articulate about what they need. Put<br />

that together with the figures from the Disability<br />

Survey (2014), which found that that self-reported<br />

visual impairment among adults increased an<br />

astonishing 100% between 2001 and 2013 (from<br />

81,500 to 163,000) and it all clearly points to an<br />

area where we all have to do our bit; and we are<br />

particularly keen to work closely with optometrists<br />

both in practice and research about low vision”<br />

To see more on of what Kiwi OTs are doing for low<br />

vision patients check out: https://www.facebook.<br />

com/Vision-Matters-OT-866464940127100. ▀<br />

Celebration and a question of style<br />

Our last month before going to press has been a<br />

whirlwind of functions. The wonderful Macular<br />

Degeneration Race Day was a chance to enjoy a<br />

stunning day for a fabulous cause. Though my hat<br />

played havoc from a picture-taking point of view,<br />

it was a pure pleasure to be involved and Jai, our<br />

new editor, got her first taste of what a wonderful<br />

industry this is.<br />

There were more celebrations at the upbeat<br />

Excellence in Ophthalmology and Vision<br />

Research Prize Evening, where some of our most<br />

experienced professionals stepped up to support<br />

and celebrate some of our budding newcomers;<br />

at Auckland Eye, which was celebrating the<br />

end of its refurbishment; and at the Summer<br />

Students Research Symposium, covered by our<br />

well-known editor-at-large, Maryanne—all<br />

included in this month’s issue.<br />

A question of style<br />

We’ve tweaked a few things this month after<br />

some of you were kind enough to provide<br />

feedback on the magazine.<br />

Thanks to all those who say you’re loving<br />

the slightly fresher, more modern look of the<br />

magazine; the content mix of news, views, and<br />

celebrations; and the more national focus—<br />

though we can always do with more stories from<br />

around the country, so keep them coming.<br />

We’ve also listened to those who weren’t quite<br />

ready for the evolution (perhaps revolution) to<br />

that doyen of journalism styles, the Associated<br />

Press (AP), followed by most western publications.<br />

The AP only use full titles on first mention and<br />

thereafter simply refer to the person by their<br />

surname. (Even President Barack Obama becomes<br />

simply Obama). This ensures consistency, clarity,<br />

accuracy and brevity—a constant challenge in<br />

publishing as there are always more stories than<br />

ads to support the publication of those stories.<br />

AP’s style was also developed to avoid<br />

stereotypes and upsetting anyone as it treats<br />

everybody the same. Many women have a<br />

problem with the “Ms”, “Mrs” or “Miss” honorifics,<br />

which force them to reveal their married status,<br />

compared with men’s simple “Mr”. Sweden even<br />


introduced a gender neutral title “hen” to avoid<br />

the problem. Some publications use first names<br />

for students instead of surnames, but just how<br />

much study, experience or age should a person<br />

have before they can be referred to in the same<br />

manner as their peers? Then there’s the question<br />

of medical doctors versus PhDs—the latter given a<br />

particularly bad rap by some honorary PhDs using<br />

the title—with many publications deciding to<br />

now only acknowledge someone’s PhD when it’s<br />

relevant to the story and only use the title “Dr” for<br />

medical practitioners.<br />

Here at NZ Optics we are your industry<br />

publication and though we can’t promise to do<br />

everything you ask (as that could diminish the<br />

editorial integrity of the publication, which is<br />

something we hold in very high regard to ensure<br />

all are treated fairly) we do care what you think<br />

and so have reinstated professional honorifics—so<br />

no Mr’s but lots of Dr’s.<br />

We love your feedback, especially your praise,<br />

and we do listen. This is your publication and the<br />

next generation’s too and everyone should have<br />

a voice, which is why we’re delighted to have an<br />

article this month from Nikku Singh (no title yet),<br />

the new president of the NZ Optometry Student<br />

Society (NZOSS).<br />

So enjoy this month’s issue, celebrating so many<br />

wonderful things people in this industry have<br />

achieved, and don’t be afraid to let us know what<br />

you think—we can take it!<br />

Lesley Springall, publisher, and Jai Breitnauer at the<br />

MDNZ Race Day<br />


University’s generous gift<br />

Joan Ready, former Faculty of Medicine<br />

and Health Sciences administrator with<br />

the Department of Ophthalmology, has<br />

donated $250,000 to her former department for<br />

department head Professor Charles McGhee to<br />

spend at his discretion.<br />

Talking at the <strong>2016</strong> Excellence in Ophthalmology<br />

and Vision Research Awards (see story p4), Professor<br />

McGhee said he was both surprised and delighted at<br />

Ready’s generous gift, which would be used to help a<br />

number of young people reach their goals.<br />

Ready worked at the Faculty for more than 35<br />

years in various research and management roles,<br />

including research technician and manager for<br />

Physiology, Pathology, Clinical Sciences, School of<br />

Nursing and the Rural Health Inter-professional<br />

Immersion Programme. She joined Professor<br />

McGhee when the Department of Ophthalmology<br />

was in its infancy and stayed there for the last 17<br />

years.<br />

In the Faculty newsletter, Professor McGhee<br />

said he was extremely grateful to have had “Joan<br />

University vice-chancellor Professor Stuart McCutcheon and<br />

Joan Ready (front) with Professor John Fraser, dean of Faculty of<br />

Medical and Health Sciences, and Professor Charles McGhee (back)<br />

as a great friend and colleague over the last 17<br />

years” and that she played an integral part in<br />

many of the department’s major developments in<br />

ophthalmology.<br />

He anticipates the Joan Ready Fund will help start<br />

the careers of several future ophthalmologists and<br />

clinician scientists in New Zealand, he said. ▀<br />

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Shamir quarter page ad NZ OPTICS APRIL <strong>2016</strong>.indd 1<br />

<strong>Apr</strong>il <strong>2016</strong><br />

11/03/<strong>2016</strong> 3:55:24 PM<br />



News<br />

in brief<br />


The inclusion of eyeball tattooing in health legislation passed by<br />

the NSW Labour government in February has effectively legalised<br />

this experimental form of “body modification” in the state. RANZCO<br />

responded by issuing a strong warning against the practice, which<br />

involves injecting ink into the sclera to make it a solid or mix of<br />

colour. “The eye is a very complex and sensitive organ and in no<br />

way should anyone consider tattooing it if they wish to retain their<br />

sight over the long-term,” said Associate Professor Mark Daniell, a<br />

corneal specialist. Eyeball tattooing has been banned in some US<br />

states due to a link to blindness and cancer.<br />


In a huge leap forward for next-generation wearable tech, a<br />

Chinese research team have built an “invisible” circuit layer within<br />

a contact lens for the first time. The team’s research, published in<br />

the journal Advanced Materials in March, was led by Professor Song<br />

Yanlin at the Chinese Academy of Sciences in Beijing. The built-in<br />

electronic circuit is invisible to the naked eye because it measures<br />

one micrometre in width, making it narrower than the average<br />

bacterial cell. It could be used to measure glucose levels in the tears<br />

of diabetic patients or become part of a layer of “invisible skin”<br />

giving a sense of feeling back to patients with prosthetic limbs, the<br />

authors said.<br />


OPSM’s Penny the Pirate--an eye test turned into a book and an<br />

associated app, designed to test kids’ eyes while reading with their<br />

parents--has been crowned the world’s most successful marketing<br />

campaign in the Warc 100 rankings, an annual report that judges<br />

the world’s best marketing campaigns by business impact.<br />

The campaign, created for OPSM by Saatchi & Saatchi Sydney with<br />

the help of paediatric eye care specialists, resulted in thousands of<br />

children having their eyes checked and increased the number of<br />

eye tests conducted by OPSM by 22.6% year-on-year. The book is<br />

now being used by not-for-profit organisation OneSight to help test<br />

children’s eyes in remote and rural Australia.<br />


Essilor International has acquired UK-based Vision Direct Group,<br />

one of Europe’s leading online contact lens retailers, with<br />

revenue of around £33 million ($71 million) in 2015. Essilor said<br />

the acquisition strengthens its current position in Europe by<br />

complementing existing activities. Fuelled by 19 new acquisitions<br />

and partnerships, Essilor also published strong financial results for<br />

2015, as the company continues to focus on its lens and optical<br />

instrument divisions, innovation and consumer marketing. Revenue<br />

was up 18.4% to €6,716 million ($11,205 million), while operating<br />

profit increased 19.6% to €1,183 million ($1,974 million).<br />


The Royal Australasian College of Surgeons (RACS) has committed<br />

to increasing the number of Maori surgeons in New Zealand as part<br />

of a newly developed Maori Health Action Plan. “At present, there<br />

are only a small number of surgeons in New Zealand who identify<br />

as Maori,” said Dr Jonathan Koea, an Auckland-based hepatobiliary<br />

and general surgeon and member of the Plan’s working group.<br />

Dr Koea notes that while this programme will take a sustained<br />

effort over years, it is a significant step forward for the College’s<br />

commitment to Maori health. “Through the Action Plan, RACS<br />

intends to increase the number of Maori in the surgical workforce,<br />

embed cultural competency as a fundamental professional skill,<br />

focus more surgical research into Maori Health and promote<br />

initiatives that will decrease the disparities that currently exist for<br />

Maori.”<br />


Bayer and the American Association for Cancer Research (AACR)<br />

announced the availability of the “AACR-Bayer Innovation and<br />

Discovery Grants”. The programme aims to promote the key tenets<br />

of the Bayer Grants4Targets initiative with a focus on oncology<br />

to provide new treatment options for cancers with high unmet<br />

medical need, to encourage innovation and translation of ideas<br />

from basic research into novel drugs and to foster collaborations<br />

between academic groups and the pharmaceutical industry.<br />


Once the privilege<br />

of TV’s Six Million<br />

Dollar Man, bionic<br />

vision is becoming<br />

more commonplace<br />

for the everyday<br />

patient. Pixium<br />

Vision have<br />

launched the Iris II,<br />

their first epiretinal<br />

implant with 150<br />

electrodes—more<br />

than three times what is currently available—suitable for patients<br />

who have lost their sight due to retinitis pigmentosa (RP). The<br />

France-based research team, headed by Professor Michel Weber,<br />

said early results with patients with RP are positive.<br />

Meanwhile in the US, optics specialist Eric Tremblay unveiled a<br />

unique contact lens that will provide the wearer with telescopic<br />

vision. The lens is just 1.55 mm thick and features a thin, reflective<br />

telescope that enables the user to zoom in and out via winking. ▀<br />

Excellence in<br />

ophthalmology<br />

celebrated<br />

The annual Excellence in<br />

Ophthalmology and Vision Research<br />

prize evening is an upbeat affair,<br />

bringing together those at the beginning<br />

of their careers with those who have more<br />

experience to share.<br />

This year event’s on March 1 was no<br />

different, with a celebratory atmosphere<br />

pervading the halls at the University of<br />

Auckland. The event was well-attended<br />

by members of the Ophthalmology<br />

Department, senior staff from the School of<br />

Medicine, donors, benefactors and friends<br />

and family members of the prize winners.<br />

Ophthalmologist and department head<br />

Professor Charles McGhee presided,<br />

explaining the evening was about<br />

celebrating past and future potential<br />

success. He reviewed the achievements of<br />

the department since it was established<br />

in 1999, including gaining more than $33<br />

million in research funding, increasing<br />

research fellows from one to 75, 700<br />

research papers published or soon-to-be<br />

published, 30 higher research degrees<br />

awarded or submitted, and 18 PhD and MD<br />

students currently enrolled. There has also<br />

been a myriad of national and international<br />

connections developed through the success<br />

of past students, many of whom have gone<br />

on to become leaders in their field both here<br />

and overseas. Professor McGhee thanked<br />

the department’s benefactors, those who’ve<br />

been supporting the department from the<br />

start such as Drs Bruce and Wendy Hadden<br />

and the Ring family to the newest supporter,<br />

former faculty administrator Joan Ready<br />

(see story P3) who he says blew him away<br />

with her generous retirement donation of<br />

$250,000.<br />

Doctoral candidate Yeri Kim provided<br />

an outline of her PhD research into the<br />

Development of connexin inhibitors for the<br />

treatment of retinal diseases to understand<br />

the mode of action of Peptagon and HCB1019<br />

to potentially treat diabetic retinopathy and<br />

macula oedema, and dry and wet AMD. Given<br />

the initial success of Kim’s research, clinical<br />

trials with Peptagon are expected to start this<br />

year.<br />

But the main reason for the evening was<br />

to celebrate seven award winners: the noted<br />

summer studentships and the winners of the<br />

prestigious William MacKenzie Medal, Arthur<br />

Thomas Paterson scholarship and Calvin Ring<br />

Undergraduate awards:<br />

Calvin Ring Undergraduate Prize in<br />

Ophthalmology—Victoria Utley<br />

Dr Peter Ring presented the Calvin Ring<br />

Undergraduate Prize for the best allround<br />

undergraduate student in clinical<br />

ophthalmology to fifth year medical student<br />

Victoria Utley.<br />

In presenting the award, Dr Ring explained<br />

that the award was given in honour of<br />

his father, Dr Calvin Ring, who was at<br />

the forefront of ophthalmology for his<br />

generation, who spearheaded good practice<br />

and the use of new IOLs in cataract surgery<br />

and who was instrumental in bringing about<br />

the Maurice Paykel Chair of Ophthalmology,<br />

held by Professor McGhee.<br />

Utley comes from a dynasty of surgeons in<br />

Christchurch whose publications and research<br />

showed a strong surgical bias, he said. Utley<br />

said she was excited to receive the award, the<br />

first since school, and though she was still<br />

undecided which direction to follow she’d<br />

always had an interest in ophthalmology. “I<br />

enjoyed my ophthalmology placement last<br />

year. I’ve always been interested in eyes, but<br />

being able to see the research and being able<br />

to understand that the eyes aren’t their own<br />

separate entity, they are kind of a window to<br />

what’s going on generally in the body, I found<br />

fascinating.” Utley said how privileged she<br />

felt to have won the award and to have met<br />

the Ring family.<br />

William MacKenzie Medal—Michael Wang<br />

The William MacKenzie Medal is awarded<br />

each year for “Early Excellence in Eye<br />

Research.” It is a highly prized award<br />

that recognises<br />

the significant<br />

contribution<br />

made by a<br />

medical student<br />

or trainee intern<br />

towards a research project, which reached<br />

publication status during the year of the<br />

award.<br />

This year’s winner, Michael Wang, a fifth<br />

year undergraduate medical student,<br />

received his award from Associate Professor<br />

Jennifer Craig who said Wang’s academic<br />

achievement, dedication toward research and<br />

enthusiastic approach was commended by<br />

a number of staff members. She explained<br />

how Wang had done an exceptional job<br />

working on a number of different projects<br />

in her department looking at some of the<br />

treatments for dry eye, mostly in the area of<br />

ocular surface disease. He has published two<br />

papers and submitted a third on the work<br />

he’s been doing and has at least two more in<br />

the pipeline. He now has eight papers to his<br />

name and six in preparation, she said.<br />

Award winners (L to R) Michael Wang, Eileen Song, Clare Wu, Victoria Utley, Andy<br />

Kim, Benjamin Wright and Dr Leo Sheck. Picture by Godfrey Boehnke (GB)<br />

Arthur Thomas Paterson Scholarship—Dr Leo<br />

Sheck<br />

Auckland Eye’s Dr Sarah Welch, the current<br />

clinical director of ophthalmology at<br />

Greenlane Clinical Centre, specialising in<br />

medical and surgical retina, presented the<br />

Arthur Thomas Paterson Postgraduate<br />

Scholarship to Dr Leo Sheck. The<br />

scholarship supports a vocational trainee<br />

in ophthalmology to pursue a fellowship<br />

overseas.<br />

In presenting the award Dr Welch said it<br />

was a pleasure having Dr Sheck as a registrar<br />

in the department and that he’s been a<br />

great asset. Dr Sheck is going to Moorfields<br />

Eye Hospital in London to study genetic eye<br />

diseases, in particular retinal dystrophies and<br />

electrophysiology and diagnostics. All areas<br />

of great need in the country and within the<br />

Auckland district, said Dr Welch.<br />

In his citation, Dr Sheck said at Moorfields<br />

he’d be working with Professor Graham<br />

Holder, a well-recognised international expert<br />

in electrodiagnostics, while his supervisor<br />

will be Professor Michel Michaelides, an<br />

international expert in retinal dystrophies.<br />

Eye Institute Summer Studentship—Andy<br />

Kim<br />

Eye Institute ophthalmologist and patron of<br />

the Buchanan Ocular Therapeutics Unit at<br />

Auckland Unversity Dr Trevor Gray, presented<br />

the Eye Institute Summer Studentship award<br />

to third year medical student Andy Kim.<br />

Kim conducted a comprehensive literature<br />

review over the summer on Demodex<br />

blepharitis under the supervision of Associate<br />

Professors Jennifer Craig and Trevor Sherwin.<br />

The aim of his project was to review the<br />

current knowledge on Demodex mites and<br />

Demodex blepharitis with the intention<br />

of identifying molecules which could be<br />

uniquely and readily expressed by Demodex<br />

mites. It was also a pre-cursor to Kim’s<br />

honours project to develop a diagnostic test<br />

for ocular demodicosis.<br />

Retina New Zealand Summer Studentship—<br />

Benjamin Wright<br />

Frazer Alexander, president of Retina New<br />

Zealand, presented the Retina NZ Summer<br />

Studentship award to fifth year medical<br />

student Benji Wright.<br />

Wright undertook a summer studentship<br />

Characterising Cystic Maculopathy in<br />

Inherited Retinal Disease, funded through<br />

Retina New Zealand and supervised by<br />

Retina Specialists’ ophthalmologist Dr<br />

Andrea Vincent, who he worked with in the<br />

Greenlane Clinicical Centre.<br />

During the summer studentship Wright<br />

determined the incidence of cystic<br />

maculopathy in a number of inherited<br />

retinal diseases, identified from the NZ<br />

Database of Inherited Retinal Disease. He<br />

reported on the differing incidences of cystic<br />

changes between autosomal dominant,<br />

autosomal recessive and x-linked retinitis<br />

PhD research presenter Yeri Kim and Professor<br />

McGhee entertain the audience. Picture by GB<br />

Naveed Yasin, Raul Ayala and Priyanka Agarwal<br />

Clare Wu and Dr Bruce Hadden share a laugh<br />

during the prize giving. Picture by GB<br />

pigmentosa. He also investigated the rates<br />

of response to carbonic anhydrase inhibitor<br />

treatment in patients who have developed<br />

cystic maculopathy, and correlated this with<br />

their genetic cause, in order to ascertain the<br />

likelihood of successful treatment.<br />

Tom Cat Trust Summer Studentship—Clare<br />

Wu<br />

Associate Professor Bruce Hadden presented<br />

the Tom Cat Trust Summer Studentship award<br />

to third-year medical student Clare Wu.<br />

Supervised by Associate Professor Trevor<br />

Sherwin and Jane McGhee, Wu researched<br />

stem cell proliferation, migration and<br />

differentiation of excised limbal tissue verses<br />

neurospheres. The cell sources were seeded<br />

onto amniotic membranes then placed on<br />

donated human cornea for varying time<br />

periods. She found neurospheres proliferated<br />

and migrated more favourably than their<br />

limbal tissue explant counterparts, informing<br />

future treatment options for patients with<br />

limbal stem cell deficiency.<br />

Ombler Trust Summer Studentship—Eileen<br />

Song<br />

Dr Andrea Vincent presented the final<br />

Summer Studentship Award, the Ombler<br />

Trust Award, to third-year medical student<br />

Eileen Song.<br />

Under Dr Vincent’s supervision, Song<br />

characterised the nature and spectrum of<br />

X-linked inherited retinal disease within<br />

New Zealand. Using the Inherited Retinal<br />

Disease Database, she identified individuals<br />

with X-linked disease and investigated the<br />

correlation between their clinical features,<br />

disease in females and the genetic test<br />

results. Results from her project show<br />

9.26% of patients from the Inherited Retinal<br />

disease Database harbour a diseasecausing<br />

mutation in a retinal gene on the X<br />

chromosome. The population studied also<br />

contained several families where the obligate<br />

female carriers were as severely affected<br />

phenotypically as the affected male family<br />

members, challenging the conventional<br />

concept that female carriers have a later<br />

onset and a milder course of disease than<br />

affected males. The study highlighted the<br />

importance of local knowledge in order to<br />

optimise management and treatment, said<br />

Dr Vincent. ▀<br />

4 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong>

IT’S TIME TO PLAY...<br />



With a market shortage of optometrists in both Australia and New Zealand, alongside a goal<br />

of further growth from Specsavers franchise partners in <strong>2016</strong>, we’re taking a new<br />

approach to boosting our optometry team – and everyone can benefit.<br />

For the months of <strong>Apr</strong>il and May, every optometrist you refer to our recruitment<br />

teams – who subsequently joins us as a locum, as a partner or in an employed role<br />

- will earn a ‘Refer a Friend’ payment. Depending on the location<br />

and role taken up, payments you are eligible for range from $1000 to $50,000!<br />

And here’s a tip – if you’re really up for it and refer yourself, you’ll still be<br />

entitled to claim your referral payment…<br />

To find out more and to explore the Terms and Conditions associated with this<br />

industry-wide offer, contact Carly Parkinson on +61 478 201 057 or<br />

carly.parkinson@specsavers.com – or visit spectrum-blog.com.<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

Franchise<br />

Innovation<br />

Award<br />

2015<br />

NZ Franchise<br />

System of<br />

the Year<br />

2014<br />

Retail<br />

Innovator<br />

of the Year<br />

2014<br />

Multichannel<br />

Retailer<br />

of the Year<br />

2014<br />

Roy Morgan<br />

Research<br />

No. 1 for eye tests<br />

2014<br />

FCA International<br />

Franchisor<br />

of the Year<br />

2014<br />

FCA Social<br />

Responsibility<br />

Award<br />

2014<br />

FCA Established<br />

Franchisor<br />

of the Year<br />

2013<br />

FCA Excellence<br />

in Marketing<br />

Award Winner<br />

2013<br />

Australian<br />

Retailer<br />

of the Year<br />

2013<br />

<strong>Apr</strong>il <strong>2016</strong><br />



New 3 point test<br />

for teachers<br />

Albany optometrist Stuart<br />

Warren has developed a 3<br />

Point Check Test for school<br />

teachers to administer to determine<br />

if near vision problems may be<br />

contributing to learning difficulties.<br />

Warren, an advocate for students<br />

with dyslexia, developed the test<br />

from his experience treating young<br />

patients whose vision problems<br />

were causing difficulties at school.<br />

“If a child has a learning problem, but passes the school screening<br />

test, teachers assume their vision is fine. But in reality there may<br />

still be a near vision problem. Over the past 10 years there have<br />

been quite a few studies to support the idea that the prevalence<br />

of near-vision problems is quite high especially if there is a<br />

background of learning difficulties.”<br />

Warren’s 3 Point Check Test assesses if a child’s near vision is<br />

clear, single and steady, which Warren refers to as the “near visual<br />

platform”. It measures amplitudes of accommodation, convergence<br />

and asks students if letters appear to be “jumping or moving” on<br />

the page--an indicator of visual stress. This latter symptom can be<br />

assessed with tinted lenses based on those used in controlled trials<br />

by the Dyslexia Research Trust at Oxford University.<br />

Warren says he is planning to sell his test as a kit for teachers, but<br />

is also making it available to optometrists. “I’m currently working<br />

with a small handful of schools. I was invited to speak to a group<br />

of teachers at the end of last year and I discussed the 3 Point Check<br />

Test and they were very positive about it. Some of the teachers<br />

were surprised because they never considered that near-vision<br />

could be a problem.”<br />

Warren says one school he worked with arranged for a dozen<br />

students with known learning difficulties to be screened and found<br />

that four of them had previously unidentified near-vision problems.<br />

The test is designed for children aged seven to 17 and can be<br />

conducted by a trained teacher in less than a minute.<br />

Children with near-vision problems may have difficulties<br />

with reading accuracy and fluency or they may have difficulty<br />

concentrating in class. Warren says he frequently uses a<br />

questionnaire that he sends out to parents and teachers to identify<br />

any correlation between vision and learning. A common symptom<br />

that appears in the questionnaire is a child’s inability to keep their<br />

place in a text. “They’re not able to allocate attention to the task of<br />

learning,” he says.<br />

Warren’s interest in behavioural optometry and helping patients<br />

with learning difficulties, led him to develop the kit. But one<br />

particular patient he saw in early 2015 was instrumental in creating<br />

the test: an eight-year-old boy who was on reading recovery for 18<br />

months and was even taken to a psychologist to determine other<br />

reasons for his reading difficulty. “When I tested the patient, I found<br />

he couldn’t converge at all, which really surprised the parents. These<br />

kinds of problems are all too common, so it makes sense to have a<br />

near screening test out there. It could solve a lot of problems.”<br />

After selling his practice, Warren is now working at Albany<br />

Optometrists and is building a number of tools for schools and<br />

optometrists to help students with learning problems including<br />

a video to demonstrate the 3 Point Check Test. For more visit his<br />

website at http://icept.co.nz. ▀<br />

See the light,<br />

not the UV<br />

Australian<br />

researchers<br />

have developed<br />

a nanoscale device<br />

that is able to filter<br />

specific colours from<br />

light. Researchers<br />

at RMIT University<br />

and the University<br />

of Adelaide have developed a stretchable material able to<br />

manipulate light while remaining transparent. Using artificial<br />

crystals known as dielectric resonators that are just 100 nm to<br />

200 nm in size, the material could be used to make contact lenses<br />

that prevent harmful rays—such as UV light—from penetrating<br />

the eye.<br />

Right now, dielectric resonators only work with specific colours,<br />

but because the scientists were able to build the material to be<br />

elastic, they were able to control the properties of the surface and<br />

filter out more colours. When combined with other advances in<br />

technology, the result could be a smart contact lens that protects<br />

the eye while gathering and transmitting live data—like a tiny<br />

version of Google Glass.<br />

“With this technology, we now have the ability to develop<br />

light weight wearable optical components, which also allow for<br />

the creation of futuristic devices such as smart contact lenses<br />

or flexible ultrathin smartphone cameras,” said lead author and<br />

RMIT researcher Dr Philipp Gutruf.<br />

The paper, Mechanically tunable dielectric resonator<br />

metasurfaces at visible frequencies, was published in the journal<br />

ACS Nano. ▀<br />

A review of ocular coherence<br />

tomography angiography<br />



Optical coherence tomography (OCT)<br />

has evolved over the past decade as<br />

one of the most important ancillary<br />

tests in ophthalmic practice. The technology<br />

was first developed in 1991 and the first<br />

clinical application reported in 1994 for the<br />

investigation of macular disease. 1, 2<br />

The first iteration time-domain OCT had<br />

both speed and sensitivity issues that<br />

limited its accuracy, reliability, and efficiency.<br />

These limitations were supplanted by the<br />

introduction of spectral-domain OCT (SD-OCT)<br />

systems, which used spectral interferometry<br />

and Fourier analysis. This allowed image<br />

acquisition 50 to 100 times faster than timedomain<br />

technology with a subsequent and<br />

dramatic improvement in quality.<br />

Optical coherence tomography angiography<br />

(OCTA) is a new non-invasive approach to<br />

diagnostic imaging in retinal disease. It<br />

identifies blood vessels because the blood<br />

flowing through them causes the reflected<br />

OCT signal to vary slightly on consecutive<br />

scans, since it is moving and altering rather<br />

than staying still like the rest of the eye,<br />

and can generate angiographic images in a<br />

matter of seconds. 3, 4 It is a new technique<br />

that enables us to image yet another<br />

anatomic structure of the eye with OCT, this<br />

time the vasculature.<br />

Previously the “gold standard” investigation<br />

for diagnosis of retinal vascular disease has<br />

been “injected dye” angiography. Standard<br />

angiography allows for dynamic visualisation<br />

of blood flow with a wide field of view.<br />

Patterns of dye leakage, pooling, and staining<br />

can be appreciated, thus allowing diagnosis<br />

of pathology. Fluorescein angiography (FA)<br />

and indocyanine green angiography (ICGA)<br />

are, however, invasive tests that require<br />

intravenous administration of dye and<br />

imaging of 10–30 minutes.<br />

Standard angiography does of course have<br />

limitations; retinal pathology can be obscured<br />

by leakage, hemorrhage and media opacities.<br />

Also, the images provided are also twodimensional,<br />

hence one cannot distinguish<br />

between blood vessels at different depths<br />

within the retina. FA and ICGA have other<br />

drawbacks that can limit their widespread<br />

use. They are invasive, relatively expensive,<br />

and time-consuming, consequently they are<br />

not ideally suited for use on a regular basis<br />

in a busy clinical setting. Although very safe,<br />

the dyes pose risks ranging from nausea to<br />

allergic reactions, including anaphylaxis in<br />

rare instances. 5 Indocyanine green dye is also<br />

contraindicated in pregnancy and kidney<br />

disease.<br />

OCTA, in comparison, is a non-invasive<br />

technique that acquires volumetric<br />

angiographic information without the use of<br />

dye. Each three-dimensional scan set takes<br />

approximately six seconds to obtain. Enface<br />

images (OCT angiograms) can then be<br />

scrolled outward from the internal limiting<br />

membrane (ILM) to the choroid to visualise<br />

the individual vascular plexus and segment<br />

the inner retina, outer retina, choriocapillaris<br />

or other area of interest. In fact the 3 × 3 mm<br />

OCT angiograms appear to be of equivalent<br />

if not a higher resolution than the currently<br />

available FA/ICGA images. 6<br />

Exact delineation and size measurements<br />

can be performed for pathology such as<br />

choroidal neovascularisation (CNV) in “wet”<br />

age-related macular degeneration (AMD).<br />

OCTA also demonstrates changes in the<br />

choriocapillaris surrounding CNV lesions.<br />

Some of these changes are thought to occur<br />

prior to CNV development, which means that<br />

we may be able to identify patients who are at<br />

risk of developing wet AMD. 7<br />

OCTA has been used to assess optic nerve<br />

head perfusion in glaucoma. OCTA of<br />

glaucomatous optic nerves demonstrated a<br />

significant decrease in blood flow compared<br />

with controls. A correlation between blood<br />

flow in the disc and visual field pattern<br />

standard deviation was observed, implying an<br />

association between decreased perfusion of<br />

the optic disc and glaucoma severity. 8<br />

As well as AMD and glaucoma, OCTA<br />

reveals the vascular changes (impaired<br />

capillary perfusion, microaneurysm turnover,<br />

and quantification of blood flow) seen in<br />

conditions such as diabetic retinopathy, retinal<br />

vein occlusions and macular telangiectasia.<br />

Of course there are some limitations to<br />

OCTA. The area visualised is much smaller<br />

than with angiography, typically commercially<br />

available machines visualise a 6 x 6 mm<br />

area compared to the 200 degree imaging<br />

now available with wide angle FA and the<br />

leakage of dye is not appreciable making<br />

conditions such as chronic central serous<br />

chorioretinopathy difficult to diagnose.<br />

Conclusion<br />

We have been fortunate enough to have<br />

the AngioPlex OCT angiography upgrade on<br />

the Zeiss Cirrus HD-OCT at Eye Institute for<br />

the last two months. The technology has<br />

been incredibly useful for the assessment<br />

and treatment of patients with retinal<br />

Eye Institute appoints CEO<br />

Eye Institute has appointed a chief<br />

executive officer to spearhead the<br />

company’s future.<br />

Dr David Fitzpatrick-Cockram brings<br />

both the knowledge and expertise to<br />

take Eye Institute to the next chapter of<br />

its development as the practice has now<br />

reached a size where it will benefit from<br />

being professionally led, said Dr Peter Ring,<br />

one of Eye Institute’s original co-founding<br />

ophthalmologists. “It’s an exciting step. He<br />

will be able to bring a wealth of personal<br />

experience in the health care world to help<br />

Eye Institute to continue to stand out as an<br />

ever-improving provider of exceptional eye<br />

care.”<br />

In Auckland, as well as its flagship premises<br />

in Remuera, Eye Institute runs fullyfunctioning<br />

surgical and clinical facilities in<br />

Manukau and North Shore, with satellite<br />

clinics in New Lynn and St. Heliers.<br />

“We were seeking someone with<br />

exceptional qualities. We have found that<br />

in David. He will be able to help guide us<br />

Fig 1. This OCTA image shows<br />

ischaemia superior to the<br />

fovea in a superotemporal<br />

branch retinal vein occlusion.<br />

No amount of avastin will<br />

be able to bring the vision<br />

back in this ischaemic area<br />

Fig 2. Telangiectatic vessels<br />

can be seen temporal to the<br />

fovea in this patient with<br />

juxtafoveal telangiectasis<br />

Fig 3. A choroidal neovascular<br />

membrane can be<br />

identified in this image,<br />

colour coded by depth<br />

disease. Importantly<br />

OCTA has minimal,<br />

if any, impact on the<br />

amount of time that<br />

the patient spends in<br />

the clinic and reduces<br />

the need for further<br />

appointments for<br />

FA and ICG. We have<br />

access to immediate<br />

imaging that can<br />

be used for disease<br />

management.<br />

We realise this technology is still in its<br />

infancy, especially with regards to image<br />

interpretation, so in the present at least<br />

OCTA is not going to replace FA and ICG<br />

entirely, but it will decrease the need for<br />

these tests and will also allow us to provide<br />

a more accurate diagnosis in cases where the<br />

risk and inconvenience of FA or ICG makes<br />

us reluctant to use those techniques. The<br />

illustrated cases show that it is turning out<br />

to be a very valuable and frequently used<br />

adjunct for Eye Institute. ▀<br />

References<br />

1. Huang D, Swanson EA, Lin CP, et al. Optical coherence<br />

tomography. Science. 1991;254 (5035):1178-1181<br />

2. Imaging of macular diseases with optical coherence<br />

tomography. Puliafito CA, Hee MR, Lin CP, Reichel<br />

E, Schuman JS, Duker JS, Izatt JA, Swanson EA,<br />

Fujimoto JG. Ophthalmology. 1995 Feb;102(2):217-29<br />

3. Kim DY, Fingler J, Zawadzki RJ, Park SS, Morse<br />

LS, Schwartz DM, et al. Optical Imaging of the<br />

chorioretinal vasculature in the living human eye.<br />

Proc Natl Acad Sci. 2013;110:14354–9<br />

4. Spaide RF, Klancnik JM, Cooney MJ. Retinal Vascular<br />

Layers Imaged by Fluorescein Angiography and<br />

Optical Coherence Tomography Angiography. JAMA<br />

Ophthalmol. 2014; E1-6.<br />

5. Kwiterovich KA, Maquire MG, Murphy RP, Schachat<br />

AP, Bressler NM, Bressler SB, et al. Frequency<br />

of adverse systemic reactions after fluorescein<br />

angiography. Results of a prospective study.<br />

Ophthalmology. 1991;98:1139–42<br />

6. Matsunaga D, Puliafito CA, Kashani AH. OCT<br />

Angiography in Healthy Human Subjects.<br />

Ophthalmic Surg Lasers Imaging Retina.<br />

2014;45(6):510–5<br />

7. Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ,<br />

et al. Quantitative Optical Coherence Tomography<br />

Angiography of Choroidal Neovascularization in<br />

Age-Related Macular Degeneration. Ophthalmology.<br />

2014;121:1435–44<br />

8. Jia Y, Wei E, Wang X, et al. Optical coherence<br />

tomography angiography of optic disc perfusion in<br />

glaucoma. Ophthalmology. 2014;121(7):1322-1332<br />


* Dr Shanu Subbiah is a refractive cataract surgeon,<br />

with dual fellowship training in both retinal and<br />

corneal disease. He’s involved in clinical research<br />

into macular degeneration and retinal disease and is<br />

actively involved in teaching.<br />

Dr Peter Hadden is a refractive-cataract and retinal<br />

surgery specialist and a clinical senior lecturer in<br />

ophthalmology at the University of Auckland. He’s<br />

involved in several research programmes and has<br />

published more than six papers.<br />

Both are consultant ophthalmologists with Eye<br />

Institute.<br />

Dr Trevor Gray, Barbara Hare and Dr Peter Ring<br />

welcome new CEO Dr David Fitzpatrick-Cockram<br />

(second from left)<br />

to provide a level of service and excellence<br />

in eye care that’s unmatched by others,”<br />

said Dr Trevor Gray. “David’s experience as<br />

both a provider and a procurer of healthcare<br />

services gives him a unique insight into<br />

healthcare management.”<br />

Dr Fitzpatrick-Cockram has more than 25<br />

years of clinical training and experience,<br />

including qualifications in healthcare<br />

leadership from Yale University and post<br />

graduate qualifications in strategy and<br />

innovation from the University of Oxford.<br />

Prior to coming to New Zealand in 2013, the<br />

South African-born Dr Fitzpatrick-Cockram<br />

was director of innovation, director of mental<br />

health and professional lead for clinical<br />

psychology for the NHS in the UK. More<br />

recently he was the senior clinical lead at<br />

Southern Cross Health Society.<br />

Dr Fitzpatrick-Cockram said he was both<br />

delighted to have returned to the warmth of<br />

the Southern hemisphere and to be joining<br />

a leading ophthalmological practice like<br />

Eye Institute. “I have a passion for patientcentred<br />

excellence in healthcare and Eye<br />

Institute is the perfect place for me to<br />

contribute to New Zealand ophthalmology<br />

with such an amazing group of surgeons and<br />

the fantastic team that supports them.”<br />

Eye Institute general manager Barbara Hare<br />

will be assisting Dr Fitzpatrick-Cockram with<br />

the running of the practice and with project<br />

management under the new title of chief<br />

operating officer. ▀<br />

6 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong>

Making the revolutionary, routine.<br />

CIRRUS HD-OCT with AngioPlex<br />

// ANGIOPLEX<br />


NEW<br />

ZEISS AngioPlex OCT Angiography<br />

Introducting All-New Technology<br />

Ultra-clear visualisation of microvascular blood flow using non-invasive CIRRUS OCT Angiography<br />

New vascular information<br />

• Ultra-clear 3D microvascular visualisations powered by OMAG C<br />

• OMAG C - the proprietary processing technique that detects motion of red-blood<br />

cells within sequential OCT B-scans performed repeatedly at the same location<br />

• Depth of retinal vasculature colour coded for ease of visual assessment<br />

Enhanced workflow<br />

• Ideal non-invasive, dye-free angiography<br />

• Single-Scan simplicity: capture OCT angiography with just one scan<br />

• Real-time tracking with FastTrac ensures artifact-free scans and precise<br />

location identification during follow-up visits<br />

ZEISS<br />

Ph: 1800 882 041 (AU)<br />

Ph: 0508 765 271 (NZ)<br />

med.au@zeiss.com<br />

<strong>Apr</strong>il <strong>2016</strong><br />



Auckland Eye celebrates new look<br />

Auckland Eye celebrated the complete<br />

refurbishment, expansion and<br />

modernisation of its headquarters at the<br />

end of February.<br />

Auckland Eye doctors and new chief executive<br />

Dr David Pendergrast, Arrow’s Mario Cross, Tracey Molloy,<br />

John Kelsey and Nia Stonex<br />

Peter Stoute with Drs Brian Kent-Smith and Hussain Patel<br />

Visionz<br />

With just over six months to go<br />

before New Zealand’s Premier Optical<br />

Event, Visionz <strong>2016</strong> opens its doors, it’s<br />

time to get organised and plan your visit.<br />

We hope 60 exhibitors will commit to Visionz<br />

<strong>2016</strong> which is being held in Auckland October<br />

14th - 16th October.<br />

WHERE<br />

Ellerslie Events Centre Ellerslie Auckland.<br />

Newmarket & Pakuranga Hunt Club Rooms<br />

WHEN<br />

Friday 14th October - 9.00am -6.00pm<br />

Saturday 15th October - 9.00am – 6.00pm<br />

Sunday 16th October - 9.30am -1.00pm<br />

<strong>2016</strong><br />

2014<br />


Education is one of the foundation elements of any good industry<br />

exhibition and at Visionz <strong>2016</strong> delegates have the opportunity to earn<br />

CPD and general points. Further details to follow.<br />


There is no charge for admission for all optical practitioners, practice<br />

managers, optical staff or students from the Auckland school of<br />

Optometry to the trade exhibition.<br />

For more Information, please contact: Gary Edgar at nzowa@live.com<br />

Registration details to follow.<br />

GRAND OPENING – 23 SEPT. <strong>2016</strong><br />

Deb Boyd, and the organisation’s former CEO<br />

Moira McInerney—who started the destruction<br />

and construction process, were joined by others<br />

involved in the project, including representatives<br />

from architects Jasmax and construction company<br />

Arrow, a host of optometrists, eye care company<br />

representatives and other special guests. All<br />

were invited to raise a glass to the new building<br />

and celebrate the end of the “noise, dust and<br />

disturbance” of the past several months.<br />

Dr Stephen Best and Dr David Pendergrast<br />

thanked attendees for their patience with their<br />

patients and support during the process, as<br />

the practice moved its clinic from one part of<br />

the building to another to maintain services<br />

throughout the duration of the project.<br />

Today the practice is larger and lighter, with more<br />

consulting rooms, waiting rooms and staff areas; a<br />

better flow between areas; no more leaky building<br />

concerns; and a whole new “less clinical” look and<br />

feel, explained Dr Pendergrast. What was two quite<br />

distinct buildings have now been joined into one,<br />

unified in their design, and related to Auckland Eye’s<br />

Oasis Surgical building, with the same external<br />

cladding, gable angles and through the use of<br />

external metal screens, which modify light entry<br />

and give the building a contemporary design. Dr<br />

Pendergrast joked there had been some arguments<br />

as to what the screens’ design represented. “They<br />

are endothelial cells from my point of view, but<br />

others say they are retinal epithelial cells, but we<br />

are decided they are cells of the eye.”<br />

Silmo Sydney<br />

partners<br />

with NRA<br />

New Australasian optical fair<br />

Silmo Sydney announced it will<br />

include an Independent Retailers<br />

Conference, which will be organised in<br />

partnership with the Australian National<br />

Retail Association (NRA).<br />

“The most successful trade shows are<br />

those which meet the needs of buyers and<br />

match them to sellers. The key is to present<br />

the right mix aligned to a common goal;<br />

it’s all about the balance,” said Gary Fitz-<br />

Roy, managing director of Silmo Sydney<br />

exhibition organisers Expertise Events.<br />

The Independent Retailers Conference<br />

programme will enable practitioners<br />

to pick up valuable retailing ideas that<br />

can have real impact and would not<br />

normally be available to them, said<br />

Fitz-Roy. “Quite often the industry is<br />

so focused on their practices that the<br />

behind-the-scenes every day running<br />

of the business doesn’t get the focus it<br />

should and it’s these aspects that can<br />

greatly affect profitability, such as leases,<br />

law and specific retailing training such as<br />

merchandising.<br />

“Our programme will run on the show<br />

floor and be made up of small concise<br />

sessions and visitors will have the<br />

opportunity to sit one-on-one with NRA<br />

specialists to discuss specifics.”<br />

Phillippa Pitcher, Naomi Meltzer and Dr Sarah Welch<br />

The newly refurbished building is also sustainably<br />

future-proofed with tanks for rainwater collection,<br />

the facility to add solar panels, room to grow and<br />

the ability for the practice to be flexible about how<br />

it uses its new, naturally-lit spaces. “The move to<br />

the reduced paper practice is accelerating, so we<br />

have made sure we have the IT infrastructure to<br />

support this,” said Dr Pendergrast.<br />

The refurbishment also allows space for the<br />

continued growth of Auckland Eye’s research<br />

department, headed by Dr Dean Corbett, while<br />

the increasing number of retinal specialists in the<br />

practice has allowed it to incorporate a dedicated<br />

retinal wing, including a small procedure room.<br />

“Tonight we wanted to say publicly that we are<br />

done and finished and back in business full speed,”<br />

summarised Dr Pendergrast. “And we have got to<br />

the finish line of what I think is an excellent<br />

result.” ▀<br />

In the same announcement, Silmo Sydney<br />

also announced that its official charity will<br />

be the Australian Royal Institute for Deaf<br />

and Blind Children (RIDBC). Funds will be<br />

donated to them from the exhibition and<br />

the organisation will have a presence at<br />

the show. “Children are our future and this<br />

is an extremely worthy cause. More than<br />

1 in 2,500 children in Australia have vision<br />

loss, there has been a 100% increase in<br />

vision-impaired children enrolled in RIDBC<br />

programmes in the last seven years,” said<br />

Fitz-Roy.<br />

“We promised to push the boundaries<br />

and create a world class event that<br />

unites the key market players and adds<br />

value to buyers. The involvement of NRA<br />

certainly adds real value and clout to the<br />

overall event; we are excited by what we<br />

have announced so far, but expect more<br />

exciting announcements soon. We have<br />

only just begun outlining our plans for<br />

SILMO Sydney.”<br />

Fitz-Roy said currently stand bookings<br />

are strong and Expertise Events was<br />

looking forward to hosting the Silmo Paris<br />

organising team in early <strong>Apr</strong>il when they<br />

come to conduct a site visit of the new<br />

Darling Harbour Centre.<br />

Silmo Sydney is set to take place from<br />

March 9-11. ▀<br />

ACBO runs<br />

basics seminar<br />

Optometrists from around New Zealand<br />

attended a seminar to learn about<br />

integrating behavioural optometry<br />

methods within their existing practice.<br />

Workshop leader Adrian Bell with ABCO member Keith<br />

Miller and CR Surfacing’s Steph Court and Lynton Dodge<br />

The Australian College of Behavioural<br />

Optometrists Kickstarter Seminar on February 21<br />

featured presentations and workshops by Adrian<br />

Bell, a Sunshine Coast-based optometrist with 30<br />

years’ experience in the field.<br />

The course was designed for new ACBO<br />

members or others getting started in Behavioural<br />

Optometry. In addition to a dinner, sponsored by<br />

CR Surfacing, attendees were taken on a step-bystep<br />

look at behavioural examinations, testing,<br />

decision-making and prescribing. It was also a reintroduction<br />

to near retinoscopy, an under-utilised<br />

tool, according to organisers.<br />

“This course is enough to make people start<br />

thinking and prescribing in different ways,” said<br />

Keith Miller, ACBO’s New Zealand director. “It’s<br />

using the tests they’re already doing but looking<br />

at the results in a slightly different manner.<br />

They’re learning new ways and getting a better<br />

understanding of using the retinoscope for<br />

investigating what a person is doing with their<br />

visual system when they’re, say, reading.”<br />

Bell took the group through an afternoon session<br />

that ended in a workshop on the retinoscope.<br />

“Retinoscopy is one of those things that some<br />

people think we don’t need any more. But I will<br />

encourage you to get your ret out, charge it, blow<br />

off the dust, because it’s a great way of observing<br />

vision, in a dynamic sense.”<br />

Bell said the retinoscope provides a dynamic view,<br />

over time, of where patients are focusing and even if<br />

they are paying attention. He also discussed methods<br />

for using the retinoscope with younger patients.<br />

“Remember your refraction is a subjective<br />

test. Retinoscopy is much more objective. You’re<br />

directing attention to a particular place, but you’re<br />

more in control. It’s objective, real-time and it’s<br />

dynamic. The focus moves, the eyes move, the<br />

reflex moves.”<br />

Feedback from the 27 attendees was positive,<br />

said Miller. If optometrists wanted to pursue<br />

behavioural optometry and earn certification,<br />

they can attend additional seminars offered over<br />

the year. March’s Practical Vision Therapy NZ -<br />

Workshop 1 with New Zealand optometrist Evan<br />

Brown was sold out.<br />

“There really are not enough behavioural<br />

optometrists in New Zealand,” Miller said. “With<br />

one-in-five children suffering a vision-related<br />

problem that can interfere with their learning,<br />

there’s a lot that could be done. But if all those<br />

children came to a behavioural optometrist for<br />

examination and vision care, we couldn’t cope.<br />

But [they] aren’t seeking help because they don’t<br />

know; nobody is offering them the appropriate<br />

levels of care.” ▀<br />


23> 26 SEPT. <strong>2016</strong><br />


Conception : CARLIN<br />


Neuro-ophthalmology evening from CVRT<br />


The first Capital Vision Research<br />

Trust (CVRT) education event for<br />

<strong>2016</strong> was themed around neuroophthalmology.<br />

Many optometrists and<br />

ophthalmologists feel less confident dealing<br />

with neuro-ophthalmic complaints because<br />

the cause of the problem is not usually visible<br />

with the slit lamp. The presenters were fellow<br />

Wellington neuro-ophthalmologist Dr Neil<br />

Aburn and myself.<br />

I started with a talk on abnormalities<br />

of the pupil, where I discussed various<br />

physiological and pathological aspects from<br />

the interesting melanopsin ganglion cells,<br />

to tips on examining pupils and measuring<br />

a relative afferent pupil defect (RAPD),<br />

causes of light-near dissociation, and a<br />

number of cases of anisocoria.<br />

Dr Aburn presented on optic neuropathies<br />

with a great range of varied cases to<br />

demonstrate the crucial principles about<br />

how the history guides the differential<br />

diagnosis and investigation. Among<br />

the interesting cases were both the<br />

common and bizarre, from urgent medical<br />

emergencies to gradual inherited problems.<br />

Our sponsor OptiMed made a brief<br />

presentation on the scanning laser<br />

ophthalmoscope called Eidon, which takes<br />

wide-field retinal images without dilation.<br />

I then presented another talk on diplopia,<br />

with cases to illustrate several important<br />

principles and some of the important<br />

patterns to recognise. Cases of monocular<br />

diplopia, cranial nerve palsies, myasthenia<br />

and orbital disease were covered, with<br />

emphasis on red flags. Both Dr Aburn and<br />

I tried to use plenty of case studies and<br />

questions to stimulate thought and draw<br />

feedback from the participants and to<br />

highlight the underlying principles and safety<br />

issues of these challenging presentations.<br />

Other CVRT education event dates for<br />

Wellington in <strong>2016</strong> are: Wednesday <strong>Apr</strong>il<br />

25, Wednesday August 24 and Thursday<br />

December 1. For more information, please<br />

visit www.capitalvision.org.nz or email<br />

info@capitalvision.org.nz. ▀<br />


* Dr Jesse Gale is an ophthalmologist with Capital &<br />

Coast District Health Board and Capital Eye Specialists<br />

in Wellington. He is a new board member at Capital<br />

Vision Research.<br />

8 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong>


After nearly two years of building,<br />

refurbishment, expansion and<br />

modernisation, Auckland Eye is delighted<br />

to announce the completion of our new<br />

and improved St Marks Road site.<br />

Welcome to the future of ophthalmic care<br />

Now finished, our new development reinforces<br />

Auckland Eye’s position as a state-of-the-art<br />

consulting facility, allowing us to accommodate<br />

future technological developments as they arise, in this<br />

highly specialised and fast-moving field.<br />

A better working environment<br />

We hope patients will enjoy the new look clinic as much as<br />

our doctors and staff do. With more consulting rooms, new<br />

examination equipment and allocated space for dedicated<br />

services like our research department headed by Dr Dean<br />

Corbett, it’s a win-win for everyone concerned.<br />

A new vision for all<br />

We believe everyone will benefit from what has been a<br />

ground-up refurbishment. Our patients remain our first<br />

priority. They will enjoy the welcoming atmosphere, the<br />

new and modernised waiting areas and facilities, enhanced<br />

by the use of natural light throughout the practice –<br />

designed to provide a better overall patient experience.<br />

Our doctors and support staff will continue to provide<br />

their expertise and perform their vital roles as ever, in<br />

a centre purposely designed for ophthalmology in the<br />

21st century.<br />

Design with focus<br />

The new clinic design unifies the two previously very<br />

different parts of the building and integrates us perfectly<br />

with our premier day-stay centre, Oasis Surgical.<br />

The new front site houses our dedicated retinal suite, designed<br />

to allow the team to provide the specialised care that patients<br />

with medical and surgical retinal problems require. The previous<br />

Auckland Eye building has been extended to cater for all eye<br />

care needs, with all areas benefitting from a modernised look<br />

and feel. Exterior cladding and external screens blend the two<br />

parts of the practice together seamlessly.<br />

Sustainability and<br />

future-proofing<br />

Wherever possible, we have incorporated sustainable<br />

technology into our new design. This includes tanks for<br />

rainwater re-use, high performance insulation, double-glazing<br />

and the facility to add solar panels in the near future.<br />

See our lives change<br />

So here’s to the new look Auckland Eye. We’d like to say<br />

thank you to everyone involved in the refurbishment – not<br />

least our patients who have been very understanding with the<br />

disruptions; our development partners who have done such<br />

an outstanding job and of course to you, our referrers, who<br />

have continued to support us throughout.<br />

With the move towards a paper-reduced practice accelerating,<br />

we have also made sure we have the IT infrastructure in place<br />

to support this, including dedicated server rooms, UPS, data<br />

cabling and upgradeable and expandable hardware.<br />

www.aucklandeye.co.nz<br />

<strong>Apr</strong>il <strong>2016</strong><br />



Photo by ACBO’s Kickstarter Seminar keynote, optometrist Adrian Bell<br />

Great day for MDNZ<br />

Macular Degeneration NZ hosted the<br />

third annual charity race day on<br />

February 20. The summer sun shone,<br />

360 guests filled the Guineas Ballroom at the<br />

Ellerslie Racecourse in Auckland—dressed in<br />

their “race day best”—and everyone had a<br />

wonderful time.<br />

“We are very grateful for the ongoing support<br />

from New Zealand’s ‘eye world’ for this annual<br />

event as without them there simply would be<br />

no event,” said Philippa Pitcher, MDNZ general<br />

manager.<br />

In her welcoming address Dr Dianne<br />

Sharp, MDNZ chair and Retina Specialists’<br />

ophthalmologist, told race day guests of<br />

the revolution over the last few years in the<br />

treatment of macular degeneration, even for<br />

the most severe cases, and the ability today to<br />

deliver amazing results for people who would<br />

otherwise experience significant troubles and<br />

hardship. Timing is critical, she said, and MDNZ<br />

is working to seize this opportunity to save sight<br />

by raising awareness and ensuring good access<br />

to treatment for everyone across the country.<br />

Race day guests were treated to a superb<br />

buffet lunch, a great day of racing and a brilliant<br />

selection of goodies in the auctions and raffles.<br />

Many also took up the opportunity to get even<br />

closer to the action through the exciting race<br />

day experiences. People went home very happy<br />

whether they won or lost, said Pitcher, with<br />

many enjoying the additional compensation of a<br />

surprise bottle of wine to take home when their<br />

“losing ticket” was drawn and became a winner<br />

after all.<br />

MDNZ Ambassadors Sir Colin Meads, John<br />

Adshead and Viv Jones joined guests on the day,<br />

while others were there in spirit if not person<br />

(due to other commitments) by providing<br />

exciting auction items, securing tables of ten or<br />

making other forms of donations. Once again<br />

Sir Colin produced two signed rugby balls to<br />

add to the auction proceeds.<br />

“The day was a great success, raising $45,000<br />

for MDNZ to continue its sight saving work for<br />

which we are very grateful,” said Pitcher. ▀<br />

The <strong>2016</strong> MDNZ 1600 race supporters group<br />

OIC’s Tim Way with Karen and Alan Saks<br />

Richard and Joy Goddard, Kumuda Setty, Chris Aldous and Barbara and Darren Savage<br />

with the winner of the Essilor 1200, Kinagat, and his jockey Chris Johnson<br />

Dr Sarah Welch, Yvonne New, Philip Walsh, Janet Wigmore, Tracey Molloy, Dr Archie McGeorge, Dr Kathryn<br />

Philipson, Lahiru Gunasena and Bethan Rajwer supporting the Auckland Eye Avondale Guineas<br />

NZ Optics’ designer Kirsten Newton with her<br />

wonderful hat and new ed. Jai Breitnauer<br />

MDNZ’s fascinator brigade: Sandy Grant, Julie Worsley,<br />

Viv Jones, Sandra Budd and Phillippa Pitcher<br />

OptiMed’s Mokta and Chris Simonson, Kerry and Craig<br />

Norman, and Robert and Karen Nyenkamp<br />

Dr Dianne Sharp, Vicki Lindsay, Julianne Horgan, Zanelle and Neville Angelo<br />

and Drs Narme Deva, Andrea Vincent and Rachel Barnes<br />

Julie Worsley, Dr Ian Elliott and Glenda<br />

Bostwick<br />

Auctioneer Michael Boulgaris, Di Goldsworthy and<br />

“best dressed lady” Paula Farrar<br />

10 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong><br />

Hamilton Eye’s Selma Matloob, Monika Pradhan, Marina Nasmith, Joanna Hood, Sally<br />

Rosenberg and Jena Youdif, backing the Hamilton Eye Clinic 1600<br />

The team from Blackmores, including country manager Deva Dhar (left of banner) with<br />

Saint Emilion, winner of the opening MDNZ 1500 race and the horse’s trainers and owners

oDocs goes commercial,<br />

seeks investment<br />

Innovative New Zealand startup and social<br />

enterprise oDocs Eye Care is rolling out its first<br />

commercial products in <strong>Apr</strong>il.<br />

oDocs (short for OphthalmicDocs) is the<br />

brainchild of registrar Dr Sheng Chiong Hong<br />

and Dr Benjamin O’Keeffe, senior house officer<br />

of ophthalmology at Wellington Eye Clinic. Its<br />

fundamental initiative was the development of<br />

an inexpensive system combining smartphones<br />

with 3D printable attachments to allow accurate,<br />

mobile visual acuity tests, slit-lamp examinations<br />

and retinal imaging with a lens that gives a 50<br />

degree field of view into the back of the eye. Sales<br />

of oDocs’ commercial products will help underwrite<br />

efforts to provide devices to health services in<br />

under-served and remote areas, especially in the<br />

developing world.<br />

To this end the company has launched visoScope,<br />

an upgraded version of its original Fundus product,<br />

and visoClip, a tool for viewing the anterior segment.<br />

“We’ve reduced the Fundus to a simplified form<br />

with a stronger structure and less parts, making it<br />

ultimately more efficient to build, and we’ve evolved<br />

it using better suited manufacturing techniques for<br />

higher quality. The lenses will be included so it will<br />

be ready to go out of the box,” says Hanna Eastvold-<br />

Edwins, oDocs chief executive officer.<br />

Keeping its social ideals at the forefront of the<br />

commercial part of the operation, oDocs is running<br />

a pre-order campaign, where half of the profits<br />

generated will go into research, education and<br />

supply of equipment to those regions most in<br />

need, says Dr Hong.<br />

oDocs will market visoScope and visoClip to<br />

ophthalmologists and optometrists. The products<br />

work with an app that currently runs on iOS<br />

tablets and handsets only. Eastvold-Edwins says<br />

the company will develop an Android app in the<br />

near future.<br />

The commercial products will be targeted at the<br />

New Zealand market first, while the company seeks<br />

approval for commercial sales in overseas markets,<br />

oDocs’ Dr Sheng Chiong Hong accepting a highly<br />

commended award at NZ Innovators <strong>2016</strong> in February<br />

from former Prime Minister Jim Bolger<br />

oDoc’s new visoScope and visoClip<br />

particularly Europe and the Americas. oDocs will<br />

begin to raise investment capital following the<br />

commercial rollout, says Eastvold-Edwins.<br />

“We are self-funded up to this point, but we will<br />

be actively seeking investment. We are hoping to<br />

attract an investor who understands how these<br />

innovations could impact eye health, not just for<br />

developed markets, but also emerging ones who<br />

really embrace mobile health technology.<br />

“At our core, we are an innovative technical team<br />

working on a medical hardware product with the<br />

potential to go global.”<br />

Eastvold-Edwins says oDocs aims to sell 1,000 kits<br />

this year. The units will be sold online with delivery<br />

expected by third quarter <strong>2016</strong>. Once the company<br />

achieves sustainability, it will develop more<br />

advanced iterations of the product, she says.<br />

To find out more go to www.odocs-tech.com. ▀<br />

New doctor for Christchurch Eye<br />

Christchurch Eye Surgery announced that<br />

Dr Logan Robinson has joined its team<br />

as an experienced cataract surgeon with<br />

subspecialty training in vitreoretinal surgery and<br />

diseases of the retina and macula.<br />

Dr Robinson joins Drs Jim Borthwick and Sean<br />

Every to complete Christchurch Eye Surgery’s<br />

surgical retinal team at the only private facility in<br />

Christchurch with a vitreoretinal surgical suite.<br />

Graduating from the University of Otago, Dr<br />

Robinson undertook his ophthalmology training in<br />

Wellington and Christchurch. He then completed<br />

vitreoretinal surgery fellowships in Wellington and<br />

at Manchester Royal Eye Hospital in the United<br />

Kingdom, where he learned the latest techniques<br />

in vitreoretinal and cataract surgery.<br />

He took up a position as a consultant<br />

ophthalmologist at Christchurch Hospital in 2015,<br />

where he is involved in the training of junior<br />

ophthalmologists as well as educational sessions<br />

for GPs and optometrists. He also joined the team<br />

at Southern Eye Specialists.<br />

Dr Robinson says he believes it is important<br />

to communicate clearly with his patients so<br />

they have a good<br />

understanding of<br />

their condition and<br />

can make informed<br />

decisions about<br />

their treatment.<br />

“When I returned<br />

to Christchurch I<br />

wanted to operate<br />

in a modern, wellequipped<br />

facility so<br />

Dr Logan Robinson<br />

I could provide the highest quality of surgical care<br />

for my patients. Christchurch Eye Surgery more<br />

than meets my expectations. It has state-of-the art<br />

surgical equipment and technology, together with<br />

experienced and friendly staff and a beautifullydesigned<br />

building. This combination makes for the<br />

best experience possible for the patient.”<br />

Away from ophthalmology, Dr Robinson is an avid<br />

sports fan and enjoys mountain-biking, golf and<br />

fishing when he isn’t spending time with his wife<br />

and young son.<br />

Christchurch Eye Surgery opened its doors in<br />

June 2014. ▀<br />

Christchurch education day<br />

Around 60 optometrists gathered for a daylong<br />

seminar in Christchurch in February,<br />

the third consecutive year for this event.<br />

Drs Zainah Asagloff, Antony Bedggood, David<br />

Kent, Ainsley Morris and Logan Robinson gave<br />

presentations this year.<br />

Dr Morris said she really enjoys the annual day<br />

spent with the optometrists—both local and<br />

from around the country. “It is a chance to learn<br />

together, build on the importance of collaboration,<br />

especially in the therapy and treatment of patients,<br />

as well as having a great day with nice people.”<br />

Dr Morris, in her first presentation, discussed<br />

pseudophakic macular oedema. The essentials of<br />

recognition and diagnosis were detailed and the<br />

importance of appropriate treatment and advice<br />

to patients emphasised. While in Glaucoma—to<br />

treat or not to treat, Dr Morris discussed conditions<br />

which can mimic glaucoma, aren’t pathological,<br />

but which have high pressures and the important<br />

fact that not all patients who develop glaucoma<br />

will lose sight over their lifetime.<br />

Dr Kent presented on corneal collagen cross<br />

linking with riboflavin (CXL)—indications,<br />

techniques and post-operative management. He<br />

covered the physicochemical changes that occur<br />

in the cornea during CXL, the original Dresden<br />

protocol and what the published studies of CXL<br />

show. The primary indication for CXL is progressive<br />

corneal ectasia including keratoconus and post-<br />

LASIK keratectasia. He discussed accelerated CXL<br />

and whether it may or may not be as effective as<br />

the original protocol and he covered post-operative<br />

management and expected clinical course.<br />

Dr Kent’s second talk was on multifocal and<br />

extended-depth-of-focus IOLs. He discussed both<br />

bifocal and trifocal diffractive multifocal IOLs and<br />

that the trifocal IOLs, such as Zeiss and FineVision,<br />

have now superseded the older bifocal IOLs. He<br />

also discussed the pros and cons of the different<br />

types of extended-depth-of-focus IOLs.<br />

His third talk was on post-LASIK keratectasia<br />

where he discussed his own cases and reviewed<br />

the risk factors and how they have been managed.<br />

He emphasised that any post-LASIK patient who<br />

develops increasing astigmatism needs corneal<br />

topography to exclude keratectasia and that CXL<br />

should be done earlier before it progresses. Dr<br />

Kent’s final talk was on the history of LASIK.<br />

Dr Robinson discussed the new OCT-based<br />

classification system for vitreomacular adhesion,<br />

vitreomacular traction, full-thickness macular<br />

holes and lamellar macular holes. He also spoke on<br />

how to differentiate papilloedema from pseudopapilloedema,<br />

with the most important message<br />

being to consider the entire clinical picture when<br />

assessing an elevated disc, and he gave tips on how<br />

to use OCT to differentiate between disc drusen<br />

and papilloedema. Dr Robinson’s final talk was<br />

on pigmented lesions of the retina and choroid,<br />

and in particular how to differentiate between a<br />

choroidal nevus and choroidal melanoma using<br />

the mnemonic: “To Find Small Ocular Melanoma<br />

Using Helpful Hints Daily”. Using this will prompt<br />

timely referral for high risk lesions, allowing earlier<br />

diagnosis, he said.<br />

In Eye diseases in South East Asia, Dr Asagloff<br />

made the following points:<br />

••<br />

Asians are more prone to endophthalmitis<br />

from blepharitis<br />

••<br />

Asian eyelids can have epicanthal folds/<br />

epiblepharon<br />

••<br />

In thyroid orbital inflammation, optic nerve<br />

compression is more common<br />

••<br />

In a submacula bleed, look out for PCV<br />

••<br />

Giant cell arteritis is most uncommon<br />

Speakers: Drs Zainah Asagloff, Logan Robinson, Antony<br />

Bedggood, Ainsley Morris and David Kent<br />

Dr Ainsley Morris (second from left) and optometrists<br />

Gavin Lim, Suney Cheung, Rochelle van Eysden and<br />

Michaella Dolling<br />

••<br />

In a bilateral panuveitis, VKH is a common cause<br />

••<br />

Angle-closure glaucoma is more common<br />

In angle-closure glaucoma, optometrists can play<br />

a vital role in detecting patients who have narrow<br />

angles before they progress to glaucoma, she said.<br />

“It is vital to detect shallow anterior chambers.<br />

And this should lead to examination of the angles,<br />

via Gonioscopy or Imaging.” Imaging modalities<br />

include the eyeCam, Scheimpflug photography,<br />

UBM and AS-OCT.<br />

Dr Asagloff went on to discuss the diagnosis<br />

of dry eyes, which can be diagnosed by simple<br />

clinical means using tests such as TBUT, Schirmer’s,<br />

staining or meniscus level. Optometrists should<br />

look for the treatable underlying cause, she said,<br />

and refer to an ophthalmologist if the dry eye<br />

is moderate to severe and if there is a definite<br />

underlying cause to treat.<br />

Dr Bedggood explained how paediatric<br />

ophthalmology is challenging, with potentially<br />

sight or life-threatening diseases presenting few<br />

or no symptoms. Fortunately there are some<br />

quite specific patterns and ‘mantras’ that can be<br />

followed.<br />

Causes of red eye in children were discussed<br />

and, apart from the rare and serious causes of<br />

retinoblastoma or rhabdomyosarcoma, they<br />

are mainly corneal and anterior segment diseases,<br />

often chronic and more aggressive than in adults.<br />

Corneal opacities and vascularisation due to<br />

staphylococcus/blepharitis is one of these, he said.<br />

Glaucoma in children and young adults is rare<br />

and universally has high IOP, so a large disc, big cup<br />

and normal IOP need not be a ‘suspect’ in someone<br />

less than 35, said Dr Bedggood, while genetic<br />

causes related to the Myocillin gene predominate.<br />

Children from five years of age presenting with<br />

bilaterally reduced vision, often mild at first, need<br />

to be “robustly followed up” and sometimes tested<br />

for retinal dystrophies, he added. “Subtle macular<br />

signs, OCT changes, retinal flecks and family history<br />

are key findings.”<br />

Finally Dr Bedggood discussed the care of children<br />

with low vision. “Providing excellent services<br />

and communicating between ophthalmologist,<br />

optometrist, BLENNZ and parents is an important<br />

priority for all of us.”<br />

Seminar organised by Fendalton Eye Clinic. Words<br />

supplied by speakers. ▀<br />

Opportunity for Community Optometrists<br />

A fantastic opportunity for optometrists who are motivated to upskill in the assessment, diagnosis and treatment<br />

of glaucoma is offered by the Department of Ophthalmology, The University of Auckland. We have established a<br />

collaborative glaucoma clinic with the Department of Ophthalmology Auckland District Health Board. The long<br />

term vision of this clinic is as a gateway to providing community based glaucoma care in the future.<br />

For further information about this clinic and associated cost please contact:<br />

Sue Raynel<br />

Department of Ophthalmology<br />

The University of Auckland<br />

Ph: (09) 923-6337 or e-mail: s.raynel@auckland.ac.nz<br />

<strong>Apr</strong>il <strong>2016</strong><br />



with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

The ABCs of OCT in glaucoma<br />

Background<br />



Glaucoma is a multifactorial optic neuropathy characterised by<br />

slowly progressive degeneration of the retinal ganglion cells and<br />

their axons. Unfortunately, there is not yet one single test that can<br />

discriminate glaucomatous eyes from normal eyes; the diagnosis<br />

of glaucoma is made based on a specific pattern of structural and<br />

functional changes. In the past, the retinal nerve fibre layer (RNFL)<br />

was only able to be assessed subjectively by slit-lamp examination<br />

and retinal photography, providing qualitative data. Optical<br />

coherence tomography (OCT) was first described by Huang and<br />

colleagues in 1991 1 . OCT, as used to acquire high resolution, crosssectional<br />

images of the ocular structures, utilises low-coherence<br />

near infrared light (800-1400 nm) generated by a super-luminescent<br />

diode, which passes through the pupil to the posterior structures<br />

of the eye 1 . It is analogous to B-scan ultrasound except that it uses<br />

light instead of sound. Over the past 10 to 15 years, OCT has become<br />

an invaluable tool and is in widespread use in both optometry<br />

and ophthalmology. OCT is used in the diagnosis and longitudinal<br />

analysis of a multitude of ophthalmic disorders that affect the optic<br />

nerve and macula, including glaucoma. Newer spectral-domain OCT<br />

has increased resolution (approximately 3 – 5 µm) and faster scan<br />

acquisition time than older time-domain OCT technology. Common<br />

spectral-domain OCT models include the Zeiss Cirrus and the<br />

Heidelberg Spectralis.<br />

Peripapillary Retinal Nerve Fibre Layer Measurements<br />

Measurement of the peripapillary RNFL thickness using OCT<br />

is now a routine component of the comprehensive glaucoma<br />

assessment. In healthy eyes, the RNFL is generally thickest in<br />

the in the inferior quadrant, followed by the superior, nasal and<br />

temporal quadrants (the “ISNT” rule). There is, however, a large<br />

degree of RNFL variability in “normal” eyes, and there is some<br />

overlap in the structural characteristics of normal eyes and eyes<br />

with early optic nerve damage due to glaucoma 2 . Many patients<br />

will have anomalous structural features that may confound<br />

the interpretation of OCT measurements, and the eye may be<br />

incorrectly classified as “abnormal”. In patients with perimetric<br />

glaucoma, the location of the RNFL thinning should correlate<br />

with the visual field defect. In those with pre-perimetric disease,<br />

it is important to compare the peripapillary RNFL thickness in the<br />

individual quadrants with the appearance of the optic nerve head<br />

on clinical examination.<br />

The ability to detect and measure structural change is essential<br />

in the diagnosis and management of glaucoma. Progression<br />

analysis software, included with some OCT models, is able to<br />

track the progression of RNFL thinning over time (figures 1 and 2).<br />

It is necessary to review the RNFL overview at each visit, as well<br />

as the progression scans, as these overview scans will give more<br />

comprehensive information regarding RNFL thickness in each eye<br />

(as well as the differences between the two eyes). It is important<br />

to discriminate true disease-related changes from measurement<br />

variability and normal age-related change. When a scan is accurate<br />

and well-centred, the 95% tolerance for average RNFL thickness<br />

is approximately 4 µm 2 . Spectral-domain OCT is more sensitive at<br />

detecting glaucoma progression than time-domain OCT 3 .<br />

Fig 1. Guided progression analysis on Zeiss Cirrus OCT. This shows progression of left RNFL<br />

thinning. The first two exams are used as baseline measurements, with subsequent scans<br />

compared to baseline. The signal strength is good in all scans however the first baseline shows<br />

an area nasal to the optic disc with an incomplete scan, hence the reason for the lower average<br />

RNFL thickness in Baseline 1 compared with Baseline 2. Over time, there has been a significant<br />

reduction in RNFL thickness in both the superior and inferior quadrants.<br />

Fig 2. Guided progression analysis on Zeiss Cirrus OCT. This shows stable RNFL thickness over<br />

six consecutive OCT scans. There is marked RNFL thinning, particularly in the superior and<br />

inferior quadrants. The fluctuation in average RNFL thickness between exams is within the 95%<br />

confidence limits for scan repeatability. Signal strength is adequate in all scans.<br />

Macular OCT Scans in Glaucoma<br />

Although the use of OCT in glaucoma has been primarily focused on<br />

the assessment of peripapillary RNFL thickness, in recent years the<br />

macular region has emerged as an area of interest; glaucomatous<br />

macular damage can occur early in the disease process. Although the<br />

macular region represents less than 2% of the retinal area, it contains<br />

30% of the retinal ganglion cells 4 . One of the main advantages of<br />

12 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong><br />

macular assessment in glaucoma is that a significant portion of<br />

retinal thickness at the macula is composed of the RNFL, ganglion<br />

cell layer and the inner plexiform layer. Spectral-domain retinal<br />

layer segmentation algorithms have allowed for the quantification<br />

of individual layers in the macular region, and the measurement<br />

of ganglion cell complex thickness (the combined thickness of the<br />

RNFL, ganglion cell layer and the inner plexiform layer, although<br />

macular analysis in some OCT models includes only the ganglion<br />

cell and inner plexiform layers) 3 . The GCC thins as the glaucomatous<br />

damage progresses, with lower thickness values associated with<br />

poorer mean deviation scores on visual field testing 2,5 . Ganglion cell<br />

complex thickness in glaucoma can correlate well with RNFL thinning<br />

and visual field loss (figure 3). Repeatability of ganglion cell complex<br />

measurements may be reduced in more advanced glaucoma 6 .<br />

Fig 3. Structure-function correlation. The top left image shows a glaucomatous right optic nerve<br />

with vertical elongation of the optic cup and thinning of the superior and inferior neuroretinal<br />

rim. The rim thinning is most pronounced inferiorly. This correlates with functional changes on<br />

visual field testing, with almost complete loss of the superior visual field, and greatly reduced<br />

sensitivity in the inferior visual field. The lower images show diffuse thinning of the ganglion<br />

cell complex (measured with the Zeiss Cirrus OCT), with more extensive thinning in the inferior<br />

region. This correlates with the optic nerve and visual field appearance.<br />

Consider Other Ocular and Systemic Pathology<br />

Glaucoma is not the only condition that can cause thinning of the<br />

retinal layers. A vast number of ocular and systemic disorders can<br />

lead to peripapillary RNFL and macular thickness changes on OCT<br />

and it is always important to consider these conditions as part of<br />

the examination process. A comprehensive history and complete<br />

eye examination is essential. The patterns of RNFL loss can vary<br />

greatly between conditions. For example, patients with optic neuritis<br />

are more likely to have temporal RNFL thinning (figure 4) and the<br />

degree of RNFL loss may be out of proportion to visual field results.<br />

Multiple sclerosis is associated with thinning of the RNFL and macula<br />

(including the ganglion cell complex), even in patients with no history<br />

of optic neuritis 7 . Patients with compressive optic neuropathies<br />

can present with thinning of the RNFL. These patients are likely to<br />

have reduced RNFL thickness in the nasal and temporal quadrants<br />

compared with glaucoma patients 8 . A tilted disc, particularly in<br />

myopic patients, can cause a localised RNFL defect in the superior or<br />

inferior quadrants, similar to glaucomatous RNFL loss 9 . Longitudinal<br />

follow-up is necessary to determine whether the RNFL thinning is<br />

glaucomatous or due to the tilting of the optic nerve head 10 .<br />

Fig 4. RNFL thinning in a patient with a history of optic neuritis. This patient had a single episode<br />

of right optic neuritis (confirmed by MRI examination). Note the dramatic reduction in RNFL<br />

thickness, particularly in the temporal quadrant (less likely to be affected in glaucoma). The<br />

average RNFL thickness was 55 µm. The visual field was normal.<br />

Factors Affecting OCT Measurements<br />

A number of factors influence the quality and accuracy of retinal<br />

measurements acquired with OCT:<br />

••<br />

Image resolution is affected by eye movement. The degradation<br />

of the image is a function of the frequency and size of saccadic<br />

eye movements, compared with the image acquisition time and<br />

the transverse resolution of the OCT 11 . Newer OCT technology<br />

attempts to counter this with the use of eye-tracking systems<br />

incorporated into the software 12 .<br />

••<br />

Scans should be well-centred: macular scans should be centred<br />

at the fovea and accurate measurement of the peripapillary<br />

RNFL requires the reference to be centred precisely at the optic<br />

nerve head 13 .<br />

••<br />

The signal strength of the scan needs to be adequate.<br />

Recommended minimum signal strength varies by manufacturer.<br />

Even scans with adequate signal strength may show software<br />

segmentation failure, where the automatic segmentation of<br />

the retinal layers is incorrect. If possible, these scans should be<br />

re-taken.<br />

••<br />

Scans can be acquired effectively over a range of pupil sizes,<br />

however if the pupil size is less than 3 mm this can affect<br />

thickness measurements and scan quality 14 .<br />

••<br />

Opacities of the lens generally give rise to lower thickness<br />

values (affecting results by up to 12%), with more advanced lens<br />

opacities leading to a greater decrease in thickness 14 . Image<br />

repeatability significantly improves following cataract extraction<br />

••<br />

OCT measurements are affected by axial length and,<br />

subsequently, refractive error 15 , and measurements are most<br />

accurate within the range of +5 to -5 dioptres 14,16 . Longer, more<br />

myopic eyes tend to have thinner RNFL thickness values 15 .<br />

••<br />

RNFL values for people of different ethnicities vary modestly,<br />

although it has been found that all ethnicities examined had<br />

95% confidence limits that overlapped 15 .<br />

••<br />

RNFL thickness decreases with age - by approximately 2 µm per<br />

decade, with loss of about 5000 axons per year 15 .<br />

Anterior Segment OCT in Glaucoma<br />

It is worth briefly mentioning the role of OCT in the examination of<br />

the anterior segment of glaucoma patients. Anterior segment OCT<br />

imaging, using a 1310 nm light source, permits the visualisation<br />

of the angle structures and provides quantitative data that can be<br />

useful in the identification of the mechanism of IOP elevation and<br />

the diagnosis of angle closure glaucoma (figure 5) 17,18 . OCT of the AC<br />

angle is a tool that is a useful addition to gonioscopy, but it should<br />

not replace gonioscopic examination. It can be used to measure<br />

the actual size of the angle, and is also particularly helpful for<br />

visualising structural changes to the angle following YAG peripheral<br />

iridotomy. Anterior segment OCT can also be used to as a noninvasive<br />

measure of central corneal thickness, a useful measure in<br />

initial glaucoma assessment.<br />

Fig 5. Anterior segment OCT scan showing narrow anterior chamber angles<br />

Conclusion<br />

There have been significant developments in glaucoma imaging<br />

over the last decade, and these imaging modalities, particularly<br />

OCT scans of the peripapillary RNFL and macula, are now used<br />

routinely in glaucoma diagnosis and on-going management. There<br />

are continuous advances in spectral-domain OCT technology, with<br />

increased resolution, reduced scan acquisition time, progression<br />

analysis software updates, en face imaging and eye movement<br />

tracking allowing for more accurate and reproducible scans, and<br />

more in-depth analysis of the ocular structures. Although OCT<br />

examination is an important component of the modern glaucoma<br />

assessment, it is not a diagnostic tool 3 ; it is a useful test in the<br />

armamentarium of the ophthalmologist and optometrist, and it<br />

should be used in conjunction with other measures of optic nerve<br />

structure and function. ▀<br />

References<br />

1. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science 1991;254:1178-1181.<br />

2. Grewal DS, Tanna AP. Diagnosis of glaucoma and detection of glaucoma progression using spectral<br />

domain optical coherence tomography. Curr Opin Ophthalmol 2013;24:150-161.<br />

3. Bussel, II, Wollstein G, Schuman JS. OCT for glaucoma diagnosis, screening and detection of glaucoma<br />

progression. British Journal of Ophthalmology 2014;98 Suppl 2:ii15-19.<br />

4. Curcio CA, Allen KA. Topography of ganglion cells in human retina. Journal of Comparative Neurology<br />

1990;300:5-25.<br />

5. Hood DC, Raza AS, de Moraes CG, Liebmann JM, Ritch R. Glaucomatous damage of the macula. Prog<br />

Retin Eye Res 2013;32:1-21.<br />

6. Sung MS, Kang BW, Kim HG, Heo H, Park SW. Clinical validity of macular ganglion cell complex<br />

by spectral domain-optical coherence tomography in advanced glaucoma. Journal of Glaucoma<br />

2014;23:341-346.<br />

7. Petzold A, de Boer JF, Schippling S, et al. Optical coherence tomography in multiple sclerosis: a<br />

systematic review and meta-analysis. Lancet neurol 2010;9:921-932.<br />

8. Danesh-Meyer HV, Yap J, Frampton C, Savino PJ. Differentiation of Compressive from Glaucomatous<br />

Optic Neuropathy with Spectral-Domain Optical Coherence Tomography. Ophthalmology 2014; 121:<br />

1516-1523<br />

9. Hwang YH, Yoo C, Kim YY. Characteristics of peripapillary retinal nerve fiber layer thickness in eyes<br />

with myopic optic disc tilt and rotation. Journal of Glaucoma 2012;21:394-400.<br />

10. Chang RT, Singh K. Myopia and glaucoma: diagnostic and therapeutic challenges. Curr Opin<br />

Ophthalmol 2013;24:96-101.<br />

11. Hee MR, Izatt JA, Swanson EA, et al. Optical coherence tomography of the human retina. Arch<br />

Ophthalmol 1995;113:325-332.<br />

12. Serbecic N, Beutelspacher SC, Aboul-Enein FC, Kircher K, Reitner A, Schmidt-Erfurth U. Reproducibility<br />

of high-resolution optical coherence tomography measurements of the nerve fibre layer with<br />

the new Heidelberg Spectralis optical coherence tomography. British Journal of Ophthalmology<br />

2011;95:804-810.<br />

13. Cheung CYL, Yiu CKF, Weinreb RN, et al. Effects of scan circle displacement in optical coherence<br />

tomography retinal nerve fibre layer thickness measurement: a RNFL modelling study. Eye<br />

2009;23:1436-1441.<br />

14. Savini G, Zanini M, Barboni P. Influence of pupil size and cataract on retinal nerve fiber layer<br />

thickness measurements by Stratus OCT. Journal of Glaucoma 2006;15:336-340.<br />

15. Budenz DL, Anderson DR, Varma R, et al. Determinants of normal retinal nerve fiber layer thickness<br />

measured by Stratus OCT.[Erratum appears in Ophthalmology. 2008 Mar;115(3):472]. Ophthalmology<br />

2007;114:1046-1052.<br />

16. Menke MN, Knecht P, Sturm V, Dabov S, Funk J. Reproducibility of nerve fiber layer thickness<br />

measurements using 3D fourier-domain OCT. Invest Ophthalmol Vis Sci 2008;49:5386-5391.<br />

17. Sharma R, Sharma A, Arora T, et al. Application of anterior segment optical coherence tomography in<br />

glaucoma. Survey of Ophthalmology 2014;59:311-327.<br />

18. Smith SD, Singh K, Lin SC, et al. Evaluation of the anterior chamber angle in glaucoma: a report by<br />

the american academy of ophthalmology. Ophthalmology 2013;120:1985-1997.<br />

* Hannah Kersten is a therapeutically qualified optometrist with<br />

glaucoma prescriber accreditation. She has recently completed<br />

her doctoral studies in the Department of Ophthalmology<br />

at the University of Auckland, under the supervision of<br />

Professor Helen Danesh-Meyer, and Dr Richard Roxburgh of the<br />

Department of Neurology. The topic of her thesis was optical<br />

coherence tomography in neurodegenerative disease. Hannah<br />

is currently working as a post-doctoral research fellow in the<br />

Department of Ophthalmology and she is also involved in<br />

glaucoma co-management with Professor Danesh-Meyer at Eye<br />

Institute in Auckland.

Colour vision test ends<br />

Routine, school-based check-ups of 11 and<br />

12-year-old students will no longer include<br />

testing for colour vision deficiency as of July 1.<br />

The Ministry of Health announced it would<br />

eliminate the test in February to allow more time<br />

for technicians to identify hearing and vision<br />

problems among children at an earlier age when<br />

intervention makes a bigger difference.<br />

Colour blindness is relatively unusual, especially<br />

among girls. The condition is found in 0.5% of<br />

the female population, whereas colour vision<br />

deficiency affects about 10% of the 26,000 boys<br />

screened annually as part of the standard Year 7<br />

checks.<br />

The Ministry’s decision was influenced by a<br />

summer research project, which reviewed the<br />

medical literature on the efficacy of colour vision<br />

testing, and was overseen by ophthalmologist Dr<br />

Graham Wilson, in his role as clinical senior lecturer<br />

at the University of Otago, and his brother Nick<br />

Wilson, a professor at Otago’s Department of Public<br />

Health.<br />

“We found there was no evidence to support<br />

screening for colour blindness,” says Dr Wilson.<br />

“We screen for things like breast cancer and<br />

cervical cancer, things that can kill you, and colour<br />

blindness doesn’t rise to that level.”<br />

Ministry Chief Advisor, Child and Youth Health, Dr<br />

Pat Tuohy explained the policy change to medical<br />

technicians who conduct the school checks at a<br />

conference in late February.<br />

“They feel it will free up their time to do other<br />

things,” says Dr Wilson, who attended the conference.<br />

“I think people see the common sense in it.”<br />

Dr Wilson, his brother and Nishanthan<br />

Ramachandran, a health policy student, published<br />

their paper Is screening for congenital colour vision<br />

deficiency in school students worthwhile? A review<br />

in the November 2014 edition of Clinical and<br />

Experimental Optometry.<br />

The review analysed the literature on screening<br />

for congenital colour vision deficiency in school<br />

students, which predominantly uses the Ishihara<br />

test, and found no association between congenital<br />

colour vision deficiency and the level of educational<br />

achievement; only a rare association between the<br />

condition and other health and lifestyle impacts;<br />

and limited interventions.<br />

“Given this picture, the weight of evidence<br />

appears to be in favour of not adopting (or<br />

discontinuing) routine colour vision screening<br />

programmes for school students; however, it may<br />

be worthwhile for a career advisor to refer school<br />

students to an optometrist or ophthalmologist for<br />

colour vision screening, upon expression of interest<br />

in an occupation where normal colour vision is<br />

either particularly desirable or is a regulatory<br />

requirement,” concluded their paper. ▀<br />

Donations for ship-clinic<br />

The Tauranga Rotary club is raising<br />

funds and looking for equipment<br />

donations for a humanitarian group<br />

to bring an ophthalmic clinic to remote<br />

Pacific islands.<br />

The club has launched a campaign<br />

to raise $95,000 for Marine Reach, a<br />

humanitarian organisation that delivers<br />

health services to isolated populations<br />

from its vessel, the MV Pacific Hope. The<br />

total money raised—likely to include a<br />

matching grant from a Rotary international<br />

fund—will be used to purchase items on<br />

an ophthalmic clinic “wish list”, including<br />

a Sonamed Portable AB Scanner, Nidek<br />

hand held keratometer, a slit lamp, an instrument<br />

sterilising container, portable microscope and an<br />

operating bed.<br />

The plan is for the ship-board clinic to be<br />

dedicated and named The Rotary Foundation<br />

Ophthalmology Clinic, with contributors of<br />

over $500 recognised by inscription on a special<br />

plaque displayed in the Clinic. Other donors<br />

will be invited to sponsor a specific piece of<br />

equipment and have their name inscribed on an<br />

appropriate plaque fixed to the item. The club<br />

is also open to surplus equipment donations or<br />

discounted price offerings.<br />

Marine Reach purchased the Pacific Hope and<br />

refit the vessel in 2013. It undertook its first<br />

clinical voyage, with a dental and general medical<br />

outreach programme in Fiji and Vanuatu, from<br />

late June to early October 2015. The next voyage<br />

is likely to begin in June <strong>2016</strong>.<br />

Anyone interested in making a financial or<br />

equipment contribution should contact project<br />

coordinator David Garland on 07 543 2012. You<br />

can also make a direct financial contribution<br />

through Give a Little at https://givealittle.co.nz/<br />

org/tgarotary. For more information on Marine<br />

Reach, visit www.marinereach.com. ▀<br />

ZEISS launches<br />

DriveSafe<br />

Zeiss has launched new DriveSafe lenses to provide better vision<br />

in challenging driving conditions.<br />

Calling them “probably the most exciting safety feature in<br />

your car,” Zeiss says the new lenses are designed to maximise safety<br />

and comfort for spectacle wearers through a new premium coating<br />

and state-of-the art lens design.<br />

According to Zeiss’ research, 83% of drivers wear glasses and the<br />

majority (72%) of these prefer a single pair for everyday use that can<br />

also assist with the visual challenges of driving. Spectacle wearers<br />

report feeling discomfort when driving in rain (94%), at dusk (88%), at<br />

night (76%) and in fog (74%). While the majority of traffic accidents<br />

occur at dusk or after nightfall. “DriveSafe lenses address the major<br />

challenges facing spectacle wearers while driving in difficult light and<br />

weather conditions,” the company said.<br />

To better understand the requirements for dynamic vision while<br />

driving, ZEISS commissioned a study by the Research Institute of<br />

Automotive Engineering and Vehicle Engines in Stuttgart (FKFS) using<br />

a modified car on a real-world course. The setup included head and<br />

eye tracking systems to observe drivers’ visual behaviour.<br />

The study found that drivers focus on the road ahead and distant<br />

moving objects about 97% of the time, look at the dashboard 2% of<br />

the time and alternate viewing between the mirrors 1% of the time.<br />

Progressive lens wearers move their heads more than single vision<br />

wearers in order to avoid lens zones of incorrect power or that have<br />

high levels of aberration. FKFS also found that the closest object<br />

viewed on the dashboard is approximately 50-75 cm away from the<br />

driver’s eye, implying the near zone of a progressive lens, designed for<br />

a much closer distance, is virtually unused.<br />

“Drivers must contend with a rapidly alternating set of<br />

circumstances that require constant attention and dynamic vision.<br />

The DriveSafe lens is optimised to provide uncompromised distance<br />

vision, with a large intermediate zone that supports quick and<br />

comfortable focus when switching between the dashboard and<br />

mirrors.”<br />

The new lenses incorporate ZEISS DuraVision DriveSafe antireflective<br />

coating to mitigate the uncomfortable blue-light glare<br />

from Xenon/HID and LED headlights and Zeiss’ Luminance Design<br />

Technology that takes into account pupil size in different light<br />

conditions to assist drivers in detecting objects in conditions where<br />

they are more likely to feel stressed or insecure, such as twilight, rain<br />

or at night.<br />

European wearer trials revealed very high satisfaction levels for<br />

ZEISS DriveSafe lenses, the company reported, with 97% of test<br />

subjects satisfied with the new lenses when driving, including in<br />

challenging situations such as in the dark and twilight. Respondents<br />

reported good dynamic vision in near, intermediate and distant<br />

zones, good perception of colours and reduced dazzle/glare from<br />

headlights. In addition, 94% of respondents found the new lenses<br />

suitable for doing everyday tasks.<br />

“Drivers require the best technology for their vision needs today,”<br />

says Hilke Fitzsimons, managing director for ZEISS Australia and New<br />

Zealand. “Surveys show over two-thirds of adults have difficulty in<br />

driving in low light or adverse weather conditions. Our new DriveSafe<br />

lenses address problems of glare, depth perception, and vision acuity<br />

at all distances.”<br />

ZEISS DriveSafe will be available in New Zealand from <strong>Apr</strong>il 4<br />

in both progressive and single vision designs. The launch will be<br />

supported by an extensive digital promotion where consumers will<br />

be invited to become “test drivers” and win a pair of ZEISS DriveSafe<br />

Lenses at www.zeiss.com.au/DriveSafe. ▀<br />

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1. Lee S et al. Klin Monatsbl Augenheilkd 2004; 221:1–12. 2. Khaireddin R, Schmidt KG. Klin Monatsbl Augenheilkd. 2010; 227: 128-134. 3. Pult H et al. Contact Lens Anterior Eye 2012, 35:203-207. Reckitt Benckiser, Auckland. TAPS DA1541<br />

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Great<br />

Memories<br />

In recent times, I’ve been writing a five<br />

thousand-word article on the history and<br />

evolution of soft lenses. In doing so, I asked<br />

my long term friend, mentor and fellow South<br />

African Des Fonn if he would like to share<br />

some of his thoughts on this subject.<br />

Des was my final year lecturer in contact<br />

lenses, after his return from spending eighteen<br />

months doing his MOptom with Brien Holden<br />

and the gang at the CCLRU in Sydney in 1980.<br />

We did some research together and served on<br />

the South African Contact Lens Society council<br />

and arranged many conferences together. He<br />

was one of the people who motivated me to<br />

excel in contact lenses and inspired me in many<br />

ways. I have mentioned Professor Desmond<br />

Fonn in numerous missives in this column over<br />

the years so won’t repeat it here but this link<br />

will give you some of that. Des is the founder<br />

of the prestigious CCLR at Waterloo, one of the<br />

top CL research facilities in the world and has<br />

published widely.<br />

Des had the following to share.<br />

The 1980s: game<br />

changing events in<br />

which Australia led<br />

the way<br />

1976 was a momentous year for the University<br />

of New South Wales School of Optometry as<br />

the Cornea and Contact Lens Research Unit was<br />

established under the leadership of Brien Holden.<br />

It was this organisation that would lead the<br />

world in cornea and contact lens research and<br />

was the forerunner of all the organisations to<br />

follow culminating in 2010 as the Brien Holden<br />

Vision Institute in recognition for his lifetime of<br />

work in research and humanitarian initiatives<br />

related to vision.<br />

During the mid 70s the popularity of soft lenses<br />

gained momentum to equal that of rigid lenses<br />

but it was soon demonstrated that daily wear of<br />

soft lenses produced clinically significant corneal<br />

edema. During this period, John De Carle had<br />

developed the high-water-content Permalens<br />

and claimed successful extended wear without<br />

ocular complications. These two topics became<br />

the cornerstones of research at the CCLRU. Drs<br />

Steve Zantos and Lewis Williams were Brien’s<br />

first two PhD students working on extended<br />

wear of soft lenses and the effects of soft lenses<br />

and hypoxia on the corneal endothelium. Brien’s<br />

paper in the Australian Journal of Optometry in<br />

1975 on the principles and practice of correcting<br />

astigmatism with soft lenses peaked my interest<br />

at that time, and thousands of others because<br />

he showed that 35% of patients require toric<br />

lenses. This figure was corroborated by others<br />

years later. It was not a coincidence that Brien<br />

and colleagues at the Institute for Eye Research,<br />

which superseded the CCLRU in the late eighties,<br />

developed a unique toric lens design that yielded<br />

millions of royalty dollars.<br />

By 1980 the CCLRU comprised about 30 people<br />

dedicated to research on contact lenses and<br />

their effects on the eye. Brien’s vision in those<br />

early years was that Australian and international<br />

collaboration were essential to understand the<br />

effects of contact lenses and this became the<br />

cornerstone of their research endeavors.<br />

The image below is a collage of colleagues<br />

working at the CCLRU in 1980. Brien used<br />

the image in his presentations to describe a<br />

renaissance that began in 1980. Of course there<br />

were many others at the time and hundreds that<br />

followed in a similar vein to work at the world’s<br />

most exciting institution in the contact lens field.<br />

During the late seventies Dr George Mertz<br />

published two important papers on corneal<br />

swelling. In his 1978 paper he showed that<br />

an ultra-thin low water HEMA lens decreased<br />

corneal swelling compared to a standard<br />

thickness lens suggesting that decreasing<br />

hypoxia led to decreased corneal swelling. His<br />

1980 paper was also on the subject of hypoxia<br />

in which he found that the overnight closed eye<br />

(without a lens) produced significant corneal<br />

swelling. These papers were part of the stimulus<br />

for further study in an attempt to determine<br />

what the critical oxygen transmission of a<br />

DO takes on the Sky Tower<br />

hydrogel lens should be to avoid corneal swelling.<br />

Holden, Mertz and McNally published a series<br />

of papers on hypoxia that started in the early<br />

eighties, the most renowned of which is the<br />

“Critical oxygen levels to avoid corneal edema<br />

for daily and extended wear contact lenses”.<br />

Their conclusion from this study was that 87 x<br />

10-9 oxygen transmissibility (Dk/t) was required<br />

for overnight wear and 24 x 10-9 for daily wear.<br />

The limitation of this work was that only one<br />

high Dk lens (silicone elastomer) and an ultra<br />

thin low water content hydrogel lens (20μm)<br />

was included in the study. This is the second<br />

most cited paper in the contact lens field aside<br />

from those on corneal infection. Since then<br />

the EW value has been revised to 150 – 190<br />

Dk/t to avoid corneal edema as a result of the<br />

availability of silicone hydrogel lenses that we<br />

used in overnight corneal swelling studies.<br />

Brien’s highest cited paper was known as the<br />

Gothenburg study. This study examined the longterm<br />

effects of extended contact lens wear and<br />

the conclusion was that adverse reactions could<br />

be avoided by fitting lenses that have higher<br />

oxygen transmissibility, looser fitting, lenses<br />

should be removed from the eye more frequently<br />

and lenses should be more regularly replaced.<br />

These studies on hypoxia and others on<br />

extended wear were unquestionably the<br />

stimulus to develop a highly oxygen permeable<br />

soft lens. The collaboration between the<br />

Cooperative Research Centre for Eye Research and<br />

Technology at UNSW with an industry partner<br />

developed the first silicone hydrogel contact lens,<br />

which was the game changer for the contact lens<br />

industry by eliminating virtually all the problems<br />

of hypoxia. These materials now constitute<br />

approximately 60% of all contact lenses worn.<br />

The hope was the same for microbial keratitis<br />

(MK) but research with silicone hydrogels has<br />

shown that elimination of hypoxia has not<br />

decreased the incidence of MK nor inflammatory<br />

complications.<br />

How amazingly fortunate I was to meet and<br />

befriend Brien and then work with those people<br />

featured in the photograph. Thirty-five glorious<br />

years of contact lens research that started in<br />

1980 at the CCLRU and was the springboard for<br />

industry/institution collaboration unmatched by<br />

any others.<br />

For more go to www.brienholdenvision.org<br />

Thanks Des for sharing your insights. Next time<br />

we see each other dinner and a few beers are<br />

on me. It’s great to see that our recollections of<br />

such things are more or less on the same page<br />

so it seems our grey matter is still having good<br />

recall of events! ▀<br />

ODMA<br />

appoints<br />

IEC<br />

The Board of the Optical Distributors &<br />

Manufacturers Association (ODMA) has<br />

appointed International Exhibition and<br />

Conference Group (IEC) to organise ODMA2017,<br />

to be held July 7 to 9 at Sydney’s International<br />

Convention Centre.<br />

“The company was selected from a very capable<br />

list due to their key personnel’s history of working<br />

with associations, their commitment to excellence<br />

and their enthusiastic and creative approach,” said<br />

Finola Carey, ODMA’s chief executive, in a statement.<br />

‘’I am confident that IEC is best-placed to closely<br />

work with ODMA to deliver the event to suit the<br />

changing needs of our members and the broader<br />

industry in general.”<br />

IEC has managed a number of major industry<br />

events, including Fashion Exposed and Furnitex,<br />

under the leadership of its CEO Marie Kinsella.<br />

“I have always admired the ODMA fair over<br />

many years for its high quality presentation and<br />

its professional approach,” said Kinsella. “We look<br />

forward to working closely with ODMA and its<br />

members to deliver outstanding results.”<br />

ODMA has frozen floor space rates at 2015<br />

levels and will include new interactive features,<br />

networking events and educational content. ▀<br />

Glaucoma NZ<br />

book fundraiser<br />

Glaucoma NZ is selling Entertainment Books,<br />

with a portion of the proceeds going<br />

towards vital funds for the charity. A digital<br />

membership is also on offer, which allows you to<br />

redeem offers from your smartphone.<br />

Entertainment Books contain hundreds of<br />

25-50% off and two-for-one offers from popular<br />

restaurants, cinemas, hotel accommodation, the<br />

arts, lifestyle and sporting events. All offers are<br />

valid until June <strong>2016</strong> to give buyers plenty of time<br />

to get their money’s worth!<br />

Books are priced at $65 for Auckland (including<br />

Whangarei and Bay of Islands), Christchurch,<br />

Canterbury and Nelson; and $60 for Waikato & Bay<br />

of Plenty, Wellington (includes Palmerston North),<br />

Dunedin, Invercargill and Queenstown.<br />

Visit https://www.entertainmentbook.co.nz/<br />

orderbooks/102253y to buy.<br />

March 6 to 12 was World Glaucoma Week, an<br />

international campaign to help raise awareness<br />

of the disease that can go undetected for years<br />

and eventually lead to blindness. A number<br />

of countries took part with events aimed at<br />

educating the public and getting people tested. ▀<br />

Optical history made at Tattoo<br />

Maria Paterson training for the Sky Tower<br />

Maria Paterson, dispensing technician<br />

with Frederick Swain Optometrists in<br />

Hawke’s Bay is going to race up the Sky<br />

Tower in her full firefighting kit to raise funds and<br />

awareness for Leukaemia & Blood Cancer NZ as<br />

part of the annual Firefighter Sky Tower Challenge.<br />

Paterson has been a volunteer firefighter for<br />

seven years with the Napier Fire Station and says<br />

she loves helping people and a challenge. She also<br />

lost her mother and brother to cancer so is<br />

proud to be able to support Leukaemia & Blood<br />

Cancer NZ.<br />

Now in its eleventh year, the Firefighter Sky<br />

Tower Challenge has grown to include more than<br />

750 firefighters, climbing 51 flights – or 1,103<br />

Sky Tower steps – wearing full kit weighing 25kg.<br />

In 2015 the event raised nearly $1.04 million, its<br />

highest fundraising total to date.<br />

Paterson says she’s had “awesome support” from<br />

her colleagues at Frederick Swain, some of whom<br />

have even been out and about with her climbing<br />

every set of steps they can find in Napier. She’s<br />

even joined a gym, she laughs.<br />

The Firefighter Sky Tower Stair Challenge takes<br />

place on Saturday May 28.<br />

To support Paterson go to http://<br />

firefightersclimb.org.nz/Donate.html and type in<br />

“Maria”. ▀<br />

Dr Simon Dean and sons Lachlan and Cameron perform at the Tattoo<br />

A<br />

little bit of optical history was made at<br />

the end of February, when Eye Institute<br />

ophthalmologist Dr Simon Dean and his sons<br />

Cameron (12) and Lachlan (10) performed with the<br />

Royal Edinburgh Military Tattoo in Wellington.<br />

Cameron on pipes and Lachlan on snare drum were<br />

the youngest performers in the 1200-strong cast,<br />

playing in the City of Auckland Pipe Band along<br />

with their father (also on snare drum).<br />

Known as the<br />

“greatest show on<br />

earth,” the Tattoo<br />

is always a sell-out<br />

in Edinburgh and it<br />

was no different in<br />

Wellington, with more<br />

than 82,000 tickets<br />

sold across four soldout<br />

performances,<br />

making it Wellington’s<br />

most popular show<br />

ever.<br />

Dr Dean said it was a<br />

lot of hard work, with<br />

their days starting at<br />

6 am and finishing at<br />

11 pm most nights for<br />

a week. But he and his<br />

wife, Associate Professor Jennifer Craig, a Scot by<br />

birth, says they couldn’t have been prouder of their<br />

sons or have enjoyed an event more.<br />

“For one of the performances, Jennifer’s parents,<br />

my parents, so all the boys’ grandparents, and Jen<br />

watched. A proud moment for all generations of<br />

our family…and a great experience and honour to<br />

be involved; only made better by having my boys<br />

playing in the band as well,” said Dr Dean. ▀<br />

14 NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong>

Summer Student Symposium <strong>2016</strong><br />

A<br />

diversity of research, from the development<br />

of aids for colour deficient optometrists<br />

to optimising a test to assess vision in<br />

Zebrafish, was presented by 11 students from the<br />

Department of Ophthalmology and the School of<br />

Optometry and Vision Science (SOVS) at the annual<br />

Summer Student Symposium hosted by the New<br />

Zealand National Eye Centre (NEC).<br />

Professor Louise Nicholson and Associate Professor<br />

Mark Barrow, associate dean (academic) for the<br />

Faculty of Medical and Health Sciences, were invited<br />

to judge the presentations made by the students<br />

who had been working on their research projects for<br />

five to 10 weeks over the summer.<br />

The symposium presentations, given in a four<br />

minute “rapid fire” format, were well attended by<br />

senior academic staff, students and funders of the<br />

summer studentship programme.<br />

Symposium moderator Associate Professor Trevor<br />

Sherwin explained that for several students their<br />

summer projects had been their first real exposure<br />

to complex research and the symposium was an<br />

opportunity for them to present their findings to<br />

the wider ophthalmic community.<br />

First prize–Jonathan Young<br />

First prize was awarded to fifth-year BOptom<br />

student Jonathan Young who was supervised by<br />

Dr Misha Vorobyev from SOVS. He was the second<br />

presenter on the project Development of aids<br />

for colour deficient optometrists, the first being<br />

John Kwak who explained the development of the<br />

software for the project, while Young presented the<br />

results and conclusions.<br />

The prevalence of inherited red-green colour<br />

deficiency is quite high among the male<br />

population (8%) so colour deficiency among<br />

medical practitioners can pose a substantial<br />

hazard to society. One of the diagnostic problems<br />

that colour deficient optometrists confront<br />

is a difficulty in differentiating pigment from<br />

haemorrhage on a fundus image, said Young. “We<br />

transformed colours in fundus images to improve<br />

the discrimination and reduce ambiguity for the<br />

colour deficient optometrists when making a<br />

diagnosis. Each colour deficient participant’s range<br />

of colour vision was modelled and a personalised<br />

image transformation algorithm was developed.<br />

We tested our participants by showing them<br />

images of either sub-retinal pigments or subretinal<br />

haemorrhages, and prompted them to<br />

make a diagnosis.”<br />

Using colour deficient optometry students<br />

for the research, it was demonstrated that<br />

image transformation improved their ability to<br />

differentiate between pigment and haemorrhage<br />

in fundus images. This was the first study of its<br />

kind to look at colour deficiency in an optometric<br />

clinical setting and was funded by the SOVS.<br />

Second prize–Nikita Govender<br />

Nikita Govender, a fourth-year BOptom student,<br />

was awarded second prize for her presentation<br />

on the Role of the retina in atropine control of eye<br />


elongation.<br />

Supervised by Dr Monica Acosta from SOVS<br />

and sponsored by SOVS, this project looked at<br />

myopia control from a different perspective. The<br />

aim was to investigate the role of the retina in<br />

atropine control of myopia by examining the effect<br />

of atropine on retinal neurotransmitter levels.<br />

The experiment involved in vitro incubation of<br />

normal and myopic chick eyes with or without<br />

atropine. Tissues were sectioned and stained with<br />

a silver intensified immuno-gold technique to<br />

label key neurotransmitters. Results showed no<br />

significant change in neurotransmitter levels with<br />

atropine, however, from the images it was evident<br />

that atropine triggered redistribution of the<br />

neurotransmitters particularly in the inner retina.<br />

The hypothesis is these effects are mediated by<br />

cholinergic amacrine cells. Neurotransmitter<br />

redistribution may correspond to a change in the<br />

functioning of the retina and perhaps an altered<br />

visual experience. The next step would be to<br />

study the in vivo effects of atropine on the retina<br />

to better understand the mechanisms of myopia<br />

control, said Govender.<br />

Third prize–Samuel Lie<br />

The third prize was awarded to second-year medical<br />

student Samuel Lie. His research, Conducting<br />

polymers as release rate controlling membranes<br />

for electrical stimuli-responsive drug delivery,<br />

was funded by the Faculty of Medical and Health<br />

Sciences and supervised by Naveed Yasin, Dr Darren<br />

Svirskis and Dr Ilva Rupenthal.<br />

Sustained release ocular drug delivery systems<br />

have gained popularity when selecting treatment<br />

methods for diseases that affect the posterior<br />

segment of the eye. There are already a number<br />

of implants on the market, but they release<br />

drugs at a fixed rate, not allowing for adjustment<br />

as required by each individual patient. In this<br />

study, the focus was on the potential of poly(3,4-<br />

ethylenedioxythiophene) (PEDOT) to be used as<br />

a membrane to control drug release rates within<br />

an ocular drug implant where tuned drug delivery<br />

can be achieved via application of electrical<br />

stimuli. Dexamethasone release through PEDOT<br />

membranes was studied using Franz diffusion cells<br />

comparing release with and without application<br />

of electrical stimulus. By comparing PEDOT coated<br />

membranes to plain cellulose membranes it was<br />

found that PEDOT can be effective in limiting drug<br />

release. Further research is required in order to fine<br />

tune the control of release to ultimately fabricate a<br />

PEDOT based ocular implant.<br />

The public’s understanding of optometry<br />

An interesting presentation was made by<br />

Janice Chung whose study was funded by the<br />

New Zealand Association of Optometrists. It was<br />

conducted at the Acute Eye Clinic, Greenlane<br />

Clinical Centre, where 311 patients completed an<br />

anonymous questionnaire. The results show the<br />

basic scope of optometry, such as prescription of<br />

corrective wear and examination of eye health,<br />

Presenters (back row) Benjamin Wright, Jaspreet Singh,<br />

Kenny Wu, Samuel Lie, Rahul Makam and Jonathan<br />

Young, (front row) Janet Chung, Nikita Govender, Eileen<br />

Song, Ye Li, John Kwak and event MC Associate Professor<br />

Trevor Sherwin<br />

The winners with the judges: Nikita Govender, A/Prof<br />

Mark Barrow, Jonathan Young, John Kwak, Prof. Louise<br />

Nicholson and Samuel Lie<br />

Fraser Alexander, Dr Monica Acosta, Shadi Jolzar and Dr<br />

Ehsan Vaghefi<br />

is well understood by the public. However, this<br />

was not the case with regards to therapeutic<br />

management and treatment of ocular disease.<br />

The majority of patient referrals were from GPs,<br />

with some being uncertain of an optometrist’s<br />

capabilities – including the ability to refer,<br />

diagnose and treat eye conditions. These findings<br />

suggest there is room for further public education<br />

by key stakeholders. This research was supervised<br />

by Robert Ng, Tina Gao and Richard Johnson. ▀<br />

NZOSS<br />

objectives for<br />

the year ahead<br />


Most of the new NZOSS excecutive, (L to R) Kendall<br />

Johnston, Oliver Munro, Jonathan Albert, Nikku Singh,<br />

Sophie Woodburn, Aaron Chin, Gunnika Gill and Alicia Han<br />

Since it was established in 2013, the New<br />

Zealand Optometry Student Society<br />

(NZOSS) has strived to provide a platform<br />

for all students to engage with the professional<br />

community. Although NZOSS has only been<br />

operating for the last few years it has rapidly<br />

built up steam, with the student committee<br />

working hard with the New Zealand eye care<br />

industry to foster a great relationship among<br />

present and future optometrists.<br />

Each year a new bunch of students are elected<br />

to form the NZOSS executive committee and it<br />

is my pleasure to introduce the team for <strong>2016</strong>:<br />

grassroots representative Kendall Johnston;<br />

sports representative Jonathan Albert; vicepresident<br />

Sophie Woodburn; treasurer Aaron<br />

Chin; public relations Gunnika Gill; secretary<br />

Alicia Han; and general members Oliver Munro<br />

and Xheida Mani.<br />

This year, our main objectives are not only to<br />

promote long-lasting relationships among all<br />

optometry students, but to further develop our<br />

strong connections with the eye care industry.<br />

Through the organisation of seminars and<br />

networking events, students will be able to<br />

gain valuable knowledge on the vast number of<br />

specialties and avenues involving optometry and<br />

visual science. We will also facilitate some much<br />

required down time through social events, such<br />

as the Optometry Pub Quiz, pub crawls, the Eye<br />

Ball and much, much more.<br />

<strong>2016</strong> is shaping up to be a great year and we<br />

look forward to all that comes our way! ▀<br />




ZEISS DriveSafe Lenses<br />




Stewart Caithness Gray Optometrists is a well<br />

established independent practice in the city of<br />

Dunedin with branches in Mosgiel and Gore.<br />

We provide a high level of professional care and<br />

service to our patients and are looking for an<br />

experienced optometrist to join our team. The<br />

position is full time with potential partnership<br />

opportunities for the successful applicant.<br />

We have a wide range of patients of all<br />

ages and therefore, communication and<br />

interpersonal skills must be excellent. You need<br />

to have a passion for independent optometry<br />

and an interest in fitting speciality contact<br />

lenses. You should be TPA endorsed and ideally<br />

have at least 2-4 years experience. Salary will<br />

be reflective on your experience.<br />

We have a fantastic support team and<br />

diagnostic equipment includes OCT, corneal<br />

topographer, fundus and slit-lamp cameras and<br />

both Matrix and Medmont VFA’s.<br />

We pride ourselves in providing excellence in<br />

eye care, eyewear and service and are excited<br />

to be able to offer this opportunity to join our<br />

great team.<br />

Please email Brian Stewart, brian@scgeyes.nz,<br />

for further details.<br />



Great opportunity for a full-time optometrist<br />

in an independent, family-owned business<br />

in New Plymouth. Known for their superb<br />

service and extremely helpful team (yes, they<br />

have won awards for it!) they really want<br />

someone who “gets their vision”.<br />

They have all the latest technology, including<br />

a Zeiss OCT/Camera and very well equipped<br />

exam room and are led by an extremely<br />

experienced Dispensing Optician.<br />

What’s unique about this practice is the loyal<br />

customer base and the amount of referrals<br />

they get. This is not a High Street “look at me”<br />

business. They really do like their customers<br />

and go out of their way to help.<br />

The good news about this role is it’s not<br />

an immediate start and no late nights or<br />

weekends. They are searching far and wide<br />

for the right person to come and join them<br />

in June of this year. So, if you are thinking<br />

of moving to “the best place to live” in<br />

New Zealand then now’s the time to start<br />

planning.<br />

Salary is in line-of-sight of market rates. For<br />

details and to arrange an interview contact<br />

fitzroyoptom@xtra.co.nz or phone Michael at<br />

027 758 4974.<br />

zeiss.com.au/DriveSafe<br />

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<strong>Apr</strong>il <strong>2016</strong><br />




ON pAgE 15<br />

Need a locum?<br />

Call Bharat Raniga, locum optometrist, on<br />

021 424 253 or email: bharatraniga@yahoo.com<br />

prActicE for sAlE<br />

Get double-digit earnings without the sweat and toil of a CBD<br />

location. Enjoy the superior work-life balance of the countryside,<br />

while still within an easy drive of civilisation in downtown<br />

Auckland. Ideally suited to an optometrist breaking out on their<br />

own, or breaking back into the business after maternity leave or<br />

OE, or a dispenser-optometrist team. Yes, double-digit earnings,<br />

and potential for even more growth. If this sounds like something<br />

you’d like to pursue, please apply in strictest confidence c/- NZ<br />

Optics, info@nzoptics.co.nz Code PFSS1.<br />


TEL:(09) 486-2070 MOB:(0274) 798-798<br />

Email: tony.maddocks@xtra.co.nz<br />

EquipmEnt And shop fittings<br />

for sAlE<br />

Six wall-mounted frame dispaly units with 10 glass shelves per<br />

unit, 1 x light box (1.2x2m), finished in white two-pot lacquer,<br />

Zeiss Visucam Pro Retinal Camera, Humphrey Matrix perimeter,<br />

Reichart refractor head, Topcon IS-80 Chair and Stand, Topcon<br />

SL3F slit lamp, Topcon OM-4 Keratometer, Nidek CR690 Projector<br />

Chart (with screen and mirror), Kowa HA2 Tonometer with<br />

LED Bulb, LED Confrontation wand, Trial Lens kit, Nidek OL-7<br />

vertometer ,GFC Frame heater, Stenersen Multi-frame gauge,<br />

Pupilometer. All offers considered. Contact<br />

michael@eyestyle.co.nz.<br />

EquipmEnt for sAlE<br />

Topcon IS700 Chair and Stand, Magnon SL350 Slit Lamp, Reichart<br />

Keratometer, Righton NP36 Projector. All in good condition.<br />

Contact c/- info@nzoptics.co.nz, Code: EQFS12<br />

for sAlE<br />

Beautiful brushed aluminium frame display, holds 312 frames.<br />

Plus lockable frame or sunglass display racks, holds 96 sunglasses/<br />

frames. Also Gatehouse internally illuminated Eye Chart. Perfect<br />

for practices wanting to upgrade their frames displays or a newly<br />

opening practice. Contact Mark at 027 3806171<br />

or focusoptom@clear.net.nz.<br />

dispEnsing opticiAn/opticAl<br />

AssistAnt<br />

Paterson Burn Optometrists is one of the largest independent<br />

optometry practice groups in New Zealand. We are totally<br />

independent and Waikato owned and we’ve maintained our<br />

independence in the ever changing environment of New Zealand<br />

optometry. Our core purpose is to improve people’s lives by<br />

providing the best visual solutions available.<br />

Paterson Burn Optometrists value respect, integrity,<br />

accountability, enjoyment, continuous improvement, freedom for<br />

initiative and teamwork.<br />

Paterson Burn Optometrists Cambridge requires an experienced,<br />

confident and enthusiastic Dispensing Optician / Optical<br />

Assistant to join our small, friendly team.<br />

The successful applicant will:<br />

• Be a qualified Dispensing Optician or Optical Assistant with a<br />

minimum of 4 years’ dispensing experience<br />

• Display exceptional customer service and sales skills<br />

• Be committed to providing excellent patient care<br />

• Be well presented with an eye for fashion<br />

• Be a self-starter who can work with minimal supervision<br />

• Be versatile, reliable and motivated.<br />

The successful applicant must be available to work full time and<br />

some Saturdays.<br />

Please email your CV and a cover letter to<br />

sandri@patersonburn.co.nz<br />

16 <strong>Apr</strong>il <strong>2016</strong><br />

NEW ZEALAND OPTICS <strong>Apr</strong>il <strong>2016</strong> classified NEW ZEALAND 1

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