Jul 2016

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Inaugural Glaucoma New Zealand symposium announced Problem Solving We often see new patients on referral from optometric or ophthalmological colleagues, and quite often too from family members, friends or work colleagues of the patient. They’re often told “Go see Alan; he’ll sort out your problems!” Such referrals, although flattering, can be quite daunting and it certainly is a challenge to deliver what people seek and to meet or exceed expectations. More often than not we do solve the problems, often with excellent results. There’s a process one needs to follow and work through. The first thing I like to have at my disposal, on first contact with the patient, is their previous ocular history. What’s been tried in the past? If the previous practitioner has tried contact lens A, B, C & D then I will avoid repeating those. With a detailed review of the data from my measurements – comparing topography and manifest Rx, corneal curvature - and refractive versus corneal astigmatism - immediately tells me what lenses would be ideal. For example if we have no corneal astigmatism but manifest spectacle astigmatism then a soft-toric or spectacles are indicated. An RGP would not be, unless you’re an extremist who thinks that front toric prism ballast lenses are cool. There are of course many other scenarios that I’ve covered in previous columns over the decades and thus will not repeat here. These days too many practitioners seem to ignore K readings and things like HVID and pupil diameter and just go for the generic 8.6/14.2 soft lens or their ‘preferred’ multifocal soft lens. In a patient with very small pupils a centre near multifocal may provide decent near vision but there’s no way it will provide adequate or safe distance vision. Such patients are much more likely to succeed with the judicious choice of something like Biofinity D&N MF lenses, appropriately fitted to the dominant and non-dominant eyes. All too often I see a patient with an 8.40mm corneal curvature who has been fitted with an 8.4BC soft lens, that is way too tight, too steep and exhibits variable vision or is difficult to remove. At the other end of the spectrum some optometrists ‘prefer’ flat base curves but a 9.0BC 1 Day lens is not going to work too well on a steeper eye like a 7.2mm corneal curvature. We also have to consider eccentricity; a very flat eye with low eccentricity (as flat corneas tend to be) may not require the ‘standard’ flattening factor of say going 0.8 flatter than K. Thus an 8.7mm radius cornea may do well with a 9.0BC fitted only 0.3 flatter than K. Similarly a steep cornea with high eccentricity (as they tend to be) may do well with a lens that is say 1.2mm flatter than flattest K e.g. a 7.4mm steep cornea may do well with an 8.6BC soft lens. Nek Level These are the things one learns by experience and applying logic and first principles but if you don’t measure things or use the measurements you have, then you will never work out these relationships and just keep blindly fitting your favourite generic 8.6/14.2 or the lens your practice gets on the best preferred-provider deal. By applying some of the aforementioned principles, I more often than not put my first lens on the eye of these frustrated patients — who have had multiple practitioners apply multiple lenses without success – and hey presto we get a great result. Avoiding the previous practitioners’ trials and errors, makes us look good. It also helps to use the latest generation lenses that have the ultimate performance, comfort and visual quality and this further boosts your likelihood of success: As opposed to using some longin-the-tooth generic 55% water, 8.6/14.2 monthly disposable. While doing some recent trials with the latest Acuvue Oasys One Day lens I had many such scenarios in patients who were unhappy with numerous lenses, over some months or years. We had many ‘wow’ responses with better vision, comfort and immediate orders of a bulk supply of lenses. I so love it when a plan comes together. So do my patients. Such results beget even more referrals from happy, enthusiastic patients. Like I’ve always said it’s far better to have enthusiastic referrers, which cost you nothing, compared to expensive marketing and advertising campaigns that may deliver very few bums on seats. That’s not to say one shouldn’t do marketing and advertising or send out newsletters or harness social media: Of course one must as keeping your name out there, in multiple media, will keep reminding current, former and future patients. When they need you they are more likely to recall your name and come and see you. Not all patients want a free, quickie eye test at a convenient chain. Many patients are prepared to pay for longer consult times, thorough investigations and top quality products. Professionals should not be providing important professional services for free. It devalues our skills and professionalism. Would a free accountant or lawyer deliver the same professional quality and thoroughness that a QC or senior partner would provide? Methinks not. Au Contraire In my discussions, lectures and writing I often cite complex cases. The reason I do this is that there’s not much point getting excited about the performance of a given lens on a simple -2.00 myope with bullet proof corneas and no worries. Throwing the toughest cases at a given new lens, that’s promoted as the best thing since sliced bread, soon sorts the wheat from the chaff. From time to time people get the impression that a given lens I’m discussing is only good for problem solving. Au contraire! If a lens works fantastically on the toughest cases imagine how well it will do in simple cases. By fitting all your new cases with the best lens available – that’s providing performance levels that outstrip competitors by two, three or nine times in patient ratings — then surely the logical step is to use the lens? At maybe only a premium of 10% to 15% on price (which is less than the difference per day between a McDonald’s coffee and a high end Barista coffee) your patients will soon find out what the difference is should they go ‘downmarket’ and get fitted by a competitor with a ‘lesser’ lens? Some even self-prescribe the cheapest daily they can find on the Internet. If the cheaper lens provides poorer visual quality, reduced comfort, excess movement, dry eye symptoms and redder eyes then your job is done. Nothing convinces a patient more than their own experience. Such experiences also reinforce the fact that you’ve done the best you can, in their best interest. If there’s a mantra to go by — be the best you can be - is one to aspire to. ▀ Editor’s note and disclosure: Alan Saks was engaged by JJVC to share his experiences fitting Acuvue Oasys 1-Day at the recent ANZ product launches. He is not paid by any manufacturer to review or promote their products in his column, which remains independent. BY HANNAH KERSTEN FOR GNZ Professor Helen Danesh-Meyer, glaucoma specialist and chairperson of GNZ On 18 September this year, Glaucoma New Zealand (GNZ) will be holding its inaugural Glaucoma Symposium at Alexandra Park in Auckland. Professor Helen Danesh-Meyer, glaucoma specialist and chairperson of GNZ, will be overseeing the symposium programme. One of the key mandates of GNZ is glaucoma education - the webbased GNZ Professional Education Programme has been hugely supported by the optometry profession. This symposium is an extension of GNZ’s commitment to glaucoma education. Professor Danesh-Meyer says, “GNZ has been wanting to implement the idea for a couple of years – it seems particularly timely given the increased opportunity for optometrists to be involved in glaucoma management. Optometrists have a pivotal role in the diagnosis of glaucoma. However, now with therapeutic optometry, optometrists are increasingly involved in the ongoing care of glaucoma patients, and are independently prescribing glaucoma medications. The more ophthalmology and optometry interact and communicate, the better the outcomes for our patients.” This symposium is the first full-day optometry education event in New Zealand focused solely on glaucoma. The conference has the support of glaucoma specialists and will include speakers from both optometry and ophthalmology, including Professors Danesh-Meyer and Charles McGhee, Associate Professors Jennifer Craig and Gordon Sanderson, Drs Mark Donaldson, Dr Sam Kain, Sonya Bennett, Hussain Patel, Shenton Chew, Jay Meyer, Alex Buller, Alan Simpson, Jesse Gale, Dean Corbett and Graham Reeves, and optometrists Grant Watters and Hannah Kersten. Professor Danesh-Meyer hopes July is Glaucoma Awareness Month Glaucoma New Zealand (GNZ) is set to hold its Annual Awareness Appeal in July. It is a call to action – with a focus on getting people to have their eyes examined, raising awareness of glaucoma, and generating vital funds to enable GNZ to continue its sight-saving work. “Raising funds for GNZ to keep saving what most people consider their most precious sense, sight, plays an important role in this year’s campaign,” says GNZ executive manager, Helen Mawn. “Since 2002, GNZ has strived to make glaucoma a highly visible disease.” GNZ offers services to everyone affected by and concerned with glaucoma; advocating for regular eye checks, educating the public and health professionals, providing support and information to those with glaucoma and their families, as well as contributing to research. This year GNZ is teaming up with Cecily – a popular cartoon character created by Cantabrian Celia Allison. All through July, for every order at www.cecily.co.nz that uses the code “Glaucoma NZ” – 50% of the sale will be donated to GNZ. Just enter “Glaucoma NZ” in the instruction box when you see “Your Cart”. Cecily humour can be found on quality merchandise such as lens cleaning cloths, cards, calendars, stationery, prints, tea towels and much more. Have a laugh, make a purchase, and help Cecily help GNZ. Also lending their loyal support are the optometrists, ophthalmologists, and pharmacists around the country who have taken GNZ’s donation boxes. “Many optometrists and ophthalmologists are also donating $2 from each eye examination undertaken during July and we are grateful for the donations that we have received in lieu of taking donation boxes,” says Mawn. About 91,000 New Zealanders over the age of 40 have glaucoma and more than half don’t know they have it. Worldwide 64 million people have glaucoma and that’s expected to grow to 111.8 million worldwide by 2040. For more information visit www.glaucoma.org.nz ▀ that the GNZ Glaucoma Symposium “provides both depth and breadth in glaucoma care.” The overall theme of the Symposium is Glaucoma – from Diagnosis to Management. The day will be divided into four main sessions: glaucoma diagnosis, special issues in glaucoma, glaucoma treatment and case presentations. Presentations at the Symposium will cover fundamentals such as optic nerve interpretation and gonioscopy, as well as some of the challenging issues in glaucoma such as the treatment of normal tension glaucoma and secondary glaucomas. There will also be a special session in which challenging glaucoma cases are presented. GNZ is looking to apply for six clinical diagnostic CPD points for this one-day event. GNZ would like to make this a regular event, and hope to have an annual Glaucoma Symposium, with each event building on the previous year. Professor Danesh-Meyer and GNZ are very excited about this initiative and look forward to bringing together both ophthalmologists and optometrists in September. ▀ Glaucoma New Zealand Symposium 2016 - Registration now open - The inaugural Glaucoma New Zealand Symposium will be held in September 2016. This is a one day education event for optometrists and other eye health professionals. WHERE: Alexandra Park Function Centre, Greenlane West Road, Auckland WHEN: Sunday 18 September 2016, 9.00 am - 5.00 pm CONFERENCE PROGRAMME: It will be an exciting one day symposium with rapid-fire presentations on a wide range of glaucoma topics, including Glaucoma Diagnosis, Special Issues in Glaucoma, Glaucoma Treatment and Challenging Cases. The scientific programme is being overseen by Professor Helen Danesh- Meyer and presentations will be given by glaucoma specialist ophthalmologists and optometrists. COST: $120 per delegate for a full day of glaucoma education PROFESSIONAL EDUCATION: Application for 6 clinical diagnostic points REGISTRATION: For more information and to register for the Glaucoma New Zealand Symposium, visit www.glaucoma.org.nz Thank you to our Silver Sponsors 18 NEW ZEALAND OPTICS July 2016
J&J launch HydraLuxe Johnson & Johnson Vision Care launched its new contact lens, Acuvue Oasys 1-Day with HydraLuxe technology at a series of events in Australia and Auckland in May. The Auckland event at the Tamaki Yacht Club on 25 May was the last on the roadshow, which featured three speakers: Dr Emma Gillies, J&J’s professional affairs manager; keynote speaker Dr Brian Pall, senior principal research optometrist at J&J in Jacksonville, Florida; and our own Alan Saks, NZ Optics columnist on all things CL and optometrist with Mortimer Hirst in Auckland. Canapes and drinks and a couple of CPD points added to the warm and welcoming atmosphere as the speakers addressed a group of about 45 eye care professionals. Sean McKiernan, J&J’s national key account manager ANZ, kicked off proceedings mentioning the problems the CL industry has faced over the last decade and how J&J hopes its new HydraLuxe lens will change all that. “We can’t change everything, but what we can do is start the journey to try and get you to fall in love with contact lenses again.” McKiernan pointed out that increasing the love affair with CLs for patients could dramatically effect an optometrist’s bottomline. In the UK, on average, contact lens revenue represents 25% of an optometrist’s total optical sales, whereas in Australia and New Zealand it’s only 5%. “So there’s really an opportunity for all of us,” said McKiernan. Key to building up this revenue is stopping people exiting the category, he said. In 2015, 302,000 new wearers entered the CL category in Australia and New Zealand, but 229,000 dropped out. One way to keep new wearers is new products, said McKiernan. Dr Gillies started her talk stating that the new HydraLuxe lens is not Oasys mass produced. She continued the theme of dropout by quoting a UK study showing the main cause of dropout for new wearers was dry eyes and discomfort. To tackle this J&J commissioned a quantitative study of soft CL wearers to better understand the lens-wearing experience throughout the day; research that focused J&J on the tear film and thus helped them develop the HydraLuxe technology, she said. Before tackling the science behind the technology, an obviously passionate Dr Pall said the most important thing the audience could do is to try the lens for themselves. The technology is so good it can speak for itself, he said. As for the science, Dr Pall explained how the new lens is an innovative new daily disposable silicone hydrogel that’s designed to work with the key components of the natural tear film to lubricate and Obituary: Denis Kennemore BY JOHN BILLINGS It is with great sadness that I report the passing of a friend and well-known character in the New Zealand optical industry; Denis Kennemore. He passed away peacefully at home, aged 83 years, early Monday morning on 30 May. Denis was born 1933 in Sydney. In 1948 he began his working career at North Shore Gas Company as a sheet metal worker but he soon moved on to become an optical mechanic starting a five-year apprenticeship with AG Thomson and Sons. Denis left soon after completing his apprenticeship to join Geddes as an optical technician where his skills at fitting glass rimless frames stood him in good stead and he was there until 1956 (apart from 1948 to 1952 when he did his National Service in the Navy). 1956 brought the Melbourne Olympics and being an ardent sports fan he wanted to go, so resigned from Geddes. To fund the visit he went to Melbourne and got a job glazing sunglasses. After the Olympics he drove back to Sydney looking for work, but nobody wanted an optical technician, so he took a job painting the bottom of boats. His next move was to join OPSM where he worked in the lab. Knowing they were looking for smart people to train in optical dispensing and wanting to get on, he wore a shirt and tie to work. Eventually this paid off and they asked him to train as an optical dispenser in a store in downtown Sydney. Shortly afterwards he was transferred as assistant manager to Tamworth, a move not entirely with his agreement but that would have life changing consequences as it was here that he met Enid, the lady who would later become his wife, lifetime friend and, towards the end of his life, his intimate carer. Always the keen sportsman, Denis played rugby league here for a year but gave it up as, in his words, “the ground was too hard!!” Dr Brian Pall, Aki Gokul, Dr Emma Gillies and Alan Saks Jenny Ogier and Cliff Harrison moisturise the lens and support the patient’s tear film during lens wear, thus minimising friction from blinking and dryness. In an article written and circulated by Dr Gillies, the technology is described as “an enhanced moisture network with increased covalent bonding designed to further reduce the adhesiveness of the lens to better mimic the eye’s own mucins.” As well as explaining the science Pall also presented the clinical evidence showing that in a J&J study, twice as many wearers preferred the new HydraLuxe lens compared with another leading daily lens. “We think it’s a game changer. We hope you will continue to be as surprised as we are.” Alan Saks took a more personal approach to the new lens, sharing some particularly difficult CL patient case studies and explaining what happened when he decided to trial the new HydraLuxe lens on them. All fell instantly in love with the new lenses, he said, and most also experienced some degree of improved vision. “It’s my first choice for new and existing wearers,” he said simply. “And you never get a second chance to make a good first impression,” summarised Dr Gillies. ▀ After marrying at Christmas in 1960, Denis and Enid moved to Wellington for a three-year stint. However, an opportunity with Optical Prescription Spectacle Makers NZ arose, and Denis purchased 51% of the business. Denis and Enid were to stay in New Zealand. In July 1961 ADONZ was formed by eight founding members, including Denis. A key milestone was the success he achieved through tough negotiations for the exclusive use of the title “dispensing optician” by people registered under the new opticians Act of 1977. Denis was the first dispensing optician to be appointed by the Board and the first registered DO in New Zealand holding the registration number 61- 00001, a fact of which he was extremely proud. In 1982 he owned a store in Capital on the Quay where he showed forward thinking by being one of the first practices to display frames rather than having them in drawers. In 1988 Denis was elected a Life Member of ADONZ. In 1990 Denis was the first DO to employ an optometrist and in November 1990 opened another store in Porirua. Unfortunately, in 1992 he began having health problems and in 1993 underwent heart surgery, which is where I came onto the scene. He brought me out from the UK to work for him as a DO in the Porirua store. Due to his ill health, he and Enid decided to sell the business and in November 1994, OPSM Australia purchased Optical Prescription Spectacle Makers NZ. On their retirement Denis and Enid established the Kennemore Education Fund. This fund was initially established to support struggling Ahead of the game Style-Eyes It was 1995 when I got my first pair of glasses and I don’t recall a single pair seeming fashionable. ‘Geek chic’ was yet to become a trend and bespectacled teenagers around the country were all given the same nickname of ‘nerd’. The only recollection I have of anyone wearing glasses as a fashion item was Lisa Loeb’s tortoiseshell cat eye frames in her 1994 music video for ‘Stay’. I chose my very first pair because they seemed handsome and well-made. They were light, round metal frames with subtle engraving. In 2016, this exact style is finally in fashion. Is this proof of the theory that fashion is currently on a cycle of around twenty years? Maybe I was just ahead of my time! I never loved my first pair of glasses the way I love the frames I have owned since. I finally took inspiration from Lisa Loeb at the age of 18 in 1998 and got a pair of retro-inspired tortoiseshell frames. Glasses became my ‘thing’. After this, I made my way through several rectangular pairs that were very popular in the early 2000s. Forest green! Lilac! Wave patterns on the temples! Apart from the colours, there was nothing particularly interesting about them. I was yet to discover the delightful world of independent designers and deadstock vintage frames! My first foray into something slightly unusual were some Modo frames. I loved the temple position. They also had crystal temples with embedded glitter! These frames could not be worn to the pub, lest some clever intoxicated person insist I was wearing my glasses upside down and that they simply must try them on! This was just the beginning. I was hooked. Around the time I purchased the Modo frames, I decided to consult the internet for eyewear advice. It was 2008 and the independent fashion blog craze was well underway. You could find blogs about almost every fashion item, except eyewear. I had been making websites since I was a teenager in the late ‘90s so, of course, I started my own and eyeheartglasses.com was born. I barely knew anything, except that I loved the look of eyewear and all of my friends and family consulted me if they needed a shopping buddy students in their education and Denis and Enid have been generous in their contributions every year since. In later years as the fund grew, it was able to support every New Zealand student DO with the purchase of their text books. While Denis retired from optics, he still kept a keen eye on what was happening, and after he lost the ability to read after several strokes, would get Enid to read him the NZ Optics magazine news articles. He retained his non-practising registration status right up until his death. Denis was not only involved with the optical industry, but he threw his heart and soul into everything he had an interest in, be that bowls, golf, horse racing or the local community. In 2014 Denis and Enid were recognised by the Porirua Mayor, being awarded a Mayoral Certificate of Recognition for voluntary services to their community Denis was a straight shooter, who told things as they were and didn’t suffer fools. Sometimes this came across as him being described by some as a “grumpy bugger” but beneath that was a heart of BY JO EATON for their new pair. I still had a lot to learn. My style evolved and I became bolder with my choices. Here, it was time to prove the twenty-year cycle wrong. In 2010, 30 years after their initial release, I happened upon some geometric Cazal frames. They’re deadstock and were made in 1980! I spent many hours hunting this exact colourway on eBay and I think my perseverance was well worth it. My blog started to become recognised in the industry and I was sent glasses by a few companies. My favourite of these were sent by Patty Perreira of Barton Perreira fame. I loved these so much that they were my number one pair for over three years. I’ve tried everything since: independent brands, chain stores and vintage deadstock. I even experimented with cheap online stores, the results being mostly awful. The one exception was a Kam Dhillon pair from Clearly that I bought in 2011. They served me well for a while! During my overseas travels in 2014, I saw a job advertised back in Melbourne at just the kind of independent boutique I’d dreamed about working in. I explained that I had no optical experience. On my return, they gave me a month trial anyway. It turned out they needed someone fully qualified, so I didn’t get to continue. But I loved working there so much, that I decided to pack in my decade-long career in digital marketing, and study the Certificate IV in Optical Dispensing full time, at RMIT. What about my glasses these days? I alternate between a deadstock vintage pair of white 1980s Martin Wells frames from Australia and a geometric orange and gold pair from Austrian brand Andy Wolf, but I always keep my eyes peeled for future trends. I look forward to sharing my insights with you here. ▀ * Jo Eaton is an optical dispensing student at RMIT. Originally from Wellington, Jo became interested in eyewear after discovering she was myopic at the age of 14. In 2008, many years after deciding to make unusual glasses her ‘thing’, she founded eyewear fashion blog ‘Eye Heart Glasses’. When she’s not immersed in the world of spectacles, she works in digital marketing, DJs, volunteers for community radio and is a director of feminist music organisation LISTEN. gold and a generous nature of spirit - and often a cheeky little smile. If it is the mark of the man what a difference he makes to people’s lives, then Denis you were a very big man, as you touched the lives of many. On behalf of his family, I would like to thank those people from the optical industry who attended his funeral, DO’s (present and retired), the president and secretary of ADONZ, wholesalers, previous employees and board staff, it was much appreciated and would have touched Denis. On behalf of the industry, I pass on our condolences to loving wife, Enid, son Bruce (DO), daughter Gillian and family. May you take comfort from the fact that many share your grief at the loss of a great man. Denis has now hung up his PD ruler, and turned off the vert, but as always I am sure he is still keeping a watch over what is happening in the industry. Denis, you will be truly missed. May you rest in peace. ▀ July 2016 NEW ZEALAND OPTICS 19
Page 1 and 2: THE MAGAZINE FOR NEW ZEALAND’S OP
Page 3 and 4: New diploma for Foundation A culmin
Page 5 and 6: ©2016 NIKE, INC. Become a stockist
Page 7 and 8: For the first time in Auckland, Alc
Page 9 and 10: It’s all in You make every move w
Page 11 and 12: A nurse’s perspective What’s ne
Page 13 and 14: The wider world of medicine and opt
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Page 17: with Prof Charles McGhee & A/Prof D

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