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THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY<br />

PO BOX 106 954, AUCKLAND CITY 1143<br />

Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz<br />

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

PAYMENTS OF<br />

UP TO $50,000<br />

ON EACH<br />

SUCCESSFUL<br />

OPTOMETRIST<br />

REFERRAL.<br />

CONTACT CARLY PARKINSON FOR<br />

FULL TERMS AND CONDITIONS.<br />

$..‘000’S ON<br />

OFFER FOR<br />

EVERY REFERRAL<br />

TO FIND OUT HOW YOU CAN BENEFIT FROM<br />

THIS INDUSTRY-WIDE OFFER, CONTACT<br />

CARLY PARKINSON ON 0800 717 350 OR<br />

CARLY.PARKINSON@SPECSAVERS.COM<br />

– OR VISIT SPECTRUM-BLOG.COM.


2015 was a challenging year for Bausch and Lomb with plenty of<br />

drama. The stage is set for a much improved <strong>2016</strong>:<br />

• Better supply direct from B+L Australia to your door<br />

• A dedicated B+L customer services team<br />

• An expanded sales team to ensure better service in store<br />

• Simplified universal pricing to ensure fairness and profitability for all<br />

• A game changing web service that will enable you to compete with the<br />

internet - watch this space!<br />

We’re determined to regain your trust and your business through<br />

exceptional service and world class products.<br />

We’re getting our act together<br />

2 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong><br />

If you would like to talk to us about our new web service or<br />

the new lenses we’re about to launch, call us on 0800 658 386


New beginnings for B+L in NZ<br />

So much to tell …<br />

Radiant Health’s team (L to R) Mikaela Gilbert, Yvette Beattie, Conor Fitzgerald, Peter <strong>May</strong>, Craig Dallas and Leanne Fierro<br />

Craig Dallas, commercial business director<br />

for Radiant Health, Bausch + Lomb’s<br />

distributor in New Zealand, admits it has<br />

been an annus horribilis for the company in terms<br />

of supply issues. But he’s confident this is about to<br />

change, with a new system for Kiwi optometrists<br />

that will transform their ordering process and<br />

could even tackle the increasingly gnarly problem<br />

of online contact lens sales.<br />

Radiant’s problems started in a minor way when<br />

they reorganised their computer and warehouse<br />

systems to make the leap from agency supplier<br />

to full distributor for B+L more than 18 months<br />

ago. As a distributor they had to purchase stock, so<br />

the company needed to manage its stock far more<br />

carefully. “But because these were changes initiated<br />

by us, we were in control of them, so they were all<br />

quite minor really,” says Dallas.<br />

But when B+L in Australia changed both their<br />

warehousing systems and moved to a new<br />

computer system in March last year, things really<br />

began to fall apart.<br />

“It caused chaos. For a period of about six weeks<br />

we didn’t receive any stock from Australia at all and<br />

then for months afterwards we received incomplete<br />

or slow orders.”<br />

The supply chain crisis affected Radiant’s ability to<br />

distribute product on both the surgical and vision<br />

care sides of the business, says Dallas. “The main<br />

impact was on contact lenses because within the<br />

portfolio there are 24,000 SKUs (stock keeping<br />

units), so there is always something you are going to<br />

be out of.”<br />

Dallas and his team grew so frustrated with<br />

Australia, they tried to bypass it and bring in product<br />

from Hong Kong, but given the Asian population<br />

are far more myopic than the West, they had few<br />

plus power products to send over. Also, under B+L’s<br />

distribution system, New Zealand is supposed to be<br />

covered by Australia’s systems so it was only going<br />

to be a one-off, short-term measure.<br />

New electronic ordering system<br />

Finally, Australia has sorted out its systems and<br />

supplies are getting back to normal, but the whole<br />

experience spurred Radiant on to completely<br />

overhaul the way it does business. A brand new<br />

electronic ordering system, developed by Radiant,<br />

with a simple website interface is due to go live on<br />

1 <strong>May</strong>.<br />

This will allow optometrists to order stock as they<br />

need it, directly from B+L, and have it delivered<br />

directly to them or, if they prefer, directly to their<br />

customers. This will speed things up exponentially,<br />

says Dallas, as it cuts out the delays caused by<br />

sending stock via a middleman, in this case Radiant,<br />

and simplifies the whole process dramatically, so<br />

there’s far less chance for any problems to arise. If<br />

optometrists prefer to continue to use their practice<br />

management system for ordering lenses etc., that’s<br />

fine too, says Dallas, as his team will enter the<br />

details on the ordering website for them. “We’ve<br />

been working furiously for the last six months to<br />

develop the electronic ordering system and remove<br />

all the delays in the supply chain.”<br />

Once the system is live, all orders sent through<br />

the web before 11 am will arrive in New Zealand<br />

the following morning to be delivered to the<br />

optometrist or their customer either that same day<br />

or the day after, with an additional day for more<br />

rural areas. Dallas says they couldn’t do it faster<br />

themselves even if they held all the right stock here.<br />

Fixing the supply chain problem was the first<br />

priority, he says, as Radiant prides itself on<br />

delivering great customer service. After just three<br />

years, Radiant was voted the No. 1 supplier in the<br />

latest New Zealand Pharmacy Coal Face customer<br />

satisfaction survey of the country’s pharmacists.<br />

“But optometrists here would just laugh if they<br />

heard that, as they would definitely vote us<br />

the worst.”<br />

New products in the pipeline<br />

Dallas says his team is determined to turn this<br />

around. With the supply chain problems fixed, the<br />

new electronic ordering system about to go live,<br />

Radiant can also finally launch the much-anticipated<br />

presbyopic range of its premium, daily-disposable<br />

contact lens brand Biotrue and its new monthly<br />

Ultra range, with its patented MoistureSeal<br />

technology (see story below).<br />

The bigger picture: taking on internet sales<br />

With all the nuts and bolts fixed, Radiant has also<br />

turned its attention to the increasing problem of<br />

online contact lens sales for Kiwi optometrists.<br />

Dallas is one of the first to admit the whole idea<br />

of CL manufacturers supplying stock at a cheaper<br />

price to online retailers who neither fit nor can<br />

recommend the right lenses for patients is more<br />

than crazy. But with the right technology, there’s no<br />

reason why optometrists can’t claim a significant<br />

portion of this online revenue for themselves, while<br />

also giving their patients the peace of mind they<br />

are getting the right lenses at an equivalent price<br />

in a secure and efficient manner.<br />

At this stage, Dallas was reluctant to reveal too<br />

many details as he didn’t want competitors getting<br />

wind of them, but he says the new technology is an<br />

add-on to the company’s newly developed online<br />

electronic ordering system that can simply and<br />

efficiently be handled by the patient themselves,<br />

allowing the optometrist to sit back and share in the<br />

profits of the sale.<br />

Radiant is planning to trial the new system in the<br />

next couple of months with a group of about 20 to<br />

30 optometrists. Once all the bugs are eliminated, it<br />

will be rolled out to the whole country.<br />

It should revolutionise the business of selling<br />

and buying contact lenses, says a very chuffed<br />

Dallas. “It’s massive. A game-changing web<br />

service, as our ad says. But for the moment you’ll<br />

just have to watch this space.” ▀<br />

Radiant bolsters B+L team<br />

Radiant has beefed up its Bausch + Lomb<br />

distributor team, with some new and some<br />

familiar account managers including Yvette<br />

Beattie, who returns from maternity leave to<br />

help with the vision care side of the business,<br />

Conor Fitzgerald, who moves across from<br />

another Radiant role, Mikaela Gilbert, who’s<br />

taken on the new sales role in Christchurch,<br />

and Peter <strong>May</strong> and Leanne Fierro.<br />

Team head, Craig Dallas, Radiant’s<br />

commercial business director, says Radiant<br />

Health Customer Services was contracted<br />

out last year to the company’s warehousing<br />

partner Supply Chain Solutions, but the<br />

decision was made to bring this service inhouse<br />

from this year to add more focus to the<br />

optometry and ophthalmology side of the<br />

business and improve the company’s service<br />

levels. “This has been a huge success,” he says,<br />

particularly the new South Island sales role.<br />

“We found that servicing the South Island<br />

from Auckland is not practical and generally<br />

means our southern customers don’t get the<br />

service they need.”<br />

Gilbert is managing both optometry and<br />

ophthalmology and will help to roll out<br />

Radiant’s new electronic ordering system and<br />

launch Ultra and Biotrue for presbyopia, says<br />

Dallas. If everything goes well, Dallas says<br />

Radiant could take on more sales people<br />

next year. ▀<br />

EDITORIAL C ▀<br />

Well the conference and seminar<br />

season has truly started, kicked off<br />

by a packed one-day event from the<br />

Cornea and Contact Lens Society (CCLS) in the<br />

comfortable and central surroundings of Mac’s<br />

Function Centre on Wellington’s waterfront.<br />

Conference venues attached to pubs, with the<br />

addition of a pub-like bar on the exhibition floor,<br />

are always an excellent idea (in my humble<br />

opinion) for encouraging networking!<br />

To make it even more appealing, CCLS added<br />

a preceding glaucoma workshop this year,<br />

that was fully booked almost as soon as it<br />

was announced. A round-up of both events,<br />

kindly supplied by Dr Jesse Gale and Roberta<br />

McIlraith, plus what’s new from CCLS’s industry<br />

supporters is included in this issue.<br />

Eye Doctors held their first Grand Round in<br />

Auckland, featuring some fascinating case<br />

studies, including the tragic case of a young man<br />

whose sight had deteriorated severely for no<br />

obvious reason. But some lateral thinking on Dr<br />

Shuan Dai’s part led to a happy ending (p13).<br />

Next month we’ll report on the inaugural<br />

Ocular Therapeutics Conference, which attracted<br />

a staggering 335 delegates, and was so packed<br />

full of information we simply didn’t have space<br />

to do it justice this month.<br />

We have included the highlights of the<br />

forthcoming RANZCO NZ Branch Meeting<br />

in Dunedin, however, for those of you still<br />

considering whether to go.<br />

Plus, there’s a host of news and a clever idea<br />

for those optometrists wishing to take on CL<br />

internet sales from B+L distributor Radiant,<br />

who gave us a very frank account of the<br />

problems it has had and why those days are<br />

truly behind them.<br />

So enjoy and, as always, if you have something<br />

to share, we’d love to hear from you.<br />

Happy school holidays! ▀<br />

Lesley Springall, publisher, NZ Optics<br />

B+L launches Ultra in NZ<br />

Bausch + Lomb distributor Radiant Health<br />

is set to launch its new premium, monthly<br />

lens Ultra from next month, as soon as its<br />

new electronic ordering system (see story above)<br />

goes live.<br />

Unveiled at the <strong>2016</strong> CCLS conference in<br />

Wellington and the first Grand Rounds seminar<br />

evening (see p13) from Eye Doctors in Auckland,<br />

B+L Ultra lenses have been designed to stop or<br />

greatly reduce the problem of contact lenses drying<br />

out and so causing discomfort to the wearer after a<br />

long-day of staring at a computer screen.<br />

The lenses incorporate what B+L terms its unique<br />

MoistureSeal technology, using a new material—<br />

designed with “water-loving molecules for excellent<br />

wettability”—and a new manufacturing process,<br />

both developed over seven years, to ensure the lens<br />

maintains 95% of its moisture for a full 16 hours.<br />

“Primarily it’s about comfort,” says Craig Dallas,<br />

Radiant’s commercial business director. “Ultra’s<br />

gone extremely well in the US, where it’s been<br />

available for just over a year, and so it’s being<br />

launched now in Australasia.”<br />

With people increasingly staring at screens and<br />

blinking far less than they used to, contact lens<br />

comfort, or lack thereof, is becoming an increasing<br />

problem. But new moisture-rich products such<br />

as Ultra should mean patients will be far happier<br />

wearing their contact lenses for longer periods of<br />

time again, says Dallas. ▀<br />

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

NEW ZEALAND OPTICS<br />

3


News<br />

in brief<br />

SAVE THE DATE FOR GLAUCOMA NZ!<br />

Glaucoma New Zealand will hold its first-ever Glaucoma<br />

Symposium on 18 September <strong>2016</strong> at Alexandra Park in Auckland.<br />

The scientific programme is being put together by Professor<br />

Helen Danesh-Meyer and will include rapid-fire presentations<br />

by glaucoma-specialists on a wide range of glaucoma-related<br />

topics, including ophthalmic imaging, glaucoma management<br />

in pregnancy, gonioscopy, selective laser trabeculoplasty, new<br />

frontiers in surgical management and case-based presentations.<br />

If you are interested in being a sponsor of this exciting event,<br />

please contact Helen Mawn, at h.mawn@auckland.ac.nz for more<br />

information.<br />

CONTACT LENS CAMERA A REALITY<br />

As children we imagined it,<br />

as adults we’ve watched it on<br />

the big screen; now, thanks to<br />

Samsung, taking photos with<br />

your eye is a reality. The Korean<br />

technology firm have applied for<br />

a patent for their smart contact<br />

lenses that contain a built-in<br />

camera, sensors and a display<br />

that allows users to take photographs by blinking their eyes and<br />

transmit those images to a smartphone or tablet. Using tiny eye<br />

sensors to detect movement commands, the smart lens also has<br />

a display that seamlessly interfaces with the user’s natural vision.<br />

Move over 007!<br />

ONLINE EYE-TEST CALLED INTO QUESTION<br />

The American Optometric Association (AOA) has submitted a<br />

complaint to the US Food and Drug Administration (FDA) about<br />

Opternative’s online eye test. Opternative is marketing the online<br />

exam direct to consumers saying it can provide prescriptions “as<br />

accurate as an in-person refractive eye exam.” AOA claims the<br />

test poses “significant health risks”, Opternative’s claims aren’t<br />

substantiated, the test uses “unproven technology”, which hasn’t<br />

been investigated by the FDA. The major concern AOA raises is that<br />

people using the test will not visit a trained professional who can<br />

detect underlying medical conditions.<br />

AUTOFOCUSING CONTACT LENSES IN DEVELOPMENT<br />

Research funded by the US National Eye Institute and the US<br />

National Institute of Health Director’s New Innovator Awards is<br />

exploring a contact lens that will focus automatically. Headed up<br />

by Dr Hongrui Jiang from the University of Wisconsin, the project<br />

aims to develop a lens that will focus within milliseconds, using<br />

algorithm-driven sensors and tiny electronic circuits that adjust<br />

lens shape. Researchers have a working prototype, but believe<br />

clinical testing may be at least 5 to 10 years away.<br />

SEE THE LIGHT<br />

A study reported in Investigative Ophthalmology and Visual<br />

Science has demonstrated that a greater light exposure elicits<br />

smaller changes in axial length over an 18-month period. The study<br />

measured axial eye growth and light exposure in 101 children<br />

(41 myopes and 60 non-myopes) between 10 and 15 years old. A<br />

wrist-worn light sensor recorded mean daily light exposure for each<br />

child. The researchers noted a modest, but statistically significant<br />

association between greater average daily light exposure and<br />

slower axial eye growth, supporting the association between<br />

greater childhood myopia and less time spent outdoors.<br />

STERILISATION PRACTICES UPDATE NEEDED<br />

A US petition has been launched to encourage the AOA to update<br />

its sterilisation guidelines. The petition, launched by the American<br />

Safe Sight Foundation, notes hundreds of thousands of people<br />

in the US annually contract preventable eye infections, including<br />

epidemic keratoconjuntivitis, from poor sterilisation practises,<br />

resulting in up to 100,000 deaths a year, mostly among elderly/low<br />

vision patients. Most US ophthalmology practices still just rely on<br />

alcohol wipes or use equipment/treatments on multiple patients<br />

that could be disposable, said the Foundation.<br />

CONTACT-LENS COMFORT MACHINE<br />

When Stanford University PhD student Saad Bhamla couldn’t<br />

stand the discomfort from his contact lenses anymore, he decided<br />

to do something about it. Together with his supervisor, Professor<br />

Gerald Fuller, Bhamla built a device that mimics the surface of the<br />

eye. The machine, called the Interfacial Dewetting and Drainage<br />

Optical Platform, or i-DDrOP, reproduces a tear film on the surface<br />

of a contact lens that allows scientists and manufacturers to<br />

systematically handle an array of variables that affect tear film,<br />

including temperature, a variety of substances, humidity and the<br />

way gravity acts along a curved surface, so they can make a more<br />

comfortable lens. ▀<br />

EVF: making a difference in schools<br />

When Essilor launched their Essilor<br />

Vision Foundation (EVF) initiative<br />

in August 2015, it was with<br />

tentative flair. The initiative’s aim was<br />

to screen year 5 and 6 children in low<br />

decile schools to determine whether they<br />

needed glasses. The first school to take<br />

part, Flaxmere in Hawke’s Bay, saw more<br />

than 120 students screened with nearly<br />

40% needing follow up appointments with<br />

optometrists.<br />

In schools like Flaxmere, where many<br />

children are considered to have learning<br />

and behavioural difficulties, it seemed<br />

incredible the simple question of whether<br />

they could see clearly enough to engage in<br />

their education had been overlooked.<br />

This pilot scheme was hailed a great<br />

success, but how that would translate<br />

into a nationwide programme seemed<br />

uncertain.<br />

“There were big challenges ahead of us,”<br />

admits Kumuda Setty, Essilor’s marketing<br />

manager who is spearheading the project.<br />

“Our focus is on decile 1 and 2 schools and<br />

many of these students have access to a<br />

Community Services Card (CSC) and help<br />

through WINZ, but they don’t have the<br />

support to access it.”<br />

One boy told Setty his mother left for<br />

work very early in the morning and didn’t<br />

get home until 8pm, making it impossible<br />

to access optometry services in normal<br />

working hours; while another mother told<br />

the school she did not want her son to be<br />

seen wearing glasses in public.<br />

Whether it is the stigma attached to<br />

wearing glasses or simply the fact the<br />

parent is not available to take their child for<br />

screening, it was clear change was needed<br />

and that had to be led by the schools,<br />

says Setty.<br />

“We wanted schools to take full<br />

responsibility for the students, from<br />

arranging follow-up tests to ensuring they<br />

wore the glasses in class. But it was hard to<br />

get buy-in, then Louisa came on board.”<br />

A patron for the cause<br />

Louisa Wall MP looks after Manurewa, one<br />

of South Auckland’s poorest districts. She<br />

has 27 schools in her area and 25 are decile<br />

1 and 2. When she heard about EVF, she<br />

decided to champion the project among her<br />

own electorate’s schools and has recently<br />

come on board as an ambassador.<br />

“The importance of finding the estimated<br />

30% of children who have vision challenges<br />

that can only be treated if diagnosed with<br />

appropriate education and glasses is vital<br />

if all our children are to fully realise the<br />

potential of our public education system,”<br />

says Wall. “It is not good enough to screen<br />

Essilor unveils Eyezen<br />

Eyezen, the new lens from Essilor,<br />

developed specifically to protect<br />

against increasing screen use, was<br />

unveiled to Essilor’s Platinum Partners in a<br />

series of regional roadshows in April.<br />

“Innovation in ophthalmic optics is more<br />

crucial than ever. Behaviours are changing<br />

rapidly and prevention must be at the<br />

heart of visual health,” said Jean Carrier,<br />

Essilor International’s chief operating<br />

officer. “Our latest innovation, the Eyezen<br />

range, illustrates our commitment to keep<br />

offering innovative solutions to answer<br />

visual correction and prevention needs for<br />

consumers across the world.”<br />

The Eyezen range, which won a gold award<br />

at Silmo in Paris at the end of last year,<br />

features two new technologies designed<br />

to support wearers who use a lot of digital<br />

media. Eyezen Focus vision correction<br />

is specifically adapted to new reading<br />

distances corresponding to each digital tool,<br />

including ultra-near vision. The average<br />

reading distance for a smartphone is 33 cm<br />

compared with 42 cm for a book. Eyezen<br />

lenses provide a new solution to ease eye<br />

accommodation, especially when switching<br />

from one type of a screen to another, said<br />

Essilor. The range also incorporates Essilor’s<br />

children and to<br />

merely identify<br />

vision challenges.<br />

They must then<br />

be tested by<br />

optometrists and<br />

if need be have<br />

access to glasses to<br />

maximise learning.”<br />

With Wall’s backing<br />

EVF, which was<br />

officially granted<br />

charitable status<br />

in January <strong>2016</strong>,<br />

gained access to<br />

a number of low<br />

decile schools in<br />

South Auckland, all<br />

agreeing to ensure<br />

they followed-up<br />

with any children<br />

found to have vision<br />

problems.<br />

Kiwi optometrists step up for<br />

the cause<br />

“We utilise our Platinum Partner network<br />

to source optometrists willing to volunteer<br />

their time in their local community,” says<br />

Setty. “We asked just for one day, but we’ve<br />

had many optometrists giving two, three<br />

and even four days to the programme so<br />

far – and some of those are even serving<br />

communities outside their area.”<br />

The screening takes place at the school<br />

with the volunteer optometrists. All the<br />

equipment is provided by Essilor. In the<br />

four schools screening in South Auckland<br />

so far, the Foundation has found between<br />

30% and 40% of children (and some staff<br />

members) needed follow-up screening.<br />

“The schools then utilise the government<br />

funding they have to take the children<br />

to a follow-up appointment with a local<br />

optometrist at a designated time,” explains<br />

Setty. “Those who need glasses are given<br />

two pairs—one for home and one for<br />

school—and the teachers then commit<br />

themselves to making sure those children<br />

look after and wear their glasses.”<br />

The glasses are paid for by the children’s<br />

CSC funding allowance, but in the few<br />

cases where no funding is available, Essilor<br />

is currently covering the cost.<br />

Support from the schools<br />

“We’ve had a remarkable response,” says<br />

Lois Hawley, deputy principal of Rowandale<br />

School. “The benefit of students getting free<br />

lenses and frames is too good to turn down.”<br />

Rowandale recently had 176 students<br />

screened in one day by optometrists from<br />

Visique Frith & Laird in Manurewa, and<br />

new LightScan technology, which selectively<br />

filters blue light to help protect users from<br />

the harmful effects of blue-violet light rays.<br />

There are 1.5 billion people in the world<br />

using a smartphone daily, and nine out of 10<br />

report spending more time on a screen than<br />

two years ago.<br />

With 70% of people also reporting an<br />

impact on their vision from screen use,<br />

including visual fatigue and neck and back<br />

pain, it’s clear a new approach for lens users<br />

is sorely needed, said Essilor, which currently<br />

invests 180 million Euros in research and<br />

development and employs 550 researchers<br />

worldwide. ▀<br />

Heather Laird and the team from Visique Frith & Laird helping low decile school kids with EVF<br />

found that 56 needed further testing. Over<br />

the next two months the school has six<br />

days earmarked to take these students in<br />

small groups to local optometrists for the<br />

next phase.<br />

“Our whanau are really involved, parents<br />

are volunteering to take students up,” says<br />

Hawley. “The follow up is a big commitment;<br />

we need to teach students to be responsible<br />

about wearing and looking after their<br />

glasses—it’s a lesson in self-management.”<br />

The school have also counteracted the<br />

potential stigma attached to wearing<br />

glasses at school by making the receipt of<br />

glasses a celebration.<br />

“We had kids running out the door yelling<br />

‘I’ve failed!’ with big smiles on their faces.<br />

They’re excited about the glasses and the<br />

support they will receive,” says Hawley.<br />

The future<br />

While this has been a great initiative for the<br />

few schools who have taken part so far, both<br />

Setty and Wall have bigger goals in sight.<br />

“I’d like to screen 3,000 students this<br />

year,” says Setty, who adds that Essilor<br />

is currently picking up the bill for the<br />

Foundation’s project. “Louisa is helping<br />

with her network of MPs to see who can get<br />

buy-in from their local schools.”<br />

Wall has also got Massey University on<br />

board to undertake a study on the impact<br />

the programme is having. They will be<br />

monitoring participating schools to see if<br />

the academic achievements of the screened<br />

students improve as a result.<br />

“We need to remove all the barriers that<br />

impact negatively on our children’s learning<br />

potential because we need all our children<br />

to be happy, engaged and fully participative<br />

members of society,” says Wall. ▀<br />

Screening<br />

MS patients<br />

A new study published in Lancet<br />

Neurology concludes the thinning<br />

of the peripapillary retinal nerve<br />

fibre layer (pRNFL) can predict the<br />

progression of multiple sclerosis (MS).<br />

The two-year study was conducted<br />

across eight countries and tracked<br />

879 MS patients who did not suffer<br />

optic neurosis. The results showed<br />

a link between a thinner pNRFL and<br />

a worsening of symptoms, leading<br />

researchers to recommend MS patients<br />

be screened yearly. ▀<br />

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand<br />

For general enquiries, please email info@nzoptics.co.nz<br />

For editorial and classifieds, please contact Jai Breitnauer, editor, on 022 424 9322 or editor@nzoptics.co.nz.<br />

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NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times<br />

a year, by New Zealand Optics 2015 Ltd. Copyright is held by NZ Optics 2015 Ltd. As well as the magazine and the website,<br />

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products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The<br />

views expressed in this publication are not necessarily those of NZ Optics (2015) Ltd.<br />

4 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


Retina NZ looks to 2018<br />

NZ short on orthoptists<br />

Long-serving Retina Society of New Zealand<br />

President Fraser Alexander has stepped<br />

down, in part to help plan for the 2018<br />

Retina International congress—the first such<br />

meeting to be hosted in New Zealand in the<br />

congress’ 34-year history.<br />

“Fraser is keeping his finger in the pie,” said<br />

Membership Officer Petronella Spicer, during<br />

Retina NZ’s 20 March meeting. “He is on the<br />

organising committee for the international<br />

congress for 2018 and he is still on the<br />

management board of Retina International.<br />

“He has been the president now for quite a<br />

number of years and he has done that job so well,<br />

so articulately. He has a wealth of knowledge<br />

about what the professionals are talking about.”<br />

Vice President Sue Emirali will be acting<br />

president in Alexander’s stead.<br />

While the congress is only two years away, it is<br />

a major undertaking for an organisation manned<br />

by volunteers.<br />

“As you appreciate, we are the smallest country<br />

to take on the assignment of the world congress,”<br />

Alexander said. “The congress depends on a lot of<br />

people working together and working efficiently.<br />

This is a two-year process and this is an exercise in<br />

coordination.”<br />

The congress will be held in February 2018 at<br />

the University of Auckland’s Owen Glenn building.<br />

More than 100 people are expected to attend. It will<br />

feature presentations by retinal disease researchers,<br />

rehabilitation professionals, adaptive technology<br />

specialists and others.<br />

The announcement of Alexander’s resignation<br />

as president came at the end of Retina NZ’s first<br />

public meeting of the year. The meeting attracted<br />

dozens of members, as well as a large group<br />

of student volunteers from the University of<br />

Auckland’s optometry programme.<br />

Retina NZ’s public meeting<br />

Attendees heard presentations from Mary<br />

Fisher, a 23-year-old Paralympic gold medalist in<br />

swimming, who was born with aniridia.<br />

Fisher won several medals at the 2012 London<br />

Olympics and set a world Paralympic record in<br />

one of her races. To even-out the playing field,<br />

competitors of varying low vision wear blacked-out<br />

goggles when swimming, which must be inspected<br />

at the end of a race to ensure they had not been<br />

tampered with to give a competitor an advantage.<br />

“There’s a wait between the end of race and the<br />

announcement of the results,” said Fisher, refering<br />

to these moments as “microwave minutes”.<br />

“It feels so much longer than it actually is. When<br />

I was told I won a gold for the last race, it felt like<br />

all the hundreds of people who helped get me<br />

there were there. It was the most amazing<br />

feeling ever”.<br />

Next, Dr Andrea Vincent gave a summary<br />

update on advances in gene therapy and gene<br />

replacement therapy for treating retinal disorders.<br />

While she acknowledged it is “always an exciting<br />

time” in retinal therapy research, several gene<br />

therapies are progressing from Phase I to Phase II<br />

studies, across multiple conditions.<br />

This includes use of viruses to correct RPE65,<br />

the gene responsible for the rare condition of<br />

amaurosis. A company called Spark Therapeutics<br />

currently has a patent in front of the FDA in the<br />

US for the therapy, following a Phase III study.<br />

“A lot of other genes have been highlighted<br />

as good candidates for gene therapy or gene<br />

replacement therapy,” said Dr Vincent.<br />

This includes a gene therapy for Choroideremia<br />

now in Phase II, a Phase I study for treating<br />

retinoschisis and a study proceeding to Phase II on<br />

the ABCA4-related Stargardt’s disease.<br />

There have also been important advances in<br />

using non-embryonic cells from the patient<br />

herself to be used in gene replacement, which<br />

negates the need to use immune-suppressants in<br />

planting donated cells into the retina.<br />

Finally, University of Auckland student Benjamin<br />

Wright spoke about his experience in the Retina<br />

NZ Summer Studentship programme, where<br />

he conducted research focused on retinitis<br />

pigmentosa, using a myomicroperimeter to<br />

determine macular sensitivity.<br />

He also researched the prevalence of macular<br />

oedema in New Zealand, as well as the prevalence<br />

of macular oedema among different genetic<br />

diagnoses found in the 500+ patient retina<br />

database. This research showed a 23% prevalence<br />

rate among all retina patients, but a 41%<br />

prevalence among retina patients with autosomal<br />

dominant inherited diseases. ▀<br />

While orthoptists are in high demand in<br />

New Zealand, the country is likely not<br />

large enough to accommodate a New<br />

Zealand-based training programme to fill the gaps<br />

with home-grown practitioners.<br />

“In New Zealand, we’re all foreigners,” explains<br />

Sally-Anne Herring, an orthoptist with the Hawke’s<br />

Bay Health District and an executive member of the<br />

New Zealand Orthoptic Society. “All of us have been<br />

shipped over from Europe and Australia. There’s no<br />

programme here. We have a small population base<br />

and I don’t think you could sustain the number of<br />

students [needed] to make it financially viable.”<br />

Add to that a lack of funding and you get a recipe<br />

for what New Zealand has now: the low number of<br />

orthoptists—there are 22 members in the Society—<br />

leaving geographic gaps in national coverage and a<br />

full schedule for every practitioner.<br />

Orthoptists train for four years and tend to<br />

specialise in children’s vision testing, amblyopia<br />

and treating anyone with strabismus, plus<br />

ophthalmic technical skills. They work closely<br />

with ophthalmologists, especially paediatric<br />

ophthalmologists, and they run clinics<br />

independently for amblyopia treatment.<br />

Eye Doctor’s Dr Shuan Dai, who chairs the NZ<br />

Paediatric Ophthalmology Interest Group, says our<br />

orthoptists shortage is a multi-faceted problem.<br />

“Our orthoptists almost exclusively come from the<br />

UK and they are very well-trained for the job they<br />

are required to do.”<br />

UK-trained orthoptists focus more on ocular<br />

motility, which is a skill orthoptists must have<br />

to fulfill their role in helping diagnose and treat<br />

amblyopia, he says, hence why UK orthoptists are<br />

favoured in New Zealand as the Australian training<br />

programme is skewed more towards ophthalmic<br />

technical skills.<br />

There is also the question of pay, says Dr Dai.<br />

“Orthoptists often have remuneration below what<br />

is expected for their skill-set and qualifications<br />

compared to the UK and elsewhere.<br />

“There is also a lack of appropriate recognition in<br />

contractual negotiations as to where orthoptists<br />

fit in and as a result there is no appropriate CME<br />

(continuing medical education) allowance to<br />

support their ongoing medical education, which is<br />

vitally important.”<br />

Herring herself trained in the UK and is a member<br />

Sally-Anne Herring, secretary of the NZ Orthoptic Society<br />

of the British and Irish Orthoptic Associations<br />

as well as Orthoptics Australia and confirms the<br />

difference between practice in New Zealand and<br />

other countries.<br />

“In Europe orthoptists are a key member of the<br />

allied health professions with additional ophthalmic<br />

associate roles in the hospital. We do the primary<br />

care screening like the vision and hearing tests, plus<br />

diagnosis and treatment in the hospital forum. Here<br />

it tends to fall on the nurses to do the tests, so our<br />

allied role, or associate tasks, are done by nurses,<br />

though there are some of us who do this as well.”<br />

Orthoptists are squeezed between nurses and<br />

ophthalmologists in New Zealand, but stretched<br />

geographically when it comes to handling the<br />

paediatric side of their jobs, she says.<br />

Herring is based in Hastings, with the District<br />

Health Board (DHB) and Eye Surgeons of Hawke’s<br />

Bay, and covers all the East Coast. Her nearest<br />

colleague is in Palmerston North. While in<br />

Wellington there’s only one orthoptist, which simply<br />

isn’t enough, she says. There is a six week waiting<br />

list for patients to see Herring.<br />

The solution to the shortage is not obvious,<br />

though DHBs are key, says Dr Dai. “The only viable<br />

option is for DHBs to recognise orthoptists as a very<br />

special group of clinicians who play a pivotal role in<br />

the care of children with eye problems and adults<br />

with ocular muscle imbalance, as it is not viable to<br />

train orthoptists in New Zealand given the small<br />

intake numbers. There should also be a formal CME<br />

allowance built into their contracts so they can<br />

continue to maintain their professional skills as<br />

others do, like doctors and nurses.” ▀<br />

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and Platinum Partner exclusive offer.<br />

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

8/04/<strong>2016</strong> 11:24:05 AM<br />

NEW ZEALAND OPTICS<br />

5


SPECIAL FEATURE: CCLS Conference<br />

CCLS Conference: a perfect day<br />

CCLS CONFERENCE<br />

CORNEA : OCULAR SURFACE : CONTACT LENSES<br />

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

CONFERENCE<br />

KEYNOTE SPEAKER<br />

Prof Fiona Stapleton, University of NSW<br />

SUNDAY 20 MARCH<br />

MAC’S FUNCTION CENTRE<br />

4 TARANAKI STREET<br />

WELLINGTON<br />

Conference and workshop registration opens December 2015.<br />

For more information visit www.contactlens.org.nz<br />

ADDITIONAL WORKSHOP<br />

GLAUCOMA WORKSHOP<br />

Run by Wellington ophthalmologists<br />

Jesse Gale, Graham Reeves, with contributions<br />

from Prof Tony Wells and Dr Chris Murphy<br />

SATURDAY 19 MARCH<br />

CENTRAL WELLINGTON VENUE<br />

CORNEA & CONTACT LENS SOCIETY<br />

of New Zealand Incorporated<br />

BY ROBERTA MCILRATIH,<br />

WITH CONTRIBUTIONS FROM ELEISHA DUDSON*<br />

The <strong>2016</strong> Cornea and Contact Lens Society<br />

One Day Conference was held on a perfect<br />

Wellington day; not a cloud in the sky and<br />

barely a puff of wind in the air. For our sins we<br />

were rewarded with an inspiring and eclectic mix<br />

of speakers inside the Mac’s Function Centre on<br />

Lambton Quay.<br />

Professor Fiona Stapleton, head of the School of<br />

Optometry and Vision Science at the University of<br />

New South Wales, was this year’s keynote speaker.<br />

She led us through several informative and clinically<br />

applicable talks ranging from the current treatment<br />

trends in contact lens-related corneal infection to<br />

the genetic factors playing a role in dry eye sufferers<br />

and the implications of eyelid pathologies on the<br />

success of contact lens wear or lack thereof. We look<br />

forward to having Fiona join us in Nelson in March<br />

next year at our two-day conference.<br />

Both John Veale and Varny Ganesalingam spoke<br />

on the use of IPL (intense pulsed light) for the<br />

treatment of Meibomian gland dysfunction in their<br />

Christchurch and Auckland practices respectively.<br />

Both clinicians reported success in around 80% of<br />

their selected patients and it certainly seems an<br />

excellent offering for those patients that need a bit<br />

more than hot compresses and digital massage.<br />

Dr Reece Hall filled us in on the Wellington<br />

Keratoconus Study (WelKS), which is an exciting<br />

initiative between the Lions Club and local eye<br />

health practitioners, and the benefits (both<br />

economic and physical) of corneal cross-linking.<br />

A large van complete with a Pentacam corneal<br />

topographer is travelling around Wellington<br />

high schools screening year 11 and 13 students<br />

Catherine Baxendale, Kevin O’Connor and Jo Arthur<br />

to find those early cases of keratoconus. So far<br />

findings suggest a higher incidence of keratoconus<br />

in secondary school students than previously<br />

thought. There is a further six months of the study<br />

to run before the final intake of data is collated and<br />

from which, hopefully, some good initiatives will<br />

arise to assist in the early detection and treatment<br />

Basically, don’t worry, do worry, the world will still keep turning and we<br />

should probably stick with eyes and not try to become dairy farmers –<br />

summary of BNZ Economist Tony Alexander’s talk at CCLS.<br />

of keratoconus.<br />

We rounded out the morning session with an<br />

entertaining and informative overview of the<br />

global and local economies by Tony Alexander,<br />

chief economist at the BNZ. Basically, don’t worry,<br />

do worry, the world will still keep turning and we<br />

should probably stick with eyes and not try to<br />

become dairy farmers. Although it might be easier<br />

to purchase a dairy farm than a house in Auckland<br />

for the foreseeable future!<br />

After a delicious luncheon and catch-up with<br />

friends, colleagues and CCLS’s industry supporters,<br />

we were back into it, with exciting times in the<br />

world of cataract referral.<br />

Dr James McKelvie, a corneal fellow at the<br />

University of Auckland, went through his project<br />

Unexpectedly<br />

Better<br />

The best IOP measurement tool just got better than<br />

anyone imagined - introducing the NEW<br />

Icare ic100 tonometer<br />

Frederick Swain and Grant Watters<br />

to develop national online referral systems for<br />

cataract surgery, hopefully reducing wait-time and<br />

the administration burden, as well as mapping the<br />

status of cataract cases approaching the threshold<br />

for care. Electronic referral and real-time audit of<br />

cataract surgery will also provide a better audit of<br />

post-operative outcomes and provide risk-analysis<br />

pre-operatively. The Ministry of Health online CPAC<br />

(clinical priority assessment criteria) is currently<br />

being rolled out and James’s system will be<br />

available soon for clinicians to use.<br />

Reuben Gordon, a speciality and paediatric contact<br />

lens optometrist with the Greenlane Clinical Centre<br />

department and Eye Institute, spoke to us about<br />

his experiences of fitting scleral lenses. His talk<br />

dovetailed nicely with Grant Watter’s presentation<br />

about the oxygen permeability of scleral lenses, in<br />

particular the matter of the Dk of the post-lens tear<br />

film. Both presentations provided excellent clinical<br />

tips and a reminder of the improved comfort and<br />

stability in vision scleral lenses can provide many of<br />

our ectatic corneas.<br />

Independent optometrist Adele Jefferies<br />

delighted us with her enthusiasm for lid wiper<br />

epitheliopathy. She reminded us all to get the<br />

lissamine green out and check for staining along<br />

the lid margin evident in many of our unhappy,<br />

and more importantly, our non-reporting-unhappy<br />

contact lens wearers. To do so may prevent<br />

avoidable contact lens drop-outs.<br />

Greg Nel presented on the topic of myopia<br />

progression control and the current therapies at<br />

hand including dilute atropine, orthokeratology<br />

and outdoor play. Although there is a lot more<br />

research to be done in the field of myopia<br />

progression, he reiterated the necessity for the<br />

current evidence-based therapies to be a part of<br />

our everyday discussions when managing our<br />

myopic progressors.<br />

Dr Sid Orga, a registrar in Wellington, further<br />

informed us about corneal cross-linking, discussing<br />

current research and the status of this treatment<br />

for keratoconus in more detail, building on Dr<br />

Reece Hall’s talk from earlier in the day. Again<br />

Sid reminded us how important cross-linking is<br />

for ocular health care in keratoconus, for both<br />

preventing patient vision loss and for the cost<br />

benefits of this ‘ambulance at the top of the hill’<br />

treatment.<br />

Varny Ganesalingam, Richard Newson and Adele Jefferies<br />

Brian Gifford and Jack Crawford<br />

Alison Chan, Sarah Lord, Claire Martin, Penny Adams and<br />

Darryl Eastabrook<br />

The conference was concluded by Eleisha Dudson,<br />

who gave a captivating discussion about different<br />

inflammation cases among her patients; from<br />

post-surgical to ortho-K and soft contact lens<br />

wearers. She emphasised the need to keep up with<br />

current research and the use of this knowledge to<br />

help make the best management decisions for our<br />

patients, whether this is therapeutic or not, or a<br />

combination of both.<br />

Following an excellent day of high-calibre<br />

speakers and presentations we retired to the<br />

bar with many taking the opportunity to enjoy<br />

some refreshments and chat before making the<br />

homeward journey. ▀<br />

* Roberta McIlraith is a speciality contact lens practitioner with<br />

Curtis Vision in Christchurch and a CCLS Councillor; conference<br />

speaker Eleisha Dudson is also a CCLS councillor and specialises<br />

in contact lens fitting at Stevenson, Sangster & Matthews in<br />

Wellington.<br />

• NEW automatic<br />

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- series or single mode<br />

with one button<br />

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CCLS <strong>2016</strong>: A highly<br />

enjoyable affair<br />

BY ANNE MATHESON, CCLS PRESIDENT<br />

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A Paragon Care Brand<br />

I<br />

enjoyed both<br />

the glaucoma<br />

workshop and the<br />

one-day conference<br />

immensely. It was a<br />

pleasure to be able to<br />

walk to both venues<br />

from home in warm<br />

weather.<br />

A bonus with the<br />

glaucoma workshop<br />

CCLS President Anne Matheson<br />

was the festive<br />

atmosphere due to<br />

Cuba Dupa (Wellington’s annual street festival)<br />

taking place outside. Drs Jesse Gale, Graeme<br />

Reeves and Tony Wells present regularly in<br />

Wellington and have been kind enough to run a<br />

glaucoma journal club for us so the workshop was<br />

a summary and update of the last couple of years’<br />

content, and it was a really useful exercise for all<br />

involved to spend a whole day thinking about the<br />

topic.<br />

The one-day conference venue, Mac’s Function<br />

Centre, right next to Te Papa, was attractive,<br />

light and spacious and the food was excellent.<br />

Everything ran smoothly, which was a great relief.<br />

Highlights for me included some of the more<br />

novel aspects of the programme: Tony Alexander,<br />

BNZ’s chief economist, on New Zealand’s economy<br />

and interest rates was fascinating, while James<br />

McKelvie presentation on modernising the<br />

cataract referral system was inspirational, and<br />

I always enjoy other optometrists telling me<br />

how they get things to work in their practices—<br />

the talks on myopia control and IPL were good<br />

examples of that.<br />

The council, which remains unchanged after a<br />

successful and supportive AGM, are all very pleased<br />

with how the weekend went and we’re looking<br />

forward to seeing you all again in Nelson in 2017. ▀<br />

6 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


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

NEW ZEALAND OPTICS<br />

7


SPECIAL FEATURE: CCLS Conference<br />

Getting to grips with<br />

glaucoma<br />

When we were asked to present<br />

a glaucoma workshop<br />

alongside the recent CCLS<br />

Conference in Wellington, we thought it<br />

was timely because more optometrists<br />

are taking on the responsibility of<br />

managing glaucoma in the community.<br />

We aimed to present ideas around the<br />

safe diagnosis and management of<br />

glaucoma and discuss concepts around<br />

how we could share the clinical risk and<br />

uncertainty appropriately.<br />

After some debate about the roles of<br />

ophthalmologists and optometrists in<br />

glaucoma care, the word collaborative<br />

care is often used to suggest a positive<br />

way forward. In my mind, collaborative<br />

care refers to safely dividing the tasks of<br />

glaucoma care in a way that optimises<br />

the convenience and cost for the patient, while<br />

protecting the patient from problems of poor<br />

quality care such as misdiagnosis, over-treatment,<br />

duplication of tests, unnecessary travel and<br />

diagnostic confusion.<br />

There was a great deal of interest in the<br />

workshop with 40 attendees and others waiting.<br />

We had, however, not planned for the CubaDupa<br />

festival happening in the brilliant sunshine outside<br />

and several attendees were seen joining in with the<br />

Michael Jackson tribute aerobics dance-off during<br />

the lunch break!<br />

Professor Tony Wells, from the Wellington School<br />

of Medicine, presented on the complex interactions<br />

between corneal biomechanics and intra-ocular<br />

pressures and how easy it is to be misguided by<br />

corneal thickness. I presented on the risk factors<br />

for glaucoma and tried to open discussion about<br />

how patients with risk factors for glaucoma<br />

should be managed both ethically and safely with<br />

neither unnecessary testing nor delayed diagnosis.<br />

BY DR JESSE GALE*<br />

CubaDupa <strong>2016</strong> provided background festivities to the glaucoma workshop<br />

I also spoke about angle closure with tips on<br />

gonioscopy and on other non-glaucomatous optic<br />

neuropathies, some of which cause cupping that<br />

should not be misdiagnosed as glaucoma.<br />

Dr Graham Reeves presented on disc assessment<br />

and imaging in glaucoma; on glaucoma treatments<br />

including laser and surgery; and on different<br />

models of community glaucoma care that have<br />

been tried and studied. While Dr Chris Murphy<br />

presented on some of the exciting future prospects<br />

for glaucoma, from new diagnostic tests to new<br />

drug delivery systems and new biological therapies.<br />

We were pleased with the encouraging feedback<br />

and that the material was of interest. We all<br />

feel that sharing and discussing these ideas is<br />

important to make sure the future evolution of<br />

collaborative care enhances the safety of our<br />

community through higher quality care. ▀<br />

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

District Health Board and Capital Eye Specialists in Wellington.<br />

He chaired the inaugural CCLS’ glaucoma workshop.<br />

What’s new...<br />

Conference and workshop registration opens December 2015.<br />

The Cornea & Contact Lens Society’s<br />

mini-conference in Wellington received<br />

good support from the industry with<br />

representatives from 10 companies on-hand<br />

to demonstrate what’s news, discuss what’s<br />

coming up and to answer delegates questions<br />

about all the latest equipment and advances in<br />

optometry. Highlights included:<br />

CLC’s Whitney Parson, Graeme Curtis and Australian optometrist<br />

Peter Haman<br />

Corneal Lens Corporation (CLC)<br />

Corneal Lens Corporation have a product so new<br />

to the market that owner, Graeme Curtis, wasn’t<br />

sure if he was going to be able to show it at this<br />

year’s CCLS Conference. The sMap3D Precision<br />

Surface mapping system and fluorescence-based<br />

structured light topographer is described as a “<br />

revolution” in scleral lens fitting. The sMap 3D<br />

measures, customises, analyses and even orders<br />

customised scleral lenses. Its widefield view, with<br />

more than 22mm range and 360° scleral coverage,<br />

allows you to actually quantify the elevation of<br />

the sclera and if there’s any toricity, explained<br />

Curtis. “Because we now have the technology to<br />

actually map what we’re dealing with, fitting the<br />

larger lenses will be more accurate and more cost<br />

effective because there won’t be so much chairtime,<br />

because this does it all for you.”<br />

Also on show was the new Menicon Signature<br />

Pack, containing 4x Menicare Soft Solution and 2x<br />

Miru monthly disposable lenses, and Macushield,<br />

the increasingly popular nutritional supplement<br />

for the treatment of age-related macular<br />

CCLS CONFERENCE<br />

CORNEA : OCULAR SURFACE : CONTACT LENSES<br />

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

CONFERENCE<br />

KEYNOTE SPEAKER<br />

Prof Fiona Stapleton, University of NSW<br />

SUNDAY 20 MARCH<br />

MAC’S FUNCTION CENTRE<br />

4 TARANAKI STREET<br />

WELLINGTON<br />

For more information visit www.contactlens.org.nz<br />

degeneration (AMD).<br />

Derived from the Marigold flower, Macushield<br />

combines three important macular carotenoids,<br />

Lutein, Zeaxanthin and Meso-zeaxathin, found at<br />

the macula, where they form the macular pigment<br />

(yellow colour). Meso-zeaxanthin is particularly<br />

concentrated at the centre of this pigment. Recent<br />

studies have shown a direct correlation between<br />

low macular pigment, a higher-incidence of AMD<br />

and poor cognitive function, including Alzheimer’s.<br />

This demonstrates the importance of the three<br />

carotenoids to our diets, especially as we get older,<br />

said Curtis.<br />

Bausch+Lomb<br />

ADDITIONAL WORKSHOP<br />

Radiant’s Yvette Beattie and Craig Dallas<br />

GLAUCOMA WORKSHOP<br />

Run by Wellington ophthalmologists<br />

Jesse Gale, Graham Reeves, with contributions<br />

from Prof Tony Wells and Dr Chris Murphy<br />

SATURDAY 19 MARCH<br />

CENTRAL WELLINGTON VENUE<br />

CORNEA & CONTACT LENS SOCIETY<br />

of New Zealand Incorporated<br />

Bausch+Lomb’s Kiwi representatives from Radiant<br />

Health, Craig Dallas and Yvette Beattie, attended<br />

the CCLS conference primarily to let delegates<br />

know the company’s supply problems were now a<br />

thing of the past.<br />

Radiant is in the process of launching a new<br />

electronic ordering system (see story p3), which<br />

will ensure a reliable and fast supply service. Once<br />

this is in place the company will also start taking<br />

orders for it’s latest product Ultra, a new monthlydisposable<br />

lens designed to retain 95% of its<br />

moisture for more than 16 hours of wear a day.<br />

Also new to New Zealand is the muchanticipated<br />

presbyopic range for B+L’s premium,<br />

daily-disposal lens brand Biotrue, which will also<br />

be rolled out once the new electronic ordering<br />

system is up and running,<br />

said Dallas.<br />

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8 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


ALLOW OCULAR<br />

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1<br />

WITH<br />

ADVANCED PROTECTION<br />

& HYDRATION 1 ±<br />

2<br />

The combination HP-Guar/HA as sodium<br />

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epithelium and entraps water to promote<br />

hydration and lubrication. 1 Recommend SYSTANE ® HYDRATION Lubricant Eye Drops<br />

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and support your patients’ ocular surface health.<br />

ALWAYS READ THE INSTRUCTIONS AND USE AS DIRECTED. PLEASE REFER TO PRODUCT PACKAGING FOR DOSE AND PRECAUTIONS. IF SYMPTOMS PERSIST PLEASE SEE YOUR EYECARE PROFESSIONAL.<br />

± than hyaluronic acid in an in vitro study<br />

Reference: 1. Rangarajan, R., et al. (2015) Effects of a Hyaluronic Acid/Hydroxypropyl Guar Artificial Tear Solution on Protection, Recovery, and Lubricity in Models of Corneal Epithelium. J Ocul Pharmacol Ther. 31 (8). p.<br />

491-497. Alcon Laboratories (Australia) Pty Ltd. 10/25 Frenchs Forest Road East, Frenchs Forest NSW 2086. Alcon Laboratories (Australia) Pty Ltd. 109 Carlton Gore Road, Ground Floor, Newmarket, Auckland 1023, New<br />

Zealand. Ph 0800 101 106. 160112YSHA. NP4.A21603454079. TAPS.PP7335.<br />

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

NEW ZEALAND OPTICS<br />

9


SPECIAL FEATURE: CCLS Conference<br />

CONTINUED FROM P8<br />

Alcon<br />

Alcon’s Caroline Perkinson, Deanne Graham and Roger Te Puni<br />

Alcon has had a busy 18 months, launching about<br />

eight new products to the market. But with the<br />

increasing interest in daily disposable contact<br />

lenses, top of the pile at CCLS was the company’s<br />

Dailies Total 1, now available in plus powers and<br />

(hot off the press) in high minus powers too.<br />

Dailies Total 1 (DT1) launched in the US in 2013,<br />

with the plus powers launched towards the end of<br />

last year and the higher minus powers introduced<br />

this year. DT1 were designed to mimic the<br />

environment of the cornea with water content of<br />

almost 100% at the outermost surface.<br />

A recent survey by Alcon of nearly 250 contact<br />

lens-wearers in Australia and New Zealand, found<br />

that 72% of patients’ experience discomfort in<br />

their habitual lenses, compared with 86% who can<br />

comfortably wear DT1 all day long, with nine out<br />

of 10 patients admitting they preferred their DT1<br />

lenses to their old lenses.<br />

According to Alcon, DT1 lenses have a core water<br />

content of 33% and a surface water content of<br />

more than 80%. It is now available from -0.50 D<br />

to -6.00 D in 0.25-D steps, from -6.50 D to -12.00<br />

D in 0.50-D steps and from +0.50 D to +6.00 D in<br />

0.25-D steps.<br />

Ophthalmic Instrument Company (OIC)<br />

The talk at the OIC stand centred on the latest<br />

in OCT technology, said Tim Way, OIC managing<br />

director. The Nidek OCT Retina Scan Duo offers<br />

extremely high definition anterior and posterior<br />

OCT and fundus imaging from a single compact<br />

system. Other items of equipment attracting<br />

attention included the new Nidek Tonoref III, a<br />

combined autorefractor, keratometer, tonometer,<br />

pachymeter, and the new tear film surface quality<br />

analysis package for the Medmont E300 Corneal<br />

Topographer. This is a free software upgrade for<br />

those practices already running their Medmont<br />

E300 in Medmont Studio 6.<br />

Medmont’s new tear film analysis software<br />

allows accurate, quantifiable, identification of<br />

tear film break up, so it can be used for objectively<br />

measuring dry eye in patients and allowing<br />

comparison over time, says Way, adding this is a<br />

great tool for, among other things, pre- and post-<br />

IPL treatment (see Dry Eye Technology below).<br />

Way highlighted a new study by Dr Laura<br />

Downie from the Department of Optometry and<br />

Vision Sciences at the University of Melbourne,<br />

entitled Automated Tear Film Surface Quality<br />

Breakup Time as a Novel Clinical Marker for<br />

Tear Hyperosmolarity in Dry Eye Disease, which<br />

utilised the Medmont E300 to perform dynamicarea,<br />

high-speed Placido disc videokeratography.<br />

The study was designed to assess the diagnostic<br />

performance of a novel, automated, non-invasive<br />

measure of tear film stability derived from<br />

Placido disc videokeratography, the tear film<br />

surface quality breakup time (TFSQ-BUT), as a<br />

clinical marker for diagnosing dry eye disease.<br />

It concluded that: “automated TFSQ-BUT is a<br />

repeatable, non-invasive clinical marker with<br />

both high sensitivity and specificity for tear<br />

hyperosmolarity.” Tear osmolarity was measured<br />

bilaterally from the inferior lateral tear meniscus<br />

using the TearLab system.<br />

OIC’s Chris Malicdem and Tim Way<br />

Abbott Eye Health<br />

Abbott’s Rachel Haynes with Dr Trevor Gray<br />

Rachel Haynes from Abbott Eye Health was on<br />

hand to introduce Abbott’s newly rebranded<br />

Complete Revitalens Multi-Purpose Disinfecting<br />

Solution (MPDS) and Blink Intensive Tears Plus Gel<br />

Drops for patients with severe dry eye.<br />

The premium Complete Revitalens MPDS has<br />

been rebranded to bring all Abbott’s contact lens<br />

solutions under its well-known Complete brand.<br />

According to recent studies by Abbott, Complete<br />

Revitalens has a significantly lower (up to four<br />

times lower) incidence of adverse events; a lower<br />

rate of solution-induced corneal staining; and,<br />

perhaps most importantly, is still effective with<br />

even the most non-compliant patients.<br />

Abbott took the opportunity at this year’s<br />

conference to also launch Blink Intensive Tears<br />

Plus liquid gel drops. Abbott claims this new<br />

addition to its eye lubricant portfolio provides a<br />

thicker, visco-elastic formula that adapts to the<br />

eye’s natural blinking function. It was developed<br />

to supply maximum viscosity, with minimal blur<br />

for persistent dry eye sufferers.<br />

Haynes, however, had plenty of knowledge and<br />

literature, but no samples to give out to delegates<br />

as these had not managed to make it to the<br />

conference, but she says she’s more than happy<br />

for anyone who was at the conference to contact<br />

her at Rachel.Haynes@abbott.com and she’ll send<br />

you a sample directly.<br />

Dry Eye Technology (E>Eye)<br />

John Veale, optometrist and director of Merivale<br />

Optical in Christchurch and distributor of the<br />

E>Eye intense pulsed light (IPL) machine, designed<br />

to treat dry eye caused by meibomian gland<br />

dysfunction (MGD), was one of the speakers at the<br />

<strong>2016</strong> CCLS Conference and one of the exhibitors.<br />

In his presentation he described his experience<br />

with the E>Eye machine and why he decided to<br />

distribute it, and the results of two studies: a<br />

double-blind, placebo-controlled clinical trial of 28<br />

patients with MGD by Associate Professor Jennifer<br />

Craig; and one by his own practice, Merivale<br />

Optical, both of which showed the efficacy of IPL<br />

in treating dry eye.<br />

The interest in dry eye and its treatment was<br />

a key theme of the <strong>2016</strong> conference, said Veale,<br />

with about a quarter of the presentations<br />

discussing it in some way, which meant there was<br />

also a lot of interest in IPL for treating dry eye<br />

and thus the E>Eye machine. “It’s certainly one<br />

modality for assisting people, especially those<br />

with severe symptoms, and they are severe in<br />

some cases.”<br />

Veale’s Merivale study found that more than<br />

80% of patients who received IPL treatment<br />

reported an improvement in their dry eye<br />

symptoms, but Veale said he’s confident by better<br />

combining IPL treatment with other proven dry<br />

eye remedies such as diet, blinking and heat<br />

treatment (using eye wheat bags) he can move<br />

this into the 90% range.<br />

Device Technologies<br />

Device Technologies’ Campbell Gordon and Diego Sonderegger<br />

Device Technologies was exhibiting a range of<br />

equipment, but top of the what’s new list was<br />

the release of OCT angiography for the Topcon<br />

DRI Triton Swept Source OCT, the latest OCT<br />

technology available on the market.<br />

With the new Topcon Triton Swept Source OCT,<br />

clinicians can do a dye-less OCT-angiography<br />

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FOR FURTHER INFORMATION CALL ABBOTT CUSTOMER SERVICE: IN AUSTRALIA ON 1800 266 111<br />

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ALWAYS READ THE LABEL, USE ONLY AS DIRECTED. Reference: 1. Dumbleton K, Woods C, Fonn D. An investigation of the Effi cacy of a Novel Ocular<br />

Lubricant. Eye & Contact Lens. 2009;35(3):149-155. Australia: AMO Australia Pty. Ltd. 299 Lane Cove Road, Macquarie Park, NSW 2113, Australia. Phone:<br />

1800 266 111. New Zealand: AMO Australia Pty. Ltd. PO Box 401, Shortland Street, Auckland, 1140. Phone: 0800 266 700. blink is a trademark owned by<br />

or licensed to Abbott Laboratories, its subsidiaries or affi liates. © <strong>2016</strong> Abbott Medical Optics Inc. PP<strong>2016</strong>CN0045_WH AMO20150/NZO<br />

10 AMO20150 NEW ZEALAND Blink IT Plus OPTICS Adv_NZO.indd <strong>May</strong> 1<strong>2016</strong><br />

8/04/16 5:22 PM


CCLS CONFERENCE<br />

CORNEA : OCULAR SURFACE : CONTACT LENSES<br />

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

CONFERENCE<br />

ADDITIONAL WORKSHOP<br />

in less than a minute, said Diego Sonderegger,<br />

product specialist at Device Technologies. “It<br />

makes sense combining OCT-A with the Swept<br />

Source laser because it penetrates deeper into<br />

the retina/choroid and, due to its high speed,<br />

it also enables the software to use the OCTARA<br />

full spectrum analysis to get better results even<br />

at low flow levels. Also, with Swept Source<br />

technology you can scan through cataract,<br />

haemorrhages and sclera as well.”<br />

Topcon claims to have the world’s fastest<br />

commercial scanning speed of 100,000 A-scans/<br />

second. It also incorporates full-colour, highresolution<br />

fundus photography. A higher spec<br />

model is also available offering fluorescein<br />

angiography and fundus autofluorescence. To<br />

date this is the only anterior and posterior sweptsource<br />

OCT on the market.<br />

Other technology on display and attracting<br />

attention was the Topcon CA-800 Corneal<br />

Analyzer, a comprehensive corneal topography<br />

solution that enables the complete evaluation<br />

of the anterior corneal surface and total analysis<br />

of the patient’s corneal surface; and Captiv8,<br />

a multi-faceted patient communication and<br />

marketing software tool, that enables users to<br />

share 3D animations between themselves and<br />

through social networking platforms such as<br />

Facebook. Captiv8 is now integrated with Twitter,<br />

allowing optometrists to monitor and respond,<br />

with 3D animation content, to any chatter that<br />

relates to their world, explained Sonderegger.<br />

Johnson & Johnson<br />

Acuvue Oasys 1-Day with HydraLuxe technology<br />

is the newest daily disposable innovation from<br />

Johnson & Johnson Vision Care. According to the<br />

company, 59% of patients experience a decline<br />

in contact lens performance due to performing<br />

multiple activities in different indoor and<br />

outdoor environments with a range of humidity,<br />

temperature and air flow conditions throughout<br />

the day i .<br />

Company representatives explained how<br />

Acuvue Oasys 1-Day complements the natural<br />

tear film to help with the feeling of dry and tired<br />

eyes, which can significantly impact a patient’s<br />

ability to fully engage in activities around them<br />

and may result in a patient discontinuing contact<br />

lens wear.<br />

KEYNOTE SPEAKER<br />

Prof Fiona Stapleton, University of NSW<br />

SUNDAY 20 MARCH<br />

MAC’S FUNCTION CENTRE<br />

4 TARANAKI STREET<br />

WELLINGTON<br />

GLAUCOMA WORKSHOP<br />

Run by Wellington ophthalmologists<br />

Jesse Gale, Graham Reeves, with contributions<br />

from Prof Tony Wells and Dr Chris Murphy<br />

SATURDAY 19 MARCH<br />

CENTRAL WELLINGTON VENUE<br />

At the heart of HydraLuxe technology is an<br />

Conference and workshop registration opens December 2015.<br />

CORNEA & CONTACT LENS SOCIETY<br />

For more information visit www.contactlens.org.nz<br />

of New Zealand Incorporated<br />

enhanced moisture network of tear-like molecules<br />

plus highly breathable silicone that integrates<br />

with the patient’s own tear film each day.<br />

This network of tear-like molecules is uniform<br />

throughout the lens, and works with the key tear<br />

film components to lubricate and moisturise the<br />

lens and support the tear film throughout the<br />

day ii . ▀<br />

i. Matthews, K. et al. Exploring variability in soft contact<br />

lens performance from moment to moment. Optom Vis<br />

Sci 2015;92:E abstract 44644<br />

ii. JJVC Data on file Sept 2015 Technology description of<br />

Hydraluxe technology<br />

OCT-A now in<br />

Tauranga<br />

Tauranga Eye Specialists is the first practice<br />

in Australasia to use Swept Source OCTangiography,<br />

reports Diego Sonderegger,<br />

product specialist at Device Technologies.<br />

The Topcon Triton Swept Source OCT is now<br />

in operation at Tauranga Eye Specialists and<br />

Drs Mike O’Rourke, Sam Kain, Mark Saunders<br />

and Andrew Thompson are excited to use its<br />

new functions, including OCT-angiography,<br />

which allows visualisation of deep retinal<br />

and choroidal layers without the use of<br />

intravenous injection of dye in less than a<br />

minute, he said. ▀<br />

Angiography images from the Topcon Triton Swept Source OCT<br />

SPECIALITY CL FORUM<br />

SCLERAL LENS FITTING FOR HIGH LEVELS OF REGULAR ASTIGMATISM<br />

In my February <strong>2016</strong> column, I described how<br />

mild to moderate levels of regular astigmatism<br />

can now be corrected with orthokeratology.<br />

However, for some patients the lifestyle<br />

consideration of using ortho-K lenses may not<br />

suit or they may just have too much astigmatism<br />

to realistically be a good ortho-K candidate.<br />

Hopefully most optometrists will know a rigid<br />

lens is the best option for these >3.00DC patients<br />

to achieve high quality vision. For the majority<br />

of patients an RGP corneal lens will work fine,<br />

however for patients desiring comfortable all-day<br />

wear and stable vision a larger scleral lens can be<br />

a preferable option in many instances.<br />

In this example my patient, a 25-year-old<br />

male, reported to our practice to investigate his<br />

contact lens options. He is a university student<br />

in the health area and plays basketball at a<br />

representative level. Unfortunately, he has high<br />

amounts of astigmatism (R +5.50/-4.50 x 168, L<br />

+5.25/-4.25 x 11, 6/5 in each eye) and came to<br />

his appointment wearing glasses, which he was<br />

very happy with. He had tried several different<br />

contact lens options in the past with little<br />

success. Customised soft toric disposable lenses<br />

had good comfort but the vision was poor and<br />

fluctuated. Rigid gas permeable bi-toric corneal<br />

lenses were tried but were poorly tolerated due to<br />

comfort despite providing good vision. They had<br />

also popped out twice during basketball games.<br />

Discouraged by this our young patient got the<br />

opinion of a corneal specialist who told him a clear<br />

lens extraction was the only permanent opinion.<br />

After discussion of his options we decided to fit<br />

a toric periphery scleral lens to be used when the<br />

patient needed to be without his spectacles.<br />

BY ALEX PETTY*<br />

Following a delivery and teach appointment and<br />

some final tweaks to the lens fit during aftercare<br />

visits (a more detailed report of this case can<br />

be found at eyespace.com.au/blog) the patient<br />

returned two weeks after picking up his final<br />

lenses. He reported vision with his new lenses<br />

was excellent and comparable with his glasses.<br />

Comfort was also reported to be very good. Vision<br />

with each lens was 6/6+2 after 4 hours of wear<br />

with no significant residual astigmatism or flexure<br />

in the over-topography.<br />

Anterior OCT of these lenses showed the central<br />

apical clearance was measuring in the low 200um.<br />

This clearance could be further decreased into the<br />

100-150µm range if desired with the predictability<br />

afforded to us by modern lathe technology.<br />

Apical clearance in the new lenses as seen with the slit-lamp and OCT<br />

The appearance of the lens under the slitlamp<br />

showed very little conjunctival vessel<br />

impingement. Upon removal, aside from some<br />

mild staining atop small pingueculae in each eye,<br />

there is no evidence of lens impression or abrasion.<br />

The cornea was also devoid of defect.<br />

Corneal topographies in Medmont Studio showing the regular limbusto-limbus<br />

WTR astigmatism.<br />

The 4 days of Optics<br />

23 - 26 September <strong>2016</strong><br />

LIVE THE EXPERIENCE<br />

silmoparis.com<br />

Until scleral mapping with technology such<br />

as the Eye Surface Profiler (Eaglet Eye) becomes<br />

commonplace in contact lens practices, trial fitting<br />

scleral lenses is still required. This can be a problem<br />

in this sort of case however, as a rotationally<br />

symmetrical trial lenses will rock along the steeper<br />

vertical meridian of a high WTR cornea. While the<br />

lens is still reasonably comfortable, a rocking lens<br />

can allow bubbles under the lens and can increase<br />

the likelihood of the patient inadvertently blinking<br />

the lens out during the fit. I have made a request<br />

that a non-rotationally symmetrical scleral trial set<br />

be available in the future for just this instance.<br />

A topography over the EyeSpace Scleral<br />

(Innovative Contacts) trial lenses I fitted to this<br />

patient showed significant with-the-rule flexure<br />

of around 2 diopters after only a few minutes.<br />

Over-refraction through the lens at this point<br />

also showed -2.00D of residual astigmatism<br />

with axis 180.<br />

Topography over the rotationally-symmetrical trial lenses shows<br />

significant flex on the toric anterior surface.<br />

I talked about minimising scleral lens flexure in<br />

the October 2015 issue of NZ Optics. It is clear that<br />

a rotationally symmetrical lens would continue<br />

to rock and cause stability issues in this patient,<br />

even with a thicker centre thickness. A lens with<br />

a difference in sagittal height in each meridian<br />

will stabilise the lens and eliminate flexure much<br />

better. The lenses were ordered with 500µm<br />

difference in sag (to account for ~2.50D of flex)<br />

between the meridians.<br />

Scleral landing zone profiles of the right lens. Note the lack of<br />

conjunctival blanching at the lens edge<br />

Overall the patient was very happy with<br />

the outcome of his scleral lens fitting. Careful<br />

assessment of the cornea for signs of hypoxia and<br />

toxicity is important during his future follow-up<br />

visits as the thickness of the lens and tear reservoir<br />

can pose barriers for oxygen to pass to the cornea,<br />

even with the high Dk materials used in modern<br />

scleral fitting. A key concept here is that a toric<br />

cornea can achieve great vision in a scleral lens<br />

with a spherical back optic zone. The difference in<br />

sagittal height of the peripheral areas is important,<br />

as this controls stability and flexure on the eye.<br />

This case shows that specialty scleral lenses are<br />

not just reserved for diseased or compromised<br />

corneas but can be a useful and effective tool in<br />

treating regular ametropias in practice.<br />

Stay tuned for the next edition of the Specialty<br />

Contact LensForum where I will write again about<br />

my favourite topic orthokeratology and how it can<br />

be useful to manage the post-LASIK cornea. ▀<br />

* Alex Petty is a Kiwi optometrist who<br />

graduated from the University of<br />

Auckland in 2010. He has an interest<br />

in specialty contact lenses, ortho-K and<br />

myopia control.<br />

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

NEW ZEALAND OPTICS<br />

11


NZAO student awards<br />

Focus<br />

on Business<br />

WHAT IS MY PRACTICE WORTH?<br />

How to prepare a practice for sale<br />

BY STU ALLAN*<br />

Planning your exit from your business is a critical process.<br />

The right advice can make the difference between<br />

obtaining full value for your business or not. This is a brief<br />

introduction to how OpticsNZ approaches valuing a practice and<br />

reaching a successful sale. It is by no means an exhaustive list, as<br />

each and every engagement is different.<br />

What is my practice worth?<br />

There is no, simplistic, one-size-fits-all, rule applied to calculate<br />

the asking price for an optical business. Historically, the simple<br />

equation—50% of turnover—was used. But those days are long<br />

gone, although the myth is still out there.<br />

Over the years, we have found the best process is to value the<br />

business using a variety of methodologies.<br />

EBIT (bottom line earnings before interest and taxation) is the<br />

most common method used. We then add a multiplier to that<br />

bottom line figure to arrive at what we perceive to be current<br />

market value<br />

When a practice shows little or no profit, we revert to an older<br />

methodology of plant, stock, assets and whatever we can justify<br />

for goodwill.<br />

In the past nobody needed to prepare for sale. Times have<br />

changed and today our role is very much a case of preparing a<br />

business proposition, which presents a company in the best light.<br />

No two practices are exactly alike and no matter what any<br />

accountant tells you, what you sell your practice for boils down to<br />

whatever the buyer is prepared and able to pay.<br />

The process<br />

The first step is to sign-off on a non-disclosure agreement<br />

(NDA) between ourselves and the vendor to ensure complete<br />

confidentiality.<br />

We then request the information required to create a practice<br />

profile. This is often a 15 to 20-page document covering such<br />

things as fees, patient base, marketplace overview, competitor<br />

analysis and photos. With supportive documents such as floor<br />

plans, employment agreements, current lease, etc. An essential<br />

inclusion is where we see opportunities for sales growth, cost<br />

reductions and/or margin gain.<br />

Once the practice profile is approved, we then take the practice<br />

to market explaining to the vendor how and to whom we plan to<br />

promote the opportunity.<br />

We handle all negotiations on the practice’s behalf, or with<br />

them, and when a sale is imminent we prepare a ‘heads of<br />

agreement’ which the prospective purchaser can then take to<br />

their solicitors to have a ‘sale and purchase’ agreement drawn up.<br />

How long do practices take to sell?<br />

The fastest process we have ever experienced is six months; the<br />

longest, more than two years.<br />

Recommendations<br />

••<br />

Potential buyers will be looking at many options, be fair and<br />

reasonable<br />

••<br />

Have a clear reason for wanting to sell<br />

••<br />

Provide clear proof of profits<br />

••<br />

Be willing to hold hands and work on for a while with the new<br />

owners to leverage the existing goodwill<br />

••<br />

Be prepared to commit to a location-based restraint of trade<br />

••<br />

Maintain a precise and accurate asset list<br />

••<br />

Keep a clear list of costs that will not transfer to the new<br />

owner. Often we include some personal costs within our<br />

businesses such as vehicle expenses, home office costs,<br />

personal travel, clothing, etc. List them so they can be<br />

identified as ‘add backs’ to boost the bottom line<br />

••<br />

Present your practice clean, neat and in an appealing manner<br />

••<br />

Never have a full valuation completed. An appraisal (costing<br />

significantly less) is more than sufficient; there is no need to<br />

count teaspoons<br />

••<br />

Inform your landlord of your intentions. Landlords can be<br />

tricky when told late in the game<br />

••<br />

Engage an experienced broker, allowing you to step back<br />

from what is often an emotional process. Your practice often<br />

equates to a lifetime’s work. The handling of the value, exit<br />

planning, marketing and sale of the business should not be<br />

entered into lightly. ▀<br />

* Stuart Allan is director of OpticsNZ, a company<br />

which specialises in human resources,<br />

recruitment, practice brokering and business<br />

development for the optics industry. Over the<br />

years, OpticsNZ has brokered dozens of practices<br />

and with each engagement tweaks and refines<br />

its processes and systems to assist in maximizing<br />

returns for clients. For more, contact Stu on 027<br />

436-9091, email stu@opticsnz.co.nz or visit<br />

www.opticsnz.co.nz<br />

The annual NZAO<br />

Student Awards<br />

Evening, a joint<br />

venture between the New<br />

Zealand Association of<br />

Optometrists (NZAO) and<br />

the University of Auckland,<br />

was an upbeat affair that<br />

attracted a large number of<br />

students.<br />

Held at the prestigious<br />

Langham Hotel in Auckland<br />

on 17 March, the evening<br />

recognised not just the<br />

students who came top of<br />

their year in 2015, but also<br />

the work and commitment of the NZAO in<br />

ensuring New Zealand optometrists, and the<br />

vital work they do in protecting eye health<br />

and the wellbeing of the New Zealand public,<br />

are recognised and respected appropriately<br />

by government and the wider community.<br />

Dr Lesley Frederikson, NZAO national<br />

director, chaired the meeting and provided<br />

both a history and an update on the<br />

Association’s ongoing work to protect and<br />

improve the status of optometrists and<br />

optometry in New Zealand. Zaria Burden<br />

and Chelsey Wood, who head the NZAO’s<br />

New Graduate Liaison Team, discussed their<br />

transition from university to work and why<br />

they chose to continue to be members of the<br />

NZAO, while Janet Chung and Joyce Mathan<br />

provided a synopsis of their Summer Student<br />

research projects and the importance of<br />

NZAO’s continuing support for research at<br />

the University. The speeches were brought<br />

to a close by Nikku Singh, the current<br />

president of the NZ Optometry Student<br />

Society (NZOSS) and NZAO President Callum<br />

Milburn, who spoke of the importance<br />

of learning from optometry’s past while<br />

working towards to a strong future. ▀<br />

Janet Chung, Joyce Mathan, Xheida Mani, Stephanie Wallen, Bianca Davidson, Huria Rahimi and Carla Sy. Picture by Bruce Tetley<br />

Jackson Harper and NZAO President Callum Milburn<br />

By Bruce Tetley<br />

NZAO graduate liaison team Chelsey Wood and Zaria Burden<br />

New show for Melbourne<br />

Anew optical industry show called the<br />

O-Show will be held in Melbourne,<br />

the fashion capital of Australia, from<br />

Saturday 21 <strong>May</strong> to Sunday 22 <strong>May</strong>, this year.<br />

Hosted and owned by the Optical<br />

Distributors & Manufacturers Association<br />

(ODMA), the O-Show is being billed as a<br />

new and exciting boutique event that will<br />

showcase the latest industry technology in<br />

Australasia.<br />

ODMA has been planning an event of this<br />

type in the alternate year to the ODMA Show<br />

for some years, said Finola Carey, ODMA chief<br />

executive. “O-Show timing fits perfectly<br />

well to be run in the alternate year to the<br />

ODMA Show and will be a great resource for<br />

the industry. It is a non CPD event with the<br />

emphasis on hands on demonstrations and<br />

the opportunity to compare and contrast<br />

new products and equipment.”<br />

At the time of going to press more than 30<br />

exhibitors for equipment, sunglasses, frames<br />

The coming of Camber<br />

Younger Optics and<br />

Independent Lens<br />

Specialists (ILS) have<br />

combined forces to introduce the<br />

latest evolution in progressive<br />

lenses to New Zealand, Camber<br />

Technology.<br />

“It’s simply the most advanced<br />

technology in optics today; it’s the next<br />

generation in free-form progressives,” says<br />

Craig Johnston, Younger Optics’ Australasian<br />

sales and marketing manager.<br />

“It is very exciting,” adds Glenn Bolton,<br />

director of ILS. “It’s another step forward in<br />

the development of free-form technology.<br />

And for us, this is an opportunity to offer a<br />

lens that is going to be significantly better<br />

for the patient; in a number of cases, quite<br />

significantly.”<br />

Developed in partnership with Indizen<br />

Optical Technologies (IOT), an independent,<br />

specialist free-form lens design company<br />

based in Spain and Los Angeles, the patented<br />

Camber Technology combines complex curves<br />

on both surfaces of the lens, improving<br />

visual acuity in all viewing zones. The key<br />

breakthrough recognises the impact the base<br />

curve has on visual acuity.<br />

“The unique, continuously changing surface<br />

curvature of the lens blank allows expanded<br />

reading zones and improved peripheral<br />

vision. When combined with a sophisticated<br />

back surface digital design, both surfaces<br />

work together to accommodate an expanded<br />

Rx range, offer better cosmetics (flatter) for<br />

many prescriptions and yield user-preferred<br />

near vision performance,” says the marketing<br />

material.<br />

Younger and IOT have been working on<br />

Camber ever since free-form was launched,<br />

so it has been in development for a number<br />

of years, says Johnston. Camber Technology<br />

2015 student awards<br />

••<br />

Top Maori/Pacific Island entering<br />

BOptom Part II in <strong>2016</strong> – Jackson<br />

Harper<br />

••<br />

Most improved student entering<br />

B.Optom. Part IV – Wanyi Zhou<br />

••<br />

Most improved student entering<br />

B.Optom. Part V – Huria Rahimi<br />

••<br />

Top Student entering B.Optom. Part<br />

III– So Yon Shin<br />

••<br />

Top Student entering B.Optom. Part<br />

IV– Bianca Davidson<br />

••<br />

Top Student (2nd) entering B.Optom.<br />

Part IV– Carla Sy (an extra award<br />

presented by Associate Professor Rob<br />

Jacobs as the level was so high)<br />

••<br />

Top Student (1st) entering B.Optom.<br />

Part V– Xheida Mani<br />

••<br />

Top Student (2nd) entering B.Optom.<br />

Part V – Stephanie Wallen<br />

••<br />

NZAO Summer Student Awards<br />

– Janet Chung and Joyce Mathan<br />

••<br />

Peg Wood Award (Top Student in<br />

Optom 441: Clinical Optometry) –<br />

Stephanie Wallen<br />

and lenses had confirmed their participation,<br />

with 85% of stand bookings allocated in the<br />

first three days after launching. Confirmed<br />

exhibitors include Frames Ectetera, Design<br />

for Vision, Tiger Vision, OptiMed, BOC<br />

Instruments, Mimo, Heidelberg Engineering,<br />

Zeiss and Device Technologies.<br />

As well as the exhibition, the new event<br />

will feature free Business Snapshot Seminars.<br />

Australian raconteur and business adviser<br />

Mark Davis will explore how to create value<br />

in order to secure and retain customers<br />

and how to educate customers, build a<br />

rapport and create no-risk sales pitches;<br />

Australian healthcare marketing specialist<br />

Robert Springer will discuss best practices<br />

in online marketing and how to master the<br />

art of personalised patient messaging; and<br />

optical retail stylist Kerry van Beuge will<br />

demonstrate what’s hot and why in window<br />

displays and give attendees some ideas<br />

about what they can do with all the point-ofsale<br />

items<br />

that end<br />

up in their<br />

practices.<br />

The<br />

organisers<br />

have also<br />

included<br />

a Cocktail<br />

Party,<br />

complete<br />

with cash<br />

prizes, on<br />

the Saturday<br />

night.<br />

‘’We are simply fulfilling the wishes of<br />

the members who have been wanting an<br />

event of this type for some time. This popup-boutique<br />

industry event will be full of<br />

energy and surprises and terrific learning<br />

opportunities,” said Carey.<br />

For more visit www.o-show.com.au. ▀<br />

has been available in the US for the past 18<br />

months and is going “extremely well,” he says.<br />

At least one lab has also been accredited by<br />

IOT to provide Camber in Australia and there<br />

are a few other Australian labs currently vying<br />

for the opportunity.<br />

In New Zealand, for Younger, ILS was the<br />

obvious lab choice as it’s already well-known<br />

for free-form lens technology. The new lens<br />

technology was given a soft launch at ADONZ<br />

in October last year, but wasn’t readily<br />

available until now, after ILS completed the<br />

accreditation process with IOT.<br />

For optometrists and dispensing opticians<br />

Camber is an easy concept to grasp so<br />

Younger is expecting it to be a very popular<br />

alternative in the premium progressive space,<br />

says Johnston. “When you explain it, Camber<br />

makes logical sense, combining the traditional<br />

laws of optics with free-form technology and<br />

making the best out of both.” ▀<br />

12 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


Optometrists<br />

needed urgently<br />

Marine Reach, a humanitarian<br />

organisation that delivers health<br />

serves to isolated populations from its<br />

vessel, the MV Pacific Hope, is urgently seeking<br />

optometrist volunteers to help with its next<br />

mission in the Pacific in June through to October.<br />

Marine Reach purchased the Pacific Hope<br />

and refit the vessel for purpose in 2013. It<br />

undertook its first clinical voyage, concentrating<br />

particularly on the outer islands in Fiji and<br />

Vanuatu, in 2015. Now, with help from<br />

the Tauranga Rotary Club, which has been<br />

raising funds and seeking donations to equip<br />

the Pacific Hope with a fully functioning<br />

ophthalmic clinic, the group is again seeking to<br />

bring help to people in need in Vanuatu.<br />

The ship will be based in Vanuatu for five<br />

medical outreaches this year, from:<br />

••<br />

June 25 – July 10<br />

••<br />

July 16 – July 31<br />

••<br />

August 6 – August 21<br />

••<br />

September 3 – September 18<br />

••<br />

September 24 - October 9<br />

Former volunteer, Wanganui optometrist John<br />

Mellsop said meeting the vision needs of the Ni-<br />

Van people on the island of Malakulu, Vanuatu<br />

was a satisfying way to spend two weeks in<br />

September and October last year. “We worked<br />

hard and I was well supported by an optometry<br />

team leader and four others who were able<br />

to take visual acuities and dispense reading<br />

glasses. Living on a ship with 50 others has its<br />

limitations, but gives you an opportunity to see<br />

places that tourists never see and get to know a<br />

lot of good people.”<br />

Marine Reach, part of Youth With A Mission<br />

(YWAM), has been operating for 25 years and<br />

has helped more than 500,000 people. If you<br />

think you could help, please contact them at<br />

medical@marinereach.com. ▀<br />

Pfizer-<br />

Allergan split<br />

Grand Round 1: VEGF, Sulcoflex,<br />

vitamin A and more<br />

The first <strong>2016</strong> Grand Round seminar evening<br />

from Eye Doctors took place on 23 March<br />

at Novotel, Green Lane. Four speakers took<br />

the stand for the evening, including keynote<br />

speaker Dr Mark Donaldson, a founding member<br />

of Eye Doctors and consultant ophthalmologist at<br />

Greenlane public hospital. He was joined by Eye<br />

Doctors’ colleagues Drs Penny McAllum, Andrew<br />

Riley and Shaun Dai. The event was sponsored by<br />

Radiant Health, distributors for Bausch + Lomb.<br />

VEGF Inhibitors made easy<br />

Dr Andrew Riley opened the event with a look at<br />

VEGF treatments for macular oedema and vascular<br />

proliferative retinal disease, with a focus on the<br />

drugs currently used to treat the condition. Eylea,<br />

Lucentis and Avastin are all prominent treatments<br />

in New Zealand, with Avastin being the most<br />

commonly prescribed. Dr Riley presented the DRCR.<br />

net diabetic retinopathy research presented by<br />

Dr Lee M. Jambol recently in Colorado. DRCR.net<br />

has now run 28 open source studies on diabetic<br />

retinopathy and is now leading research in this<br />

field. Dr Riley also talked about treatment regimens<br />

of VEGF injections such as required treat-andextend<br />

intervals and how optometry practices can<br />

help patients get better outcomes. Dr Riley noted<br />

that Greelane spends millions on VEGF treatment<br />

now with most being spent on the 10% of patients<br />

who don’t respond to Avastin.<br />

Managing refractive surprise<br />

Refractive cataract surgery is one of Dr Penny<br />

McAllum’s specialty interests, and her talk<br />

focused on the treatment of refractive surprise<br />

after surgery. Dr McAllum noted there are a<br />

number of causes of refractive surprise, including<br />

measurement inaccuracies in unusually long<br />

or short eyes and abnormalities of the cornea,<br />

such as keratoconus or scars. To reduce the risk<br />

of refractive surprise there are a number of steps<br />

that can be taken from checking biometry several<br />

times to treating dry eyes and managing patient<br />

expectations. Understanding a patient’s needs<br />

from their post-surgery eyesight can help with<br />

advising them of the best lens choice to minimise<br />

the chance of unexpected outcomes.<br />

There are several options for managing<br />

refractive surprise. In some patients, simple<br />

reassurance or a pair of glasses may be the best<br />

choice. Laser refractive surgery is a good option<br />

for younger patients, but can sometimes be<br />

associated with problems like dry eye in older<br />

patients. Using a sulcus piggyback lens is another<br />

option Dr McAllum favours. While in the past<br />

there have been issues around similar lenses,<br />

like interlenticular opacities and iris chafing,<br />

the newer ‘Sulcoflex’ lenses produced by Rayner<br />

overcomes the previous obstacles. Their most<br />

commonly used product is the Sulcoflex Aspheric<br />

that is readily available from -5 to +5D and<br />

custom-made to ±10D. An online calculator assists<br />

with the decision over what lens to use and<br />

primarily uses subjective refraction to calculate<br />

the required lens, avoiding potential biometric<br />

inaccuracies. These lenses are also available in<br />

toric and multifocal formats. The implantation<br />

procedure takes just a few minutes under topical<br />

anaesthetic and many patients experience an<br />

almost instant improvement<br />

in vision.<br />

Cataract and Glaucoma<br />

Dr Mark Donaldson provided<br />

the keynote speech for<br />

the night on treatment<br />

regimens across cataract<br />

and glaucoma patients.<br />

He noted that contrast<br />

acuity is an important<br />

theme in glaucoma, where<br />

the damaging effects are<br />

irreversible – unlike cataract<br />

patients who find relief<br />

from these symptoms after<br />

treatment and that, of all<br />

quality of life measures,<br />

contrast acuity of glaucoma<br />

patients is the best correlate.<br />

The daily comfort of a<br />

glaucoma patient is affected<br />

greatly by contrast acuity, with<br />

one of Dr Donaldson’s patients<br />

reporting she could not even<br />

see to eat because her vision<br />

was so washed out. As a result,<br />

she was helped by using high<br />

contrasting utensils in order to<br />

stay comfortably independent.<br />

Another example of practical help would be a<br />

black switch on a white baseboard instead of the<br />

usual white switch on a white wall plate.<br />

Dr Donaldson also noted in patients with both<br />

cataracts and glaucoma, surgery choices need<br />

to be timed correctly. He suggested waiting<br />

12 months after phacoemulsification before<br />

performing trabeculectomy surgery to avoid bleb<br />

fibrosis and that, in some cases, stenting at the<br />

time of cataract procedure can give the space to<br />

operate on a cataract first.<br />

Unnecessary visual loss in a teenage boy<br />

The evening ended with a fascinating tale from<br />

Dr Shaun Dai, who reported on the unusual case<br />

of a 14-year-old, caucasian boy from the South<br />

Island who was suffering from low vision with no<br />

apparent, detectable cause. His family medical<br />

history was uneventful, but the boy’s vision had<br />

become so bad he had sought assistance from the<br />

Blind & Low Vision Education Network.<br />

On examination the boy was lethargic and clearly<br />

unwell, said Dr Dai. On further questioning the<br />

patient reported a severe allergy to dairy products<br />

and peanuts. He had subsisted on an anxiety-driven<br />

diet of chips and white bread. The boy was admitted<br />

to Middlemore Hospital in Christchurch where he<br />

was diagnosed with a serious vitamin A and B12<br />

deficiency, which has been associated with optic<br />

neuropathy in the past. Once the deficiency was<br />

treated, and he was put on a more nutritional diet,<br />

some vision was restored, to the point where he<br />

could return to mainstream education.<br />

Dr Dai noted that vision problems in adolescents<br />

related to vitamin A deficiency are becoming more<br />

prevalent in New Zealand.<br />

The next Grand Round is on Wednesday 8 June<br />

at Ormiston Hospital (by invitation only due to<br />

limited space). ▀<br />

Aggressive new US Treasury Department<br />

reforms have ended the proposed<br />

Dennis Oliver, Lorraine Beattie and Cecilia Turnbull<br />

US$160 billion merger of international<br />

pharmaceutical companies Pfizer and Allergan.<br />

The proposed reforms target inversions, where<br />

large US corporations seek to avoid paying US<br />

corporate taxes by moving their tax residence<br />

abroad through merger deals. The move was seen as<br />

a direct attack against Pfizer-Allergan’s plans, which<br />

would have shifted Pfizer’s official headquarters<br />

to Allergan’s base in Dublin, greatly reducing its<br />

tax rate and almost certainly leading to the loss of<br />

thousands of jobs in the US. The deal would also<br />

have allowed Pfizer to access what is believed to<br />

be about US$74 billion in foreign profits offshore,<br />

without having to pay the 35% US corporation tax.<br />

Deborah Chan and Vaishna Singavarothayan<br />

Pfizer announced the deal had been called off on<br />

6 April “by mutual agreement” driven by the actions<br />

of the US Treasury.<br />

“We plan to make a decision about whether to<br />

pursue a potential separation of our innovative and EyE DOctORS GRAND ROUNDS<br />

GRAND ROUNDS - <strong>2016</strong><br />

established businesses by no later than the end of<br />

<strong>2016</strong>, consistent with our original timeframe for the<br />

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

We look forward to seeing you.<br />

decision prior to the announcement of the potential<br />

Allergan transaction,” said Ian Read, chairman and<br />

CEO of Pfizer, in the statement.<br />

8th June - Ormiston Hospital<br />

Pfizer will pay Allergan $150 million as<br />

(by invitation only due to limited space)<br />

reimbursement for expenses associated with the<br />

transaction, as required under the terms of the<br />

14th September - Novotel, Ellerslie<br />

merger agreement.<br />

President Barack Obama promised to crack down<br />

No registration fee . cPD points available<br />

on tax inversions more than two years ago to deter<br />

Visit our website for more details.<br />

companies from leaving for tax advantages and<br />

had repeated that call after Pfizer-Allergan’s merger<br />

announcement. Following Treasury’s decision,<br />

Obama urged Congress to close the loophole for<br />

good by reforming the US tax system accordingly.<br />

Dr Andrew Riley<br />

Dr Mark Donaldson<br />

“Let’s stop rewarding companies that are shipping FRANZCO<br />

FRANZCO<br />

jobs overseas and profit overseas and start<br />

Dr Penny McAllum<br />

Dr Shuan Dai Ascot Clinic (09) 520 9689 - Botany Junction (09) 277 6787<br />

rewarding companies that create jobs right here at<br />

home and are good corporate citizens,” he said. FRANZCO<br />

FRANZCO<br />

▀<br />

EYE 0765<br />

Kathryn Bierre, Donald Klaasen, Sue Kanani, Odette Smith and Shookria Ranjaiy<br />

Dr Shuan Dai, Melissa Lee Sang, B+L representatives Yvette Beattie and Julian Knaggs, and<br />

Dr Penny McAllum<br />

Shirley Ip and Wen Li Keng<br />

www.eyedoctors.co.nz<br />

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

NEW ZEALAND OPTICS<br />

13


SPECIAL FEATURE: RANZCO NZ BRANCH SCIENTIFIC MEETING<br />

Welcome to Dunedin!<br />

This year’s Royal Australian and New Zealand<br />

College of Ophthalmologists New Zealand<br />

Branch Annual Meeting will be in Dunedin<br />

on the 27-28 <strong>May</strong> at The Dunedin Centre.<br />

The theme is The developing eye, developing<br />

techniques and developing therapies, and the<br />

organisers are very pleased to be hosting a<br />

selection of high-profile, international speakers<br />

around this topic.<br />

Running alongside the scientific meeting will<br />

be the NZ Ophthalmic Nurses’ Group meeting,<br />

which includes Tricia Cairns, from Mercy Hospital<br />

in Dunedin, on ethics and informed consent and<br />

Marie Strauss, a designer and owner of Dunedin’s<br />

OPHTHALMIC INSTRUMENT COMPANY (OIC)<br />

We look forward to welcoming you onto the OIC stand<br />

at the New Zealand branch meeting of RANZCO. We<br />

will have the Nidek RS-330 DUO on display, which<br />

combines high resolution retinal photography with<br />

optical coherence tomography (OCT). Also being shown,<br />

for the first time in New Zealand, will be the Nidek<br />

RS-3000 Advanced SLO based OCT, which includes<br />

OCT angiography. The latest release from Nidek is the<br />

compact HandyRefK, which is a highly portable, handheld<br />

autorefractor/keratometer, which also has an opacity<br />

measurement function for imaging, quantifying and<br />

measuring cataracts with central and peripheral opacity<br />

indexes. Among the Sonomed Ultrasound devices on<br />

display will be the Vu-Pad, a compact tablet-based<br />

ultrasound A/B Scan with optional UBM probe, the<br />

industry leading Sonomed Vu-Max HD UBM and the USBbased<br />

Master-Vu A&B Scans. We will also have a large<br />

range of orthoptic and vision testing supplies with special<br />

unique and popular Dada Boutique, on eyewear<br />

fashion.<br />

As normal the New Zealand branch meeting<br />

includes a full social programme, including a<br />

street art and heritage walk on the Saturday<br />

morning and Saturday evening’s formal dinner,<br />

to be held at the architecturally-designed Toitu<br />

Otago Settlers Museum.<br />

Dunedin itself provides a beautiful setting<br />

for two days of networking, socialising and<br />

professional development among our ophthalmic<br />

community.<br />

The NZ Optics team look forward to seeing<br />

you there! ▀<br />

The iconic railway station Dunedin<br />

BY DRS LOGAN MITCHELL, MARY JANE SIME AND<br />

CASEY UNG, CO-CONVENERS OF THE NZ BRANCH<br />

RANZCO <strong>2016</strong> MEETING<br />

The team in Dunedin are pleased to be hosting<br />

the annual meeting of the New Zealand<br />

Branch of the Royal Australian and New<br />

Zealand College of Ophthalmologists for <strong>2016</strong>.<br />

The meeting is entitled The developing eye,<br />

developing techniques and developing therapies. It<br />

is hoped this forum will provide an update, relevant<br />

to a broad audience, on some of the latest advances<br />

in our specialty from international keynote speakers<br />

and well-respected local experts. It is also a platform<br />

for our younger colleagues to present local research<br />

to a national audience.<br />

We look forward to welcoming to the conference<br />

our three keynote speakers, Professor Andrew Lotery<br />

from the UK, Professor Glen Gole from Brisbane and<br />

Dr Mark Chehade from Adelaide. Andrew Lotery will<br />

be speaking on medical retina topics, giving new<br />

insights into AMD, genetics and gene therapy. Glen-<br />

Gole is well-known to New Zealand audiences as<br />

an engaging and informative speaker on paediatric<br />

topics. Mark Chehade, in addition to his clinical<br />

interests, has a passion for registrar training and<br />

will also help us to think outside of the box when<br />

it comes to developing strategies to overcome the<br />

challenge of workforce shortages in the face of<br />

increased workload.<br />

Ophthalmologists have a two-day programme,<br />

with concurrent programmes for ophthalmic<br />

nurses and ophthalmic technicians. Although<br />

the orthoptists are not meeting this time (after<br />

meeting at the RANZCO Congress in Wellington last<br />

November) any orthoptists wishing to attend other<br />

sessions are still welcome. There is a registrar-only<br />

training day on Thursday 26 <strong>May</strong> and a Younger<br />

Fellows’ Breakfast planned for Saturday morning.<br />

Dunedin is a city with a proud heritage,<br />

particularly with its association with the University<br />

of Otago. The students bring vibrancy to the<br />

city and, combined with its legendary southern<br />

hospitality, is a unique place to visit. For those who<br />

like the city scene, there are good restaurants and<br />

cafés close at hand. Take time to explore some<br />

of the fine examples of Victorian and Edwardian<br />

architecture Dunedin is celebrated for and you will<br />

find artisans, fashion designers, and vibrant street<br />

art tucked away in unexpected places.<br />

For those more intrepid, there are opportunities to<br />

see wildlife in their natural habitat within easy reach<br />

of the city, either by land or by boat on the Otago<br />

Harbour. The albatross colony, yellow-eyed penguins<br />

and the Orokonui Ecosanctuary are all nearby.<br />

We invite you to join us, and even if the southern<br />

temperatures are cool, you can be assured of a<br />

warm welcome.<br />

We look forward to seeing you in person in <strong>May</strong>.<br />

To view the conference programme and register,<br />

please visit www.ranzco<strong>2016</strong>.co.nz. ▀<br />

conference pricing. See you in Dunedin. ▀<br />

phone: 09 443 0072<br />

Ranzco NZ <strong>2016</strong><br />

keynote speakers<br />

Distributed by:<br />

email: tim@oic.co.nz<br />

This year the keynote speakers are Professor<br />

Andrew Lotery, from the University<br />

of Southampton in England; Dr Mark<br />

Chehade from the South Australian Institute of<br />

Ophthalmology in Adelaide; and Professor Glen<br />

Gole, from Children’s Health, Queensland and the<br />

Lady Cilento Children’s Hospital in Brisbane.<br />

Professor Andrew Lotery<br />

Professor Andrew<br />

Lotery is chair of<br />

ophthalmology at<br />

the University of<br />

Southampton in<br />

England. His clinical<br />

specialty is medical<br />

retina with major<br />

research interests in<br />

age-related macular degeneration, ophthalmic<br />

genetics, gene and stem cell therapies. He is<br />

editor-in-chief of the journal Eye, the official<br />

scientific journal of The Royal College of<br />

Ophthalmologists in the UK. He has been awarded<br />

the Nettleship Award for Research by the Royal<br />

College of Ophthalmologists and was listed in The<br />

Times newspaper as one of the United Kingdom’s<br />

top 100 doctors. He and his team have performed<br />

over 70 clinical trials and published more than<br />

166 papers in leading journals including Nature<br />

Genetics, Nature Communications, The Lancet<br />

and The New England Journal of Medicine.<br />

Professor Lotery will be talking on: New insights<br />

into AMD from genetics, Gene therapy for rare<br />

and common eye diseases and New therapies for<br />

non-neovascular macular diseases.<br />

Dr Mark Chehade<br />

Dr Mark Chehade is<br />

director of the Cornea<br />

and External Disease<br />

Unit at the South<br />

Australian Institute of<br />

Ophthalmology based<br />

at the Royal Adelaide<br />

Hospital, a position<br />

he has held since<br />

leaving Moorfields Eye Hospital in the UK in 1997.<br />

His sub-specialty interest is surgical glaucoma,<br />

choosing a fellowship with Dr Clive Migdal, senior<br />

glaucoma research fellow at Moorfields, after it<br />

became evident that many patients with anterior<br />

segment disease lost their sight to glaucoma. His<br />

current research interests include the ocular surface<br />

microbiome, proteomics and tear film compositional<br />

analysis. Together with Drs Aanchal Gupta and<br />

Nadia Wittles, Dr Chehade’s unit trains a fellow each<br />

year, with some staying on for two years to ensure<br />

competency in treating complex external disease,<br />

cornea component transplantation, filter and<br />

implant drainage surgery.<br />

Dr Chehade is a ‘Sight For All’ visionary to<br />

Vietnam and Myanmar, where he supervises the<br />

training of transplant surgeons, and a dedicated<br />

trainer of ophthalmology registrars.<br />

Dr Chehade will be talking on: Applying the “good<br />

enough principle” to potential surgical cases,<br />

Imparting surgical skills to the ophthalmology<br />

trainee, and Developing strategies to overcome<br />

the ophthalmology workforce shortage<br />

Professor Glen Gole<br />

Professor Glen<br />

Gole is director of<br />

the Department of<br />

Ophthalmology at<br />

Children’s Health,<br />

Queensland and<br />

the Lady Cilento<br />

Children’s Hospital in<br />

Brisbane. He trained in<br />

ophthalmology under Professor Fred Hollows at the<br />

Prince of Wales Hospital in Sydney and completed<br />

a paediatric ophthalmology fellowship at the<br />

University of Iowa in the USA in 1984. He was on<br />

the staff of the Royal Children’s Hospital (RCH),<br />

Brisbane as a visiting medical officer from 1990 to<br />

2010 and was director of ophthalmology at RCH<br />

from 2010 to 2014. His research interests include<br />

retinopathy of prematurity, strabismus surgery and<br />

amblyopia. He has published more than 100 papers<br />

and several book chapters.<br />

Professor Gole will be talking on Managing<br />

amblyopia, ROP-is it all Retcam and Avastin from<br />

now on? and Ocular treatments and outcomes. ▀<br />

14 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


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©<strong>2016</strong> Abbott Medical Optics Inc. www.AbbottMedicalOptics.com PP<strong>2016</strong>CT0415<br />

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

NEW ZEALAND OPTICS<br />

15


SPECIAL FEATURE: RANZCO NZ BRANCH SCIENTIFIC MEETING<br />

Discover Dunedin<br />

ABBOTT MEDICAL OPTICS<br />

At Abbott, everything we do is<br />

in service to a simple, but vitally<br />

important mission: We want to<br />

help people around the world<br />

live their best possible lives.<br />

Our businesses are varied—<br />

offering both state-of-the-art<br />

technologies and time-proven<br />

solutions across the continuum<br />

of care—but we share an<br />

unshakable commitment to<br />

addressing some of the world’s<br />

most pressing health needs.<br />

Regardless of the specific job<br />

each of us does, Abbott people<br />

understand that our work<br />

matters in important ways.<br />

Abbott Vision is focused<br />

on providing the full range<br />

of advanced refractive<br />

technologies and support to<br />

help eye care professionals<br />

deliver optimal vision and<br />

lifestyle experiences to patients<br />

of all ages.<br />

Ophthalmic surgical products<br />

include intraocular lenses,<br />

laser vision correction systems,<br />

phacoemulsification systems,<br />

viscoelastics and related<br />

products used in cataract and<br />

refractive surgery. Contact lens<br />

and eye care products include<br />

disinfecting solutions, enzymatic<br />

cleaners, lens rewetting drops<br />

and dry eye drops. ▀<br />

Toitu Otago Settlers museum<br />

If you’re coming to the conference, why not take<br />

some time out during your stay to see what<br />

this heritage city has to offer?<br />

Visit:<br />

Toitu Otago Settlers museum, where Saturday’s<br />

dinner will be held. Spend some time soaking up<br />

the atmosphere of this beautiful, architecturally<br />

designed museum that will walk you through the<br />

history of the region from early Maori to modern<br />

day. Nearby the iconic railway station is well worth<br />

the time it takes to appreciate it, while the Dunedin<br />

Public Art Gallery, on the Octagon, is running<br />

an exhibition called The Analysis of Billy Apple’s<br />

Genome, which explores the future of medicines<br />

through sequencing Apple’s DNA.<br />

Eat:<br />

Marbecks Foodstore on George Street describes<br />

itself as a deli, but it’s more of a curiosity, with<br />

products on sale from truffle oil to Otago chocolate,<br />

plus a great ‘eat-in’ menu, it offers food for the<br />

stomach and the mind. Saturday morning see’s the<br />

farmers market outside the train station, including<br />

the Peasant Bakery, with its delightful selection<br />

of artisan patisseries. Well-known among the<br />

local student population is Capers café on George<br />

street, serving a selection of eccentric pancakes at<br />

a reasonable price.<br />

Nightcap:<br />

LENTIS® Comfort<br />

An advanced extended<br />

depth of focus IOL for<br />

new-age cataract patients<br />

By Emmanuel Calligeros<br />

oday’s new-age cataract patients, mostly<br />

Tbaby boomers, are a lot more active and<br />

demanding than previous generations. Gone<br />

are the days where good distance vision but<br />

compromised intermediate and near vision<br />

are acceptable. This new-age mature<br />

generation (of which I am a member) has<br />

more leisure time, is more active and<br />

technology savvy than their parents. Mobile<br />

phones and tablets are now part of their<br />

everyday life. They are also more inclined<br />

to research their options and demand the<br />

latest and the best.<br />

According to research conducted by Market<br />

Scope, presbyopia correcting IOLs accounted<br />

for only 2.4% of total IOLs implanted globally<br />

in 2014, with annual growth averaging 6%<br />

since 2010. 3<br />

ue to its aspheric, EDOF design LENTIS<br />

DComfort provides a range of focus<br />

from distance to as near as 60cm, reducing<br />

dependence on spectacles to a pair for fine near<br />

tasks for those patients who need them. (Fig.2)<br />

With LENTIS Comfort costing patients little<br />

more than monofocal IOL options and<br />

providing a much better lifestyle for patients it<br />

has the potential to replace monofocal IOLs for<br />

the majority of cataract patients in the future.<br />

For further information<br />

P: 0508 338 423 or 09 913 2000<br />

W: www.device.co.nz E: sales@device.co.nz<br />

Clinical & Business Development Specialist<br />

Ophthalmic Surgical Division, Device Technologies Australia<br />

Although most often providing excellent<br />

refractive outcomes, diffractive IOLs are<br />

associated with dysphotopic symptoms<br />

such as glare, halos and ghosting. 1<br />

Oculentis has addressed these limitations<br />

with the development of the LENTIS Comfort<br />

(MF15) IOL in both standard and toric form.<br />

The result is a refractive segmental near<br />

addition IOL, utilising extended depth of<br />

focus (EDOF) technology (Fig.1). The blended<br />

transition zone design delivers patients<br />

comparable distance vision to monofocal<br />

IOLs and excellent intermediate vision.<br />

Patrick Versace (eye surgeon at the Vision Eye<br />

Institute, Sydney) recently conducted a study,<br />

on his cataract patients, utilising a subjective<br />

questionnaire and a halos and glare simulation<br />

Albar is a cosy, Scottish-style whisky destination on<br />

Stuart street. They offer tastings, or just enjoy their<br />

‘malt of the month’ by the fire. During the month<br />

of <strong>May</strong>, Albar is also serving many hand-pumped<br />

beers — its answer to Oktoberfest.<br />

Ombrello’s on Clarendon Street also serve a great<br />

range of craft beer and is a good place for a late<br />

night coffee and cake fix.<br />

Or for those seeking a little more comfort and<br />

refuge from the noisier city bars try Pequeno, a<br />

warm and comfortable lounge bar with leather<br />

chairs and couches, in the basement of the historic<br />

Savoy building, which serves a variety of local and<br />

international wines, spirits, cocktails and Cuban<br />

cigars! ▀<br />

Fig. 1<br />

Toric LENTIS Comfort IOL<br />

tool to compare patient satisfaction with<br />

leading diffractive IOLs versus LENTIS Comfort.<br />

Dr Versace found that patient satisfaction with<br />

the LENTIS Comfort IOL was the highest of any<br />

multifocal included in the study. 2<br />

LENTIS Comfort also provides excellent<br />

contrast sensitivity (with 95% light transmission)<br />

for improved twilight vision as well as<br />

minimising glare and halos. 2<br />

LENTIS Comfort is available in an extensive<br />

range of parameters including custom torics in<br />

0.01D steps. (Table 1)<br />

Comfort Sports (lifestyle) Vision<br />

LENTIS COMFORT<br />

LENTIS COMFORT<br />

LENTIS COMFORT LENTIS COMFORT TORIC (Standard) LENTIS COMFORT TORIC (Customised)<br />

OPTIC SIZE 6.0mm 6.0mm 6.0mm<br />

OPTIC DESIGN Aspheric Aspheric toric Aspheric toric<br />

posterior, sectorshaped nearvision seg. posterior, sectorshaped nearvision seg. posterior, sectorshaped nearvision seg.<br />

anterior: +1.50D anterior: +1.50D anterior: +1.50D<br />

POWER RANGE -10D to -1D (1D), 0D to +36D (0.5D) SE: +10D to +30D (0.50D) sph:-10D to +35D (0.01D)<br />

cyl: +1.50, +2.25,+3.00, +3.75, +4.50, +5.25 cyl:+0.25D to +12.0D (0.01D) 1 deg steps<br />

REFRACTIVE INDEX 1.46 1.46 1.46<br />

Table 1<br />

References<br />

Fig. 2<br />

1 Alio JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Moreno LJ, Pinero DP “Comparison of a New Refractive<br />

Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular<br />

Lens.” Ophthalmology. 2012 Mar; 119(3): 555-63<br />

2 Versace P. Photic phenomena of different multifocal IOL designs.” The Oculentis Toolbox for Lens Surgery;<br />

Cataract & Refractive Surgery Today, Europe January 2015.<br />

3 Smolinsky, M. “Looking Deep at Extended Depth-of-Focus IOLs”. Eye on Innovation Newsletter, Nov. 3, 2015.<br />

DEVICE TECHNOLOGIES<br />

Proudly supporting RANZCO<br />

<strong>2016</strong>, Device Technologies will<br />

showcase:<br />

Oculentis Comfort IOL:<br />

With the toric version of our<br />

unique LENTIS Comfort lens<br />

—the pioneer in modern EDOFlens<br />

technology (extended<br />

depth of focus) — you now<br />

have the perfect tool to correct<br />

astigmatism.<br />

RANZCO: Choosing wisely<br />

The Royal Australian and New Zealand<br />

College of Ophthalmologists (RANZCO)<br />

issued five recommendations for its part in<br />

Choosing Wisely Australia.<br />

Choosing Wisely is a multi-disciplinary, global<br />

initiative to identify medical procedures that<br />

clinicians and consumers should know are of<br />

proven low value or carry an unnecessary risk,<br />

and so avoid wasteful or unnecessary medical<br />

tests and treatments. RANZCO was among 13<br />

health and medical associations and colleges<br />

participating in the second Choosing Wisely<br />

Australia round.<br />

The recommendations, along with explanations<br />

and supporting evidence, include:<br />

1. In the absence of relevant history, symptoms<br />

and signs “routine” automated visual fields and<br />

optical coherence tomography are not indicated.<br />

2. AREDS-based vitamin supplements only have<br />

a proven benefit for patients with certain<br />

subtypes of age-related macular degeneration.<br />

Topcon Triton:<br />

Swept Source “Deep Range<br />

Imaging” OCT and latest full<br />

spectrum OCT-A technology;<br />

DRI OCT Triton, anterior and<br />

posterior Swept Source OCT,<br />

with multi-modal true fundus<br />

imaging.<br />

••<br />

More confident initial<br />

diagnosis and ability to track<br />

change over time<br />

••<br />

Greater clinical efficiency<br />

••<br />

Greater patient comfort<br />

••<br />

Single scan capture of<br />

comprehensive data<br />

The Device Technologies<br />

team—Diego and Campbell—<br />

provide a complete business<br />

partnership by discussing<br />

your needs and helping you<br />

discover what best suits your<br />

practice. ▀<br />

There is no evidence to prescribe these<br />

supplements for other retinal conditions, or for<br />

patients with no retinal disease.<br />

3. Don't prescribe tamsulosin or other alpha-1<br />

adrenergic blockers without first asking<br />

the patient about a history of cataract or<br />

impending cataract surgery.<br />

4. Intravitreal injections may be safely performed<br />

on an outpatient basis. Don't perform routine<br />

intravitreal injections in a hospital or daysurgery<br />

setting unless there is a valid clinical<br />

indication.<br />

5. In general there is no indication to perform<br />

prophylactic retinal laser or cryotherapy to<br />

asymptomatic conditions such as lattice<br />

degeneration (with or without atrophic holes),<br />

for which there is no proven benefit.<br />

For more information, including explanations for<br />

patients on each of the five recommendations go<br />

to: https://ranzco.edu/media-and-advocacy/blog/<br />

ranzco-choosing-wisely-messages ▀<br />

New in cataract surgery<br />

Two major challenges have troubled<br />

surgeons and patients since the dawn of<br />

cataract surgery. The first is how to correct<br />

presbyopia to improve near vision; the second is<br />

increasing resolution capacity to allow the patient<br />

to perceive a distinct image.<br />

Now, Neuchatel-based company, Swiss Advanced<br />

Vision (SAV) have launched a new product that<br />

it says could solve both these issues—the InFo<br />

Instant Focus intraocular lens. The product is the<br />

first implant able to correct optical capacity without<br />

interfering with resolution, instantly, the company<br />

claims. By applying state-of-the-art optical physics<br />

to ophthalmology, it allows perfect vision, whatever<br />

the distance or light conditions, without halos or<br />

ghost images.<br />

“We launched IOL InFo Instant Focus at the<br />

beginning of January <strong>2016</strong>,” says Jean-Baptiste<br />

Marceau SAV sales and marketing manager.<br />

“Patient and surgeon feedback has all been very<br />

positive so far. We are currently distributing in<br />

Europe and looking to expand to the rest of the<br />

world.”<br />

It is estimated that 18 million people globally<br />

will need to replace their natural lens or face the<br />

prospect of going blind. InFo is the first and only<br />

replacement solution that offers the acuity of<br />

a 20-year-old, SAV claims, releasing data which<br />

shows that four years after surgery 98% of<br />

patients report completely distinct vision.<br />

“For patients, it’s life in real time again,” says Max<br />

Boysset, SAV chief executive. “The brain loves it:<br />

patients adapt to InFo almost instantly. Our mission<br />

is to restore their original vision after (cataract)<br />

surgery through a unique solution, without<br />

compromise on image quality or resolution.” ▀<br />

To restore the gift of sight through vision research.<br />

Capital Vision are proud to announce the extension of<br />

our world-first, Wellington Keratoconus Study<br />

(WELKS) being conducted in secondary schools. This<br />

Research Project, now extended to the end of <strong>2016</strong>,<br />

will expand its screening programme to the greater<br />

Wellington Region and beyond, to ensure the most<br />

accurate and scientific data results.<br />

As a registered charity, Capital Vision needs your<br />

support to expand our programme of critical scientific<br />

research and succeed in our mission “to undertake<br />

world-class scientific research to develop and enhance<br />

methods of treating and avoiding blindness”.<br />

For more information, please feel free to visit our<br />

website www.capitalvision.nz or you can contact us<br />

direct at: info@capitalvision.nz.<br />

16 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

“Engineering the Cornea in vivo”<br />

BY DR CAROL ANN GREENE<br />

AND A/PROF. TREVOR SHERWIN<br />

In the last decade there has been an emphasis on finding<br />

new therapeutic interventions for tissue engineering and<br />

regeneration. Although current tissue regeneration technology<br />

holds considerable promise it is yet to deliver in the clinical<br />

setting. The introduction of cell reprogramming via the production<br />

of induced pluripotent stem cells has heralded a new revolution<br />

and has further fuelled the development of the ultimate tissue<br />

regeneration treatment. However, before genetically induced cell<br />

reprogramming based methods can be successfully translated<br />

from the laboratory to the hospital problems such as the low<br />

efficiency and safety issues concerning such technology first need<br />

to be addressed.<br />

The cornea in particular presents a challenge to tissue engineers.<br />

This small, transparent tissue is the major refractive element<br />

of the eye. Corneal damage and diseases are the second largest<br />

cause of vision loss and affect more than 10 million people<br />

worldwide. Currently, the most successful treatment for corneal<br />

blindness is full-thickness replacement of damaged corneal<br />

tissue with human donor cornea. Apart from drawbacks such<br />

as complications arising from immune rejection, donor-derived<br />

infection, and the high cost of pretransplant screening, the major<br />

problem with this approach is the severe shortage of donor tissue.<br />

It is increasingly difficult to keep up with the demand for donor<br />

corneas; therefore new avenues which include the generation<br />

of artificial corneas and stem cell therapy to regenerate the<br />

individual layers of the cornea are being explored. Although we<br />

have seen significant progress in both of these areas, corneal<br />

transplantation using cadaveric donor corneas has largely<br />

remained irreplaceable. Keratoconus, an ectatic corneal dystrophy<br />

affecting approximately 1 in 2,000 individuals worldwide, is one<br />

of the main indications for corneal grafts carried out in New<br />

Zealand owing to its particularly high incidence and severity. The<br />

progressive thinning of the corneal stroma typically occurs over<br />

decades and results in a conical shaped cornea that then impairs<br />

vision due to irregular astigmatism and myopia. It has been<br />

established that the corneal thinning is a result of the loss of corneal<br />

stromal extracellular components including collagen 1-3 . Currently<br />

there are no treatments available which address the problem<br />

of corneal thinning and interventions are mainly focussed on<br />

Fig 1. A: Cross section of the cornea. B-E: Immunohistochemical labelling of reprogrammed cells and matrix deposition.<br />

Human keratocytes in culture (B) and in ex vivo corneal culture (C) secrete collagen type II when treated with chondrogenic<br />

differentiation factors (green labelling; nuclei are stained with DAPI and appear blue). D: human keratoconic corneas treated<br />

in vitro also express collagen type II (green). E: Rat corneas treated in vivo and later removed for immunohistochemical<br />

labelling express collagen type II.<br />

stiffening a weakened cornea or improving the visual acuity rather<br />

than stopping disease progression.<br />

The replacement of damaged tissue with engineered tissue has<br />

been a successful method for the epithelial and endothelial layers<br />

of the cornea 4, 5 . The corneal stroma, however, has proved to be<br />

more of a challenge owing to the fact that it comprises about 90%<br />

of the corneal tissue and has a highly organised microstructure.<br />

Traditionally, tissue engineering has encompassed in vitro<br />

techniques that involve the utilisation of cells and extracellular<br />

matrix scaffolds to produce substitutes that could replace<br />

wounded or diseased tissues. So far, it has not been possible to<br />

engineer clinically viable corneas mainly because classical tissue<br />

engineering methods, based on a scar model, do not support the<br />

production of a highly organised tissue such as that produced<br />

during normal stromal development. Current efforts in this field<br />

are focussed at defining the physiologically relevant in vitro<br />

microenvironments and using a more developmental approach for<br />

building stromal tissue. Alongside the progress made in the fields<br />

of biomaterials and tissue engineering, there has also been some<br />

progress made towards understanding the effect of different<br />

microenvironment conditions on cells and their potential to selforganise<br />

and produce useful proteins in these altered conditions.<br />

The in situ induction of tissue resident cells can be used to drive<br />

tissue repair and regeneration; however, such a strategy when<br />

employed in the cornea would lead to the activation of corneal<br />

keratocytes into the undesirable wound healing fibroblast<br />

and myofibroblast phenotypes. Corneal collagen is composed<br />

of heterotypic fibrils consisting of type I and type V collagen<br />

molecules. Although it is possible to induce keratocytes to<br />

secrete these collagens via activation into a fibroblast, such an<br />

induction would lead to the production of a fibrotic scar rather<br />

than organised collagen fibrils. Therefore, if such an approach is<br />

to be utilised it would need to be done in a way that bypasses the<br />

normal wound healing pathway. It appears, for the corneal stroma<br />

at least, that traditional tissue engineering methods do not<br />

currently provide a viable solution.<br />

In our lab we have taken an in vivo approach to corneal<br />

regeneration. Corneal keratocytes are extremely difficult to<br />

culture due to their phenotypic instability and therefore our in<br />

vivo approach allows us to circumvent difficulties associated<br />

with the in vitro manipulation of corneal keratocytes. We have<br />

shown that adult cells in the human body are far more plastic<br />

than previously thought and that specific cell lineage defining<br />

Fig 2. Permanent reshaping of the cornea by combining<br />

in vivo cell reprogramming with a rigid contact lens to<br />

hold the desired corneal shape during treatment.<br />

combinations of exogenous factors can direct cells to change<br />

into required types 6, 7 . Specifically, our research has shown that<br />

keratocytes are induced to secrete collagen type II, a cartilage<br />

matrix specific collagen, when treated with chondrogenic<br />

differentiation factors. We hypothesised that this approach could<br />

potentially be used as a treatment to increase corneal integrity of<br />

a cornea weakened by keratoconus, or as a therapeutic approach<br />

to correct myopia induced vision defects, by inducing keratocytes<br />

to secrete extracellular matrix components in conjunction with a<br />

method for reshaping the cornea.<br />

Initially in our human ex vivo culture experiments using normal<br />

as well as keratoconic corneas the chondrogenic differentiation<br />

factors led to the uniform deposition of type II collagen along the<br />

stromal lamellae. Furthermore, in vivo treatment of corneas in<br />

rats also resulted in the deposition of type II collagen in a manner<br />

similar to that seen in ex vivo culture (Figure 1). Collagen type<br />

II, a fibrillar collagen, is very similar to collagen I in function and<br />

is thought to be the cartilage analogue of collagen I in other<br />

tissues. Collagen type II is also expressed during development of<br />

the chick corneal stroma. It is only later replaced by type I in the<br />

mature chick stroma 8 . An advantage of inducing the secretion<br />

of a non-stromal collagen by the keratocytes is that this new<br />

collagen would be less prone to degradation by native degradative<br />

enzymes which are known to be upregulated in keratoconus 9 .<br />

The induction of type II collagen enables development of a novel<br />

stromal tissue regeneration method without compromising<br />

corneal integrity or transparency. Data from in vivo rodent and<br />

ex vivo human studies have both shown that the deposition<br />

of collagen II can be stopped upon withdrawal of the cell<br />

differentiation factors and that deposition results in a transparent<br />

more elastic and stiffer cornea.<br />

We propose a unique treatment by combining in vivo tissue<br />

engineering with prescription contact lenses to permanently<br />

reshape and stabilise the cornea in an effort to demonstrate the<br />

applicability of taking an in vivo approach to tissue regeneration<br />

(Figure 2). Our research is now focussed at building upon our<br />

human corneal tissue experiments and in vivo rodent studies<br />

to demonstrate therapeutic proof of concept. We aim to<br />

demonstrate the deposition of corneal tissue matrix and also the<br />

subsequent reshaping of the cornea in a large animal study in<br />

partnership with collaborators at Lincoln University. This stage<br />

of the project includes an ex vivo sheep eye study to confirm<br />

treatment efficacy and optimum dose, an initial in vivo sheep eye<br />

test for adverse reactions (if any), and the in vivo proof of concept<br />

demonstration of our technology’s potential for treatment of<br />

human ocular disease.<br />

We believe that our method of in situ modulation of the cells<br />

of the corneal stroma to affect extracellular matrix deposition<br />

is a viable approach for stopping the progression of corneal<br />

thinning and could provide a long term solution for correcting<br />

corneal ectasia. The development of such a treatment would<br />

pave the way for the use of biochemical and biological molecules<br />

that effectively provide signalling to stimulate the self-healing<br />

potential of the patient’s own cells thereby ushering a new<br />

frontier in regenerative medicine. ▀<br />

References<br />

1. Chang, C.-Y., et al., Acute wound healing in the human central corneal<br />

epithelium appears to be independent of limbal stem cell influence.<br />

Investigative ophthalmology & visual science, 2008. 49(12): p. 5279-5286.<br />

2. Rabinowitz, Y.S., Keratoconus. Survey of ophthalmology, 1998. 42(4): p. 297-<br />

319.<br />

3. Patel, D. and C. McGhee, Understanding keratoconus: what have we learned<br />

from the New Zealand perspective? Clinical and Experimental Optometry,<br />

2013. 96(2): p. 183-187.<br />

4. Pellegrini, G., et al., Long-term restoration of damaged corneal surfaces with<br />

autologous cultivated corneal epithelium. The Lancet, 1997. 349(9057): p.<br />

990-993.<br />

5. Ide, T., et al., Structural characterization of bioengineered human corneal<br />

endothelial cell sheets fabricated on temperature-responsive culture dishes.<br />

Biomaterials, 2006. 27(4): p. 607-614.<br />

6. Greene, C.A., et al., Cells from the adult corneal stroma can be reprogrammed<br />

to a neuron-like cell using exogenous growth factors. Experimental cell<br />

research, 2013. 322(1): p. 122-132.<br />

7. Greene, C.A., C.R. Green, and T. Sherwin, Transdifferentiation of chondrocytes<br />

into neuron‐like cells induced by neuronal lineage specifying growth<br />

factors. Cell biology international, 2015. 39(2): p. 185-191.<br />

8. Linsenmayer, T.F., J.M. Fitch, and D.E. Birk, Heterotypic collagen fibrils and<br />

stabilizing collagens. Annals of the New York Academy of Sciences, 1990.<br />

580(1): p. 143-160.<br />

9. Kenney, M.C. and D.J. Brown, The cascade hypothesis of keratoconus. Contact<br />

lens and anterior eye, 2003. 26(3): p. 139-146.<br />

About the author<br />

* Dr Greene completed her PhD on keratocyte<br />

multipotency at the Department of<br />

Ophthalmology in 2014. In October 2015 she<br />

started a Postdoctoral Fellowship that has<br />

allowed her to ‘pick up where she left off ’ at<br />

the end of her PhD and pursue translational<br />

research. Her mentors at the Department of<br />

Ophthalmology are Associate Professor Trevor<br />

Sherwin and Professor Colin Green. The team<br />

recently received Return on Science funding to<br />

work on the development of a novel treatment<br />

for regenerating the corneal stroma.<br />

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

NEW ZEALAND OPTICS<br />

17


ANZ Cornea Society report<br />

Challenges<br />

One of the things we’re sometimes<br />

faced with is dealing with challenging<br />

patients. Some patients simply have<br />

tricky personalities. They can be combative<br />

in nature, withdrawn or disinterested with<br />

a variety of other personality traits that are<br />

difficult to deal with. Many have already been<br />

through the mill with a history of seeing a<br />

variety of optometrists, ophthalmologists,<br />

dispensers and other medical practitioners.<br />

They’re often frustrated by having less than<br />

optimal outcomes. Some are what are known as<br />

‘doc shoppers’, hoping to have a better resolution<br />

to their problems by seeking the opinion and<br />

services of yet another professional. Others are<br />

referred by specialists or colleagues who hope<br />

that our particular skill-set and management<br />

strategies will lead to a better solution.<br />

In some cases, other practitioners are simply<br />

trying to get rid of what they regard as an<br />

impossible patient!<br />

We will all come across a few of these in our<br />

professional lifetimes but more often than not,<br />

careful attention to detail and application of the<br />

right optical appliances and tools will provide the<br />

desired outcome.<br />

Of course there is often a financial aspect with<br />

some patients having spent thousands of dollars<br />

and much valuable time, effort and travel in the<br />

pursuit of happiness. No one likes wasting money<br />

and some see such things as ‘grudge purchases’.<br />

When one does, however, solve the problems<br />

you often end up with a loyal patient for life and<br />

a great source of referrals for their friends, family<br />

and colleagues.<br />

On the other hand, for some practitioners, the<br />

hurdles seem insurmountable, or they simply<br />

don’t have the passion, interest or compassion<br />

necessary for dealing with such cases.<br />

Secrets of Success<br />

So what are the secrets to success in such cases?<br />

To me the cornerstones of dealing with these<br />

patients are the basic fundamentals of good<br />

practice.<br />

Passion and confidence are critical aspects.<br />

A great chair-side manner also makes all the<br />

difference.<br />

Getting the patient onside, in that initial<br />

encounter, usually smoothes the way to getting<br />

the job done to everyone’s satisfaction.<br />

Ideally one would have obtained previous<br />

records, reports, prescriptions and what<br />

spectacle and contact lenses have already<br />

been tried. In most cases there’s no point in<br />

prescribing the same lens designs and expecting<br />

to reinvent the wheel and obtain a different<br />

outcome. Such foresight can help steer you in<br />

the right direction and avoid repetition.<br />

Having caring, efficient staff and colleagues<br />

who have dealt considerately with the patient<br />

in terms of making contact and booking the<br />

appropriate appointment also helps us start off<br />

on the right foot.<br />

Listen Carefully<br />

Our first patient contact should involve an<br />

empathic, careful and detailed history as the<br />

starting point. Digging deeper and using detective<br />

skills to draw out unmentioned or undisclosed<br />

aspects or issues that may affect the outcome and<br />

solution need to be extracted. In some cases the<br />

patients will not tell you all the facts—some want<br />

to almost trick you to see if you can determine<br />

what these issues are. It may be a previous<br />

history of LASER Vision Correction or there may be<br />

medications that are aggravating things. Patients<br />

often don’t regard some pills as medication: one<br />

may need to ask “are you taking any pills, drugs,<br />

medicines, skin treatments or oral contraceptives?”<br />

which will elicit a very different answer to “are<br />

you taking any medication?” Looking up the side<br />

effects then and there (or better still being able to<br />

roll them off your tongue), helps get the message<br />

across. Getting patients to take ownership of their<br />

issues is helpful as opposed to them thinking we<br />

are magicians that will miraculously make all their<br />

problems disappear.<br />

They may waffle on for 20 minutes on the case<br />

history alone. If so, let them get their story across.<br />

Too many practitioners cut them off and miss out<br />

on critical information. One can of course deduce<br />

that those wanting to complete a whole patient<br />

exam in a quickie 20 minute consultation, are<br />

not going to have much chance of getting results<br />

in these cases. For that reason, people practising<br />

in such environments are often some of our key<br />

referrers or at any rate the source of many such<br />

challenging patients.<br />

I’ve had a number of such cases of late. The<br />

occasional interjection or probing question will,<br />

however, often help focus you and the patient<br />

on what the issues are, which options are likely<br />

to work and which one’s are not. A recent case<br />

involved someone with a history of major<br />

problems relating to a choroidal melanoma. One<br />

possible solution was enucleation of the eye. They<br />

made it abundantly clear that was an option they<br />

were violently opposed to and was not up for<br />

discussion.<br />

Focus<br />

Letting patients know you’re on their side, have<br />

their best interests at heart and a strong desire<br />

to solve their problems is also helpful in winning<br />

them over.<br />

Once we have all the basics out of the way, we<br />

can then direct our diagnostic tests in the area that<br />

is going to provide us with the fastest way to zero<br />

in on the problem and potential solutions. This<br />

may involve topography or OCT on the high-tech<br />

end, or be as simple as picking up your retinoscope<br />

or direct ophthalmoscope—these two centuryold<br />

tools can in an instant diagnose a previously<br />

missed keratoconus, early PCO or cataract.<br />

We then collate all our data and in as simple<br />

terms as possible—ideally with the aid of<br />

diagrams or Google—demonstrate and explain the<br />

problem and possible solutions.<br />

Fortunately we have access to the most fantastic<br />

spectacle and contact lens technology we’ve ever<br />

had. Applying the correct occupational lens, prism<br />

or contact lens—as we’ve discussed in recent<br />

columns—can often be a quick and easy fix.<br />

Of course for some of these patients we need<br />

to do a lot more. We may need to work through<br />

a myriad of options and trial or fine-tune<br />

increasingly complex solutions.<br />

My philosophy is to start with the simplest<br />

options and slowly work through ever more<br />

complex alternatives. For example, we may<br />

start with a soft contact lens and then move<br />

onto a corneal RGP. When all else fails, we may<br />

need to look into a scleral contact lens. In turn<br />

we may need to refer to a colleague with more<br />

specialised skills than ours or seek appropriate<br />

referral to an ophthalmologist for a surgical<br />

solution. It’s all about having the necessary<br />

skills to make the optimum decisions and seek<br />

the most appropriate management for the<br />

particular case we are involved with.<br />

Don’t let ego be a barrier.<br />

By applying the above philosophies—over my<br />

three decades of practice—there are only a few<br />

cases where I’ve not been able to break down the<br />

barriers and find a satisfactory outcome. ▀<br />

Modern classic from Bon Vivant<br />

Ogi brand Bon Vivant<br />

have just announced<br />

the launch of their new<br />

eyewear collection. A classic, cateye<br />

shape given a modern twist,<br />

the Noelle range offers a trendy<br />

stainless steel frame in four<br />

matte, autumnal colours, with<br />

adjustable nose-pads for comfort.<br />

Inspired by French glamour but<br />

with a durable, contemporary<br />

feel, Noelle is designed to appeal<br />

to the interlectual and lover of<br />

haute couture. Ogi is distributed<br />

in New Zealand by Whakatanebased<br />

distributor BTP. ▀<br />

Delegates at the 33rd Annual Cornea and Eye Bank Meeting in Melbourne<br />

The 33rd Annual Cornea and Eye Bank Meeting<br />

was held in Melbourne from 10-11 March.<br />

Organisers Associate Professor Mark Daniell<br />

and Dr Jacqueline Beltz reportedly arranged an<br />

excellent scientific programme, which ran very<br />

smoothly and was enjoyed by all.<br />

Professor Massimo Busin from Italy presented<br />

engaging lectures on corneal transplantation and<br />

actively took part in discussions. In particular, he<br />

spoke about his modifications to DMEK surgery, how<br />

to standardise DALK surgery and how to choose the<br />

best surgical procedure for patients with corneal<br />

endothelial failure.<br />

Professor Kerryn Williams from South Australia<br />

delivered the Coster lecture. It was excellent to hear<br />

from Professor Williams just prior to her retirement<br />

after an amazing career researching and reporting<br />

on the immunobiology of corneal transplantation<br />

and her involvement in setting up and continuing<br />

the Australian Corneal Graft Registry.<br />

Professor Barry Jones AC gave a wonderful<br />

lecture entitled Science and Politics, captivating<br />

the audience with his musings on politics, policy<br />

and science. In a day when politicians might be<br />

promoted for loyalty rather than thinking, and<br />

political processes are often driven by opinion rather<br />

Snowvision<br />

sells fast<br />

Interest in the 11th Snowvision conference being<br />

held in Queenstown from 3-6 August has been<br />

phenomenal.<br />

In true Snowvision style, 75% of the 100 available<br />

delegate places were taken within the first week of<br />

registrations opening.<br />

Organisers Grant Watters, Catherine Small,<br />

Hamish Caithness and Dave Robinson said the<br />

conference appeals to those optometrists who<br />

wish to combine a learning experience with<br />

pleasure. “It’s great that our event still has<br />

momentum after establishing it 20 years ago. It is<br />

a truly special event and provides the perfect blend<br />

of education, social events and winter outdoor<br />

activities in the most stunning action-packed<br />

centre in the country,” they said.<br />

The conference is being held at the Crowne Plaza<br />

Hotel. At the time of going to print there were 10<br />

places available.<br />

Industry support is always a key feature of<br />

Snowvision and greatly appreciated. Sponsors<br />

include, Ophthalmic Instrument Company (OIC) for<br />

loaning and setting up all the equipment for the<br />

workshops; Hoya for the opening cocktail function;<br />

Corneal Lens Corporation for the BBQ lunch at<br />

Coronet Peak; Independent Lens Specialists for<br />

the golf at The Hills; and CR Surfacing for the Go-<br />

Karting championship<br />

To view the programme and to register go to<br />

www.registerhere.co.nz. ▀<br />

than evidence, many were left wondering how we<br />

might be able to encourage more politicians who<br />

believe in evidence-based policy.<br />

Other speakers included Dr Enrique Graue<br />

Hernandez from Mexico who spoke about<br />

combined treatments for keratoconus; Professor<br />

Charles McGhee who outlined what we can learn<br />

from corneal transplantation in New Zealand;<br />

and Professor Stephanie Watson from New South<br />

Wales, who brought us all up to date with stem cell<br />

therapies for corneal disease.<br />

A video competition was run in which presenters<br />

had five minutes to present a video related to eye<br />

banking or corneal surgery. The presenters provided<br />

live commentary and the session was engaging and<br />

fun. Dr Simone Beheregaray from Brazil, currently<br />

working as a corneal fellow in Sydney, won the<br />

competition with her video entitled Artificial Iris.<br />

Overall, the Cornea Society and Eye Bank Meeting<br />

was well attended and included content that was<br />

informative and of high quality. Participants are<br />

looking forward to the 34th Meeting in Brisbane<br />

next year on 4 February, just prior to the ASIA-ARVO<br />

meeting, also in Brisbane. ▀<br />

Edited from an original article supplied by the ANZ<br />

Cornea Society<br />

Hywel Bowen<br />

retires<br />

Hywel Bowen is<br />

retiring after 43<br />

years. He has had<br />

a long and distinguished<br />

career as an optometrist, and a long association<br />

with Thames, where he owned and operated a<br />

practice for 23 years before joining the Paterson<br />

Burn Thames practice six years ago. He lectured<br />

at the optometry school for 20 years and has<br />

been an examiner for five years. He was also on<br />

the NZAO Council, was NZAO Waikato Branch<br />

chair, and he’s undertaken more than 60 trips as<br />

a VOSO volunteer. Paterson Burn held a farewell<br />

function for Bowen in April to celebrate his<br />

retirement, his contribution to optometry and to<br />

wish him well. ▀<br />

How’s your<br />

Macula?<br />

This year Macular Degeneration Awareness<br />

Week runs from the 23-29 <strong>May</strong> and will<br />

ask the public, “How’s your Macula?” to<br />

encourage people to test their vision with a<br />

simple test.<br />

The Amsler grid test gives Kiwi’s an indication<br />

of whether they need to seek specialist help, as<br />

caught early the disease can be slowed and even<br />

halted, but vision lost cannot be restored.<br />

“Time lost is vision lost. Research shows 50%<br />

of people with wet macular degeneration will<br />

lose vision within three months,” said Dr Dianne<br />

Sharp, MDNZ chair. “Early recognition is essential<br />

now that treatment options are available.”<br />

MDNZ will be distributing materials to<br />

optometrists at the start of the month,<br />

including posters and Amsler grids to help<br />

raise awareness among their patients to<br />

encourage regular eye tests.<br />

For more information, visit www.MDNZ.org.nz. ▀<br />

18 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong>


Focus on<br />

Eye Research<br />

Age Related Macular Degeneration<br />

REVIEWED BY NADEEM AHMAD*<br />

COMPARISON OF RETINAL PIGMENT EPITHELIUM-<br />

CHOROID GRAFT SURGERY AND ANTI-VEGF THERAPY<br />

IN PATIENTS WITH WET AMD<br />

van Zeeburg EJT, Cereda MG, Amarakoon S, van<br />

Meurs JC<br />

OPHTHALMOLOGICA 2015;233:134-45<br />

Review<br />

The purpose of this study was to investigate whether<br />

patients with exudative age-related macular<br />

degeneration and a sub-macular hemorrhage, retinal<br />

pigment epithelium (RPE) tear or non-responders to<br />

anti-vascular endothelial growth factor (VEGF) benefit<br />

more from a free RPE-choroid graft transplantation<br />

surgery than from (continuation of) anti-VEGF<br />

treatment.<br />

A total of 20 patients were included in this<br />

prospective, international, multicenter, randomised<br />

intervention study. Patients were randomised into<br />

6 groups based on the presenting abnormality (sub<br />

macular hemorrhage, RPE tear, or non response to<br />

Anti VEGF) and the intervention (surgery vs anti VEGF<br />

therapy).<br />

The change in the mean number of Early Treatment<br />

of Diabetic Retinopathy Study (ETDRS) letters in the<br />

graft group 1 year postoperatively was -15 (range<br />

-54 to +26), whilst 2 patients experienced a gain of<br />

>10 letters. The median preoperative visual acuity<br />

(VA) was 0.75 logMAR (range 0.46-2.8), and the mean<br />

postoperative VA was 1.48 logMAR (range 0.14-2.8).<br />

The change in the mean number of ETDRS letters<br />

in the anti-VEGF group was -8 (range -26 to +6); no<br />

patients experienced a >10 letter gain. The median<br />

preoperative VA was 1.36 logMAR (range 0.58-1.6), and<br />

the median postoperative VA was 1.42 logMAR (range<br />

0.44-1.66).<br />

The authors concluded that the included patient<br />

group was far too small to draw conclusions. However,<br />

both gain and loss of VA may be experienced by<br />

patients undergoing either treatment method; more<br />

gain might be possible for patients with a graft in the<br />

absence of complications.<br />

Comment<br />

This study looks at a particular sub group of patients<br />

that traditionally carry a poor prognosis for vision.<br />

Continuation of anti VEGF therapy has limited<br />

benefit in this group, and this was also confirmed in<br />

this small study. The use of RPE-choroid graft shows<br />

promising results with >10 letter gain seen in 2<br />

patients. However the surgical group was also likely<br />

to lose more vision when unsuccessful, and major<br />

complications (recurrent retinal detachment with<br />

proliferative vitreoretinopathy, severe hypotony etc)<br />

were also only seen in the surgical group. Refinements<br />

in tissue culture techniques and the improvement in<br />

controlling proliferative vitreoretinopathy may help<br />

improve outcomes in future.<br />

A COMPARISON OF SAME SETTING VERSUS DELAYED<br />

VITRECTOMY IN THE MANAGEMENT OF RETAINED<br />

LENS FRAGMENTS AFTER CATARACT SURGERY<br />

Orlin A, Parlitsis G, Chiu Y, et al.<br />

RETINA 2014;34:1969-76<br />

Review<br />

This retrospective non-randomised study looked at the<br />

outcomes of vitrectomy for retained lens fragments<br />

from cataract surgery complicated by capsular rupture<br />

based on the timing of intervention (early or same<br />

setting, vs delayed).<br />

The authors reviewed outcomes for all patients<br />

undergoing pars plana vitrectomy for retained lens<br />

fragments after cataract surgery from 2007 to 2012 in<br />

their centre. Outcomes included visual acuity and the<br />

development of various complications such as retinal<br />

detachment, elevated intraocular pressure >30 mmHg,<br />

and cystoid macular edema. Multivariate analysis<br />

was performed to adjust for potentially confounding<br />

variables such as age and preoperative visual acuity.<br />

Twenty-eight consecutive eyes (13 same setting,<br />

15 delayed setting) were included in the analysis.<br />

Patients in the same setting group were older than in<br />

the delayed group (81.00 vs. 72.87 years, P = 0.053).<br />

No other preoperative differences existed between<br />

the groups (axial length, preoperative vision, and<br />

intraocular pressure). The mean time to pars plana<br />

vitrectomy in the delayed group was 26.6 days (range,<br />

1–91 days).<br />

No significant differences existed in mean vision<br />

between the same setting (logMAR, 0.42) and the<br />

delayed group (logMAR, 0.57) (P = 0.132). Multivariate<br />

analysis showed no difference in final vision when<br />

adjusting for age and preoperative vision. Although<br />

there was a trend for eyes in the same setting group<br />

to obtain good vision (≥20/40) faster, a higher<br />

percentage of eyes in the delayed group obtained<br />

better vision at the most recent follow-up (66.7 vs.<br />

23.1%, P = 0.02). More eyes in the delayed group had<br />

an intraocular pressure >30 at any point (P = 0.055).<br />

There was no significant difference between the<br />

groups in any other complications such as retinal<br />

detachment, choroidal detachment, and cystoid<br />

macular edema during the follow-up.<br />

Based on their findings, the authors concluded<br />

that same setting pars plana vitrectomy offers no<br />

significant visual acuity advantage over delayed<br />

pars plana vitrectomy in patients with retained lens<br />

fragments.<br />

Comment<br />

The timing of intervention following dropped lens<br />

fragments from a complicated cataract operation is<br />

an important discussion point. Several meta-analyses<br />

have looked previously at this question, and there is<br />

no consensus on the best approach given the number<br />

of confounding factors (e.g. immediate management<br />

of the complication by the operating surgeon,<br />

control of intraocular pressure and inflammation<br />

etc). An early vitrectomy, especially a same setting<br />

procedure done as an extended operation following<br />

the complication, is possible only when vitreoretinal<br />

expertise is available at hand. This is only possible in<br />

a tertiary care unit as peripheral/smaller units either<br />

do not have a vitreoretinal surgeon, or the vitrectomy<br />

equipment may not be available. This study therefore<br />

helps in evaluating if a delay in the second procedure<br />

is detrimental for the patient. Given that this is a<br />

relatively rare complication, the study is limited by<br />

the small number of patients included. The results<br />

however are reassuring for surgeons and patients alike<br />

in the peripheral units that the visual outcomes will<br />

not be adversely affected if the secondary procedure<br />

is not done during the same setting. These patients<br />

however should be referred promptly for assessment<br />

in a vitreoretinal unit.<br />

25-GAUGE PARS PLANA VITRECTOMY FOR RETAINED<br />

LENS FRAGMENTS IN COMPLICATED CATARACT<br />

SURGERY<br />

Scupola A, Abed E, Sammarco MG, et al.<br />

OPHTHALMOLOGICA 2015;234:101-8<br />

Review<br />

This study was conducted to verify the efficacy<br />

of 25-gauge pars plana vitrectomy (PPV) for the<br />

management of posteriorly dislocated lens material<br />

after complicated cataract extraction, and to determine<br />

in which patients this would be the optimal approach.<br />

Forty eyes of 40 patients with retained lens<br />

fragments undergoing early (within 1 week) or late<br />

(within >1 week) 25-gauge PPV were retrospectively<br />

reviewed. The amount of dislocated nuclear material<br />

was graded by the surgeon intraoperatively, and the<br />

patients were divided into two groups accordingly:<br />

group A (≤50% dropped nucleus) and group B (>50%<br />

dropped nucleus). The presence of brunescent<br />

nuclear pieces was noted.<br />

The outcomes measured included bestcorrected<br />

visual acuity (BCVA) and postoperative<br />

complications such as retinal detachment, cystoid<br />

macular edema (CME) and postoperative ocular<br />

hypertension or hypotoy.<br />

A significant positive correlation was found between<br />

nuclear material grade and PPV duration (R2 = 0.81,<br />

p < 0.0001). None of the patients had brunescent<br />

nuclear pieces. There were no cases of ocular<br />

hypotony. Retinal detachment developed in 4 patients<br />

(10%), occurring only in patients of group B (p < 0.002).<br />

Four patients with late PPV developed postoperative<br />

CME, with no case of CME among patients with early<br />

vitrectomy (p = 0.014).<br />

The author concluded that removal of dislocated<br />

lens fragments after complicated cataract surgery can<br />

be effectively managed with 25-gauge PPV, although<br />

it appears to be most efficient for cases with a limited<br />

amount of dislocated lens material. In consideration<br />

of the higher rate of retinal detachment observed in<br />

cases of prolonged PPV time, the expected duration<br />

of surgery should be taken into account when<br />

choosing the best surgical approach. Visual outcomes<br />

were not affected by the timing of PPV, whereas<br />

early vitrectomy seemed to prevent the onset of<br />

inflammatory macular edema.<br />

Comment<br />

The introduction of small gauge instruments in<br />

vitreoretinal surgery has seen a significant evolution<br />

of surgical techniques, with an ever increasing list of<br />

indications. Initially used for technically easier ‘routine’<br />

cases, the improvement in instrument designs,<br />

cutting rates and aspiration pressures, and availability<br />

of a variety of instruments means that more<br />

complex cases are now performed with small gauge<br />

instruments. The study looks at the use of 25G cutter<br />

in removing retained lens fragments and supports<br />

the view that softer/limited lens material can be<br />

safely dealt with 25G vitrectomy. For larger/harder<br />

fragments, use of a phacofragmotome is required<br />

– this instrument is not yet available in a small<br />

(sub 20) gauge, and these patients will require an<br />

additional larger port for inserting this instrument.<br />

The study is however limited by the subjective<br />

assessment of retained nuclear size, unavailability<br />

of pre-operative cataract grading, and a lack of<br />

comparison with larger gauge instruments. ▀<br />

* Dr Nadeem Ahmad is a consultant<br />

ophthalmologist working for both<br />

the ADHB and CMDHB, with private<br />

sessions at the Milford Eye clinic. He<br />

specialises in management of medical<br />

and surgical retinal conditions, as well<br />

as cataract surgery. He completed his<br />

ophthalmology training in the UK,<br />

with further fellowships in Sheffield,<br />

Southampton, and Moorfields Eye<br />

Hospital, London. He has worked as an<br />

ophthalmic consultant since 2008.<br />

MORE CLASSIFIEDS PAGE 20<br />

CLINICAL OPTOMETRIST REQUIRED-<br />

BRISBANE, AUSTRALIA<br />

Do you want to work in a vibrant, independent optometry practice,<br />

with flexible working hours? Somewhere your clinical skills are<br />

highly valued and you’ll be able to use your therapeutics? Eyecare<br />

Plus at Alexandra Hills in Queensland, Australia is seeking a full<br />

time optometrist. The position is suitable for a caring, enthusiastic<br />

person with good communication skills, who is passionate about<br />

providing a high standard of care and is eager to learn new skills.<br />

We have been established for over 27 years and are Brisbane’s<br />

only Colour Blind Sight Centre. There is no Sunday work and an<br />

excellent salary is offered, with a wage range between $80,000 to<br />

$150,000 per year, commensurate with experience.<br />

To apply call Aphrodite Livanes on 0407 585 952 or email<br />

apli2@bigpond.com<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 />

PART-TIME DISPENSER / OPTICAL<br />

ASSISTANT, AUCKLAND<br />

I am looking for a part-time Dispenser/Optical assistant to fill a<br />

weekdays only position at my premises in Auckland.<br />

Please email your CV and contact details to Donald Klaassen at<br />

eyeweardirect@xtra.co.nz.<br />

PART-TIME DISPENSING OPTICIAN /<br />

OPTICAL ASSISTANT, TAKAPUNA<br />

We are looking for a dispensing optician/optical assistant to<br />

join our independent, high-end optometry practice in Takapuna,<br />

by the beach. The position is for 50-60 hours per fortnight –<br />

including alternate Saturdays and Mondays.<br />

The successful applicant will:<br />

- Be a qualified Dispensing Optician or Optical Assistant with<br />

dispensing experience.<br />

- Display exceptional customer service and sales skills.<br />

- Have a passion for fashion eyewear and leading edge lens<br />

technology.<br />

- Have some social media skills – e.g. Facebook, online customer<br />

communications.<br />

- Have flexibility to provide leave cover for our full-time<br />

Dispensing Optician.<br />

- Be a good team player.<br />

If this sounds like you, please email your CV to<br />

david@haydons.co.nz<br />

OPTOMETRIST<br />

WITH PARTNERSHIP OPPORTUNITY AT LEADING<br />

DUNEDIN INDEPENDENT<br />

Stewart Caithness Gray Optometrists is a well established<br />

independent practice in the city of Dunedin with branches in<br />

Mosgiel and Gore. We provide a high level of professional care<br />

and service to our patients and are looking for an experienced<br />

optometrist to join our team. The position is full time, although<br />

part time may be considered and there is a partnership<br />

opportunity for the successful applicant.<br />

We have a wide range of patients of all ages and therefore,<br />

communication and interpersonal skills must be excellent. You<br />

need to have a passion for independent optometry and ideally<br />

an interest in fitting speciality contact lenses. You should be TPA<br />

endorsed and have at least 2-4 years experience. Salary will be<br />

reflective on your experience.<br />

We have a fantastic support team and diagnostic equipment<br />

includes OCT, corneal topographer, fundus and slit-lamp cameras<br />

and both Matrix and Medmont VFA’s.<br />

We pride ourselves in providing excellence in eye care, eyewear<br />

and service and are excited to be able to offer this opportunity to<br />

join our great team.<br />

Please email Brian Stewart brian@scgeyes.nz for further details.<br />

CLASSIFIED ADVERTISING<br />

Looking for staff or a new position? Want to buy or<br />

sell some equipment? Place a classified!<br />

Email editor@nzoptics.co.nz or use the form online at<br />

www.nzoptics.co.nz<br />

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

NEW ZEALAND OPTICS<br />

19


MORE CLASSIFIEDS INSIDE<br />

ON pAgE 19<br />

Need a locum?<br />

Call Bharat Raniga, locum optometrist, on<br />

021 424 253 or email: bharatranlga@yahoo.com<br />

SPECIALIST SHOPFITTERS & dESIgnERS TO THE OPTOMETRIC PROFESSIOn<br />

TEL:(09) 486-2070 MOB:(0274) 798-798<br />

Email: tony.maddocks@xtra.co.nz<br />

oPtoMetriSt PoSition,<br />

PatterSon Burn thaMeS<br />

Paterson Burn Optometrists is one of the largest independent<br />

optometry practice groups in New Zealand. We have eight<br />

practices, are totally independent and Waikato owned, and<br />

have maintained our independence in the ever changing<br />

environment of New Zealand optometry. Our core purpose is<br />

to improve people's lives by providing the best visual solutions<br />

available. Paterson Burn Optometrists value respect, integrity,<br />

accountability, enjoyment, continuous improvement, freedom for<br />

initiative and teamwork.<br />

We are currently looking for a passionate Optometrist to join our<br />

team in Thames.<br />

Working with Paterson Burn Optometrists will offer you the<br />

ability to develop your clinical skills to its full potential and the<br />

opportunity to specialise in your desired field. You will have<br />

the ability to work independently and, with fourteen other<br />

optometrists in the group, you will be part of a larger group of<br />

highly qualified, experienced and dedicated optometrists. Our<br />

Optometrists have special interests in Low Vision, Children's<br />

Vision, Ortho K, Specialised contact lens fits, Dry eye and Irlen<br />

lenses. You will also have the opportunity to meet regularly for<br />

peer review sessions while gaining CE points within our practice<br />

As an Optometrist working with Paterson Burn Optometrists you<br />

will be able to provide exceptional patient care with access to the<br />

most up to date technology and state of the art equipment. (OCT,<br />

Corneal Topographer, Medmont VFA's, IPL etc. )<br />

The successful applicants must be available to work full-time and<br />

some Saturdays.<br />

If this sounds like you, please send your CV with a covering letter<br />

to: sandri@patersonburn.co.nz<br />

Applications close 5pm Monday 30st of <strong>May</strong> <strong>2016</strong><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 />

equiPMent for Sale<br />

Zeiss Visucam Pro Retinal Camera, Topcon IS-80 Chair and Stand,<br />

Topcon SL3F slit lamp, Topcon OM-4 Keratometer, Nidek CR690<br />

Projector Chart (with screen and mirror), Trial Lens kit ,GFC Frame<br />

heater.<br />

All offers considered. Contact michael@eyestyle.co.nz<br />

diSPenSing oPtician/oPtical<br />

aSSiStant, Wellington<br />

Total Eyecare is an independent optometry group with practices in<br />

Lower Hutt, Johnsonville and Wellington CBD.<br />

Our Wellington practice, Designed for Vision, needs a dispensing<br />

optician/optical assistant.<br />

This is at times a sole charge position working with a number of<br />

part-time optometrists, so you’ll need to be able to work with<br />

minimal supervision and cover all the admin duties as well.<br />

If you -<br />

- Are confident and a self-starter<br />

- Have a real flair for sales and fashion<br />

- Show exceptional customer service skills<br />

- Have experience in optical dispensing or as an optical assistant<br />

- Have a basic grounding in accounts and admin<br />

- Are reliable and versatile<br />

- Can use a data base to help promote future sales opportunities,<br />

then this could be a great opportunity to put your own stamp on<br />

a position.<br />

This is a full-time placement, Monday to Friday.<br />

Please email a cover letter and CV to jane@totaleyecare.co.nz<br />

20 NEW ZEALAND OPTICS <strong>May</strong> <strong>2016</strong><br />

<strong>May</strong> <strong>2016</strong> classified 3<br />

NEW ZEALAND<br />

1

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