May 2016

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY 

PO BOX 106 954, AUCKLAND CITY 1143 

Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz 

MAY 2016 

PAYMENTS OF 

UP TO $50,000 

ON EACH 

SUCCESSFUL 

OPTOMETRIST 

REFERRAL. 

CONTACT CARLY PARKINSON FOR 

FULL TERMS AND CONDITIONS. 

$..‘000’S ON 

OFFER FOR 

EVERY REFERRAL 

TO FIND OUT HOW YOU CAN BENEFIT FROM 

THIS INDUSTRY-WIDE OFFER, CONTACT 

CARLY PARKINSON ON 0800 717 350 OR 

CARLY.PARKINSON@SPECSAVERS.COM 

– OR VISIT SPECTRUM-BLOG.COM.

2015 was a challenging year for Bausch and Lomb with plenty of 

drama. The stage is set for a much improved 2016: 

• Better supply direct from B+L Australia to your door 

• A dedicated B+L customer services team 

• An expanded sales team to ensure better service in store 

• Simplified universal pricing to ensure fairness and profitability for all 

• A game changing web service that will enable you to compete with the 

internet - watch this space! 

We’re determined to regain your trust and your business through 

exceptional service and world class products. 

We’re getting our act together 

2 NEW ZEALAND OPTICS May 2016 

If you would like to talk to us about our new web service or 

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

New beginnings for B+L in NZ 

So much to tell … 

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

Craig Dallas, commercial business director 

for Radiant Health, Bausch + Lomb’s 

distributor in New Zealand, admits it has 

been an annus horribilis for the company in terms 

of supply issues. But he’s confident this is about to 

change, with a new system for Kiwi optometrists 

that will transform their ordering process and 

could even tackle the increasingly gnarly problem 

of online contact lens sales. 

Radiant’s problems started in a minor way when 

they reorganised their computer and warehouse 

systems to make the leap from agency supplier 

to full distributor for B+L more than 18 months 

ago. As a distributor they had to purchase stock, so 

the company needed to manage its stock far more 

carefully. “But because these were changes initiated 

by us, we were in control of them, so they were all 

quite minor really,” says Dallas. 

But when B+L in Australia changed both their 

warehousing systems and moved to a new 

computer system in March last year, things really 

began to fall apart. 

“It caused chaos. For a period of about six weeks 

we didn’t receive any stock from Australia at all and 

then for months afterwards we received incomplete 

or slow orders.” 

The supply chain crisis affected Radiant’s ability to 

distribute product on both the surgical and vision 

care sides of the business, says Dallas. “The main 

impact was on contact lenses because within the 

portfolio there are 24,000 SKUs (stock keeping 

units), so there is always something you are going to 

be out of.” 

Dallas and his team grew so frustrated with 

Australia, they tried to bypass it and bring in product 

from Hong Kong, but given the Asian population 

are far more myopic than the West, they had few 

plus power products to send over. Also, under B+L’s 

distribution system, New Zealand is supposed to be 

covered by Australia’s systems so it was only going 

to be a one-off, short-term measure. 

New electronic ordering system 

Finally, Australia has sorted out its systems and 

supplies are getting back to normal, but the whole 

experience spurred Radiant on to completely 

overhaul the way it does business. A brand new 

electronic ordering system, developed by Radiant, 

with a simple website interface is due to go live on 

1 May. 

This will allow optometrists to order stock as they 

need it, directly from B+L, and have it delivered 

directly to them or, if they prefer, directly to their 

customers. This will speed things up exponentially, 

says Dallas, as it cuts out the delays caused by 

sending stock via a middleman, in this case Radiant, 

and simplifies the whole process dramatically, so 

there’s far less chance for any problems to arise. If 

optometrists prefer to continue to use their practice 

management system for ordering lenses etc., that’s 

fine too, says Dallas, as his team will enter the 

details on the ordering website for them. “We’ve 

been working furiously for the last six months to 

develop the electronic ordering system and remove 

all the delays in the supply chain.” 

Once the system is live, all orders sent through 

the web before 11 am will arrive in New Zealand 

the following morning to be delivered to the 

optometrist or their customer either that same day 

or the day after, with an additional day for more 

rural areas. Dallas says they couldn’t do it faster 

themselves even if they held all the right stock here. 

Fixing the supply chain problem was the first 

priority, he says, as Radiant prides itself on 

delivering great customer service. After just three 

years, Radiant was voted the No. 1 supplier in the 

latest New Zealand Pharmacy Coal Face customer 

satisfaction survey of the country’s pharmacists. 

“But optometrists here would just laugh if they 

heard that, as they would definitely vote us 

the worst.” 

New products in the pipeline 

Dallas says his team is determined to turn this 

around. With the supply chain problems fixed, the 

new electronic ordering system about to go live, 

Radiant can also finally launch the much-anticipated 

presbyopic range of its premium, daily-disposable 

contact lens brand Biotrue and its new monthly 

Ultra range, with its patented MoistureSeal 

technology (see story below). 

The bigger picture: taking on internet sales 

With all the nuts and bolts fixed, Radiant has also 

turned its attention to the increasing problem of 

online contact lens sales for Kiwi optometrists. 

Dallas is one of the first to admit the whole idea 

of CL manufacturers supplying stock at a cheaper 

price to online retailers who neither fit nor can 

recommend the right lenses for patients is more 

than crazy. But with the right technology, there’s no 

reason why optometrists can’t claim a significant 

portion of this online revenue for themselves, while 

also giving their patients the peace of mind they 

are getting the right lenses at an equivalent price 

in a secure and efficient manner. 

At this stage, Dallas was reluctant to reveal too 

many details as he didn’t want competitors getting 

wind of them, but he says the new technology is an 

add-on to the company’s newly developed online 

electronic ordering system that can simply and 

efficiently be handled by the patient themselves, 

allowing the optometrist to sit back and share in the 

profits of the sale. 

Radiant is planning to trial the new system in the 

next couple of months with a group of about 20 to 

30 optometrists. Once all the bugs are eliminated, it 

will be rolled out to the whole country. 

It should revolutionise the business of selling 

and buying contact lenses, says a very chuffed 

Dallas. “It’s massive. A game-changing web 

service, as our ad says. But for the moment you’ll 

just have to watch this space.” ▀ 

Radiant bolsters B+L team 

Radiant has beefed up its Bausch + Lomb 

distributor team, with some new and some 

familiar account managers including Yvette 

Beattie, who returns from maternity leave to 

help with the vision care side of the business, 

Conor Fitzgerald, who moves across from 

another Radiant role, Mikaela Gilbert, who’s 

taken on the new sales role in Christchurch, 

and Peter May and Leanne Fierro. 

Team head, Craig Dallas, Radiant’s 

commercial business director, says Radiant 

Health Customer Services was contracted 

out last year to the company’s warehousing 

partner Supply Chain Solutions, but the 

decision was made to bring this service inhouse 

from this year to add more focus to the 

optometry and ophthalmology side of the 

business and improve the company’s service 

levels. “This has been a huge success,” he says, 

particularly the new South Island sales role. 

“We found that servicing the South Island 

from Auckland is not practical and generally 

means our southern customers don’t get the 

service they need.” 

Gilbert is managing both optometry and 

ophthalmology and will help to roll out 

Radiant’s new electronic ordering system and 

launch Ultra and Biotrue for presbyopia, says 

Dallas. If everything goes well, Dallas says 

Radiant could take on more sales people 

next year. ▀ 

EDITORIAL C ▀ 

Well the conference and seminar 

season has truly started, kicked off 

by a packed one-day event from the 

Cornea and Contact Lens Society (CCLS) in the 

comfortable and central surroundings of Mac’s 

Function Centre on Wellington’s waterfront. 

Conference venues attached to pubs, with the 

addition of a pub-like bar on the exhibition floor, 

are always an excellent idea (in my humble 

opinion) for encouraging networking! 

To make it even more appealing, CCLS added 

a preceding glaucoma workshop this year, 

that was fully booked almost as soon as it 

was announced. A round-up of both events, 

kindly supplied by Dr Jesse Gale and Roberta 

McIlraith, plus what’s new from CCLS’s industry 

supporters is included in this issue. 

Eye Doctors held their first Grand Round in 

Auckland, featuring some fascinating case 

studies, including the tragic case of a young man 

whose sight had deteriorated severely for no 

obvious reason. But some lateral thinking on Dr 

Shuan Dai’s part led to a happy ending (p13). 

Next month we’ll report on the inaugural 

Ocular Therapeutics Conference, which attracted 

a staggering 335 delegates, and was so packed 

full of information we simply didn’t have space 

to do it justice this month. 

We have included the highlights of the 

forthcoming RANZCO NZ Branch Meeting 

in Dunedin, however, for those of you still 

considering whether to go. 

Plus, there’s a host of news and a clever idea 

for those optometrists wishing to take on CL 

internet sales from B+L distributor Radiant, 

who gave us a very frank account of the 

problems it has had and why those days are 

truly behind them. 

So enjoy and, as always, if you have something 

to share, we’d love to hear from you. 

Happy school holidays! ▀ 

Lesley Springall, publisher, NZ Optics 

B+L launches Ultra in NZ 

Bausch + Lomb distributor Radiant Health 

is set to launch its new premium, monthly 

lens Ultra from next month, as soon as its 

new electronic ordering system (see story above) 

goes live. 

Unveiled at the 2016 CCLS conference in 

Wellington and the first Grand Rounds seminar 

evening (see p13) from Eye Doctors in Auckland, 

B+L Ultra lenses have been designed to stop or 

greatly reduce the problem of contact lenses drying 

out and so causing discomfort to the wearer after a 

long-day of staring at a computer screen. 

The lenses incorporate what B+L terms its unique 

MoistureSeal technology, using a new material— 

designed with “water-loving molecules for excellent 

wettability”—and a new manufacturing process, 

both developed over seven years, to ensure the lens 

maintains 95% of its moisture for a full 16 hours. 

“Primarily it’s about comfort,” says Craig Dallas, 

Radiant’s commercial business director. “Ultra’s 

gone extremely well in the US, where it’s been 

available for just over a year, and so it’s being 

launched now in Australasia.” 

With people increasingly staring at screens and 

blinking far less than they used to, contact lens 

comfort, or lack thereof, is becoming an increasing 

problem. But new moisture-rich products such 

as Ultra should mean patients will be far happier 

wearing their contact lenses for longer periods of 

time again, says Dallas. ▀ 

May 2016 

NEW ZEALAND OPTICS 

3

News 

in brief 

SAVE THE DATE FOR GLAUCOMA NZ! 

Glaucoma New Zealand will hold its first-ever Glaucoma 

Symposium on 18 September 2016 at Alexandra Park in Auckland. 

The scientific programme is being put together by Professor 

Helen Danesh-Meyer and will include rapid-fire presentations 

by glaucoma-specialists on a wide range of glaucoma-related 

topics, including ophthalmic imaging, glaucoma management 

in pregnancy, gonioscopy, selective laser trabeculoplasty, new 

frontiers in surgical management and case-based presentations. 

If you are interested in being a sponsor of this exciting event, 

please contact Helen Mawn, at h.mawn@auckland.ac.nz for more 

information. 

CONTACT LENS CAMERA A REALITY 

As children we imagined it, 

as adults we’ve watched it on 

the big screen; now, thanks to 

Samsung, taking photos with 

your eye is a reality. The Korean 

technology firm have applied for 

a patent for their smart contact 

lenses that contain a built-in 

camera, sensors and a display 

that allows users to take photographs by blinking their eyes and 

transmit those images to a smartphone or tablet. Using tiny eye 

sensors to detect movement commands, the smart lens also has 

a display that seamlessly interfaces with the user’s natural vision. 

Move over 007! 

ONLINE EYE-TEST CALLED INTO QUESTION 

The American Optometric Association (AOA) has submitted a 

complaint to the US Food and Drug Administration (FDA) about 

Opternative’s online eye test. Opternative is marketing the online 

exam direct to consumers saying it can provide prescriptions “as 

accurate as an in-person refractive eye exam.” AOA claims the 

test poses “significant health risks”, Opternative’s claims aren’t 

substantiated, the test uses “unproven technology”, which hasn’t 

been investigated by the FDA. The major concern AOA raises is that 

people using the test will not visit a trained professional who can 

detect underlying medical conditions. 

AUTOFOCUSING CONTACT LENSES IN DEVELOPMENT 

Research funded by the US National Eye Institute and the US 

National Institute of Health Director’s New Innovator Awards is 

exploring a contact lens that will focus automatically. Headed up 

by Dr Hongrui Jiang from the University of Wisconsin, the project 

aims to develop a lens that will focus within milliseconds, using 

algorithm-driven sensors and tiny electronic circuits that adjust 

lens shape. Researchers have a working prototype, but believe 

clinical testing may be at least 5 to 10 years away. 

SEE THE LIGHT 

A study reported in Investigative Ophthalmology and Visual 

Science has demonstrated that a greater light exposure elicits 

smaller changes in axial length over an 18-month period. The study 

measured axial eye growth and light exposure in 101 children 

(41 myopes and 60 non-myopes) between 10 and 15 years old. A 

wrist-worn light sensor recorded mean daily light exposure for each 

child. The researchers noted a modest, but statistically significant 

association between greater average daily light exposure and 

slower axial eye growth, supporting the association between 

greater childhood myopia and less time spent outdoors. 

STERILISATION PRACTICES UPDATE NEEDED 

A US petition has been launched to encourage the AOA to update 

its sterilisation guidelines. The petition, launched by the American 

Safe Sight Foundation, notes hundreds of thousands of people 

in the US annually contract preventable eye infections, including 

epidemic keratoconjuntivitis, from poor sterilisation practises, 

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

vision patients. Most US ophthalmology practices still just rely on 

alcohol wipes or use equipment/treatments on multiple patients 

that could be disposable, said the Foundation. 

CONTACT-LENS COMFORT MACHINE 

When Stanford University PhD student Saad Bhamla couldn’t 

stand the discomfort from his contact lenses anymore, he decided 

to do something about it. Together with his supervisor, Professor 

Gerald Fuller, Bhamla built a device that mimics the surface of the 

eye. The machine, called the Interfacial Dewetting and Drainage 

Optical Platform, or i-DDrOP, reproduces a tear film on the surface 

of a contact lens that allows scientists and manufacturers to 

systematically handle an array of variables that affect tear film, 

including temperature, a variety of substances, humidity and the 

way gravity acts along a curved surface, so they can make a more 

comfortable lens. ▀ 

EVF: making a difference in schools 

When Essilor launched their Essilor 

Vision Foundation (EVF) initiative 

in August 2015, it was with 

tentative flair. The initiative’s aim was 

to screen year 5 and 6 children in low 

decile schools to determine whether they 

needed glasses. The first school to take 

part, Flaxmere in Hawke’s Bay, saw more 

than 120 students screened with nearly 

40% needing follow up appointments with 

optometrists. 

In schools like Flaxmere, where many 

children are considered to have learning 

and behavioural difficulties, it seemed 

incredible the simple question of whether 

they could see clearly enough to engage in 

their education had been overlooked. 

This pilot scheme was hailed a great 

success, but how that would translate 

into a nationwide programme seemed 

uncertain. 

“There were big challenges ahead of us,” 

admits Kumuda Setty, Essilor’s marketing 

manager who is spearheading the project. 

“Our focus is on decile 1 and 2 schools and 

many of these students have access to a 

Community Services Card (CSC) and help 

through WINZ, but they don’t have the 

support to access it.” 

One boy told Setty his mother left for 

work very early in the morning and didn’t 

get home until 8pm, making it impossible 

to access optometry services in normal 

working hours; while another mother told 

the school she did not want her son to be 

seen wearing glasses in public. 

Whether it is the stigma attached to 

wearing glasses or simply the fact the 

parent is not available to take their child for 

screening, it was clear change was needed 

and that had to be led by the schools, 

says Setty. 

“We wanted schools to take full 

responsibility for the students, from 

arranging follow-up tests to ensuring they 

wore the glasses in class. But it was hard to 

get buy-in, then Louisa came on board.” 

A patron for the cause 

Louisa Wall MP looks after Manurewa, one 

of South Auckland’s poorest districts. She 

has 27 schools in her area and 25 are decile 

1 and 2. When she heard about EVF, she 

decided to champion the project among her 

own electorate’s schools and has recently 

come on board as an ambassador. 

“The importance of finding the estimated 

30% of children who have vision challenges 

that can only be treated if diagnosed with 

appropriate education and glasses is vital 

if all our children are to fully realise the 

potential of our public education system,” 

says Wall. “It is not good enough to screen 

Essilor unveils Eyezen 

Eyezen, the new lens from Essilor, 

developed specifically to protect 

against increasing screen use, was 

unveiled to Essilor’s Platinum Partners in a 

series of regional roadshows in April. 

“Innovation in ophthalmic optics is more 

crucial than ever. Behaviours are changing 

rapidly and prevention must be at the 

heart of visual health,” said Jean Carrier, 

Essilor International’s chief operating 

officer. “Our latest innovation, the Eyezen 

range, illustrates our commitment to keep 

offering innovative solutions to answer 

visual correction and prevention needs for 

consumers across the world.” 

The Eyezen range, which won a gold award 

at Silmo in Paris at the end of last year, 

features two new technologies designed 

to support wearers who use a lot of digital 

media. Eyezen Focus vision correction 

is specifically adapted to new reading 

distances corresponding to each digital tool, 

including ultra-near vision. The average 

reading distance for a smartphone is 33 cm 

compared with 42 cm for a book. Eyezen 

lenses provide a new solution to ease eye 

accommodation, especially when switching 

from one type of a screen to another, said 

Essilor. The range also incorporates Essilor’s 

children and to 

merely identify 

vision challenges. 

They must then 

be tested by 

optometrists and 

if need be have 

access to glasses to 

maximise learning.” 

With Wall’s backing 

EVF, which was 

officially granted 

charitable status 

in January 2016, 

gained access to 

a number of low 

decile schools in 

South Auckland, all 

agreeing to ensure 

they followed-up 

with any children 

found to have vision 

problems. 

Kiwi optometrists step up for 

the cause 

“We utilise our Platinum Partner network 

to source optometrists willing to volunteer 

their time in their local community,” says 

Setty. “We asked just for one day, but we’ve 

had many optometrists giving two, three 

and even four days to the programme so 

far – and some of those are even serving 

communities outside their area.” 

The screening takes place at the school 

with the volunteer optometrists. All the 

equipment is provided by Essilor. In the 

four schools screening in South Auckland 

so far, the Foundation has found between 

30% and 40% of children (and some staff 

members) needed follow-up screening. 

“The schools then utilise the government 

funding they have to take the children 

to a follow-up appointment with a local 

optometrist at a designated time,” explains 

Setty. “Those who need glasses are given 

two pairs—one for home and one for 

school—and the teachers then commit 

themselves to making sure those children 

look after and wear their glasses.” 

The glasses are paid for by the children’s 

CSC funding allowance, but in the few 

cases where no funding is available, Essilor 

is currently covering the cost. 

Support from the schools 

“We’ve had a remarkable response,” says 

Lois Hawley, deputy principal of Rowandale 

School. “The benefit of students getting free 

lenses and frames is too good to turn down.” 

Rowandale recently had 176 students 

screened in one day by optometrists from 

Visique Frith & Laird in Manurewa, and 

new LightScan technology, which selectively 

filters blue light to help protect users from 

the harmful effects of blue-violet light rays. 

There are 1.5 billion people in the world 

using a smartphone daily, and nine out of 10 

report spending more time on a screen than 

two years ago. 

With 70% of people also reporting an 

impact on their vision from screen use, 

including visual fatigue and neck and back 

pain, it’s clear a new approach for lens users 

is sorely needed, said Essilor, which currently 

invests 180 million Euros in research and 

development and employs 550 researchers 

worldwide. ▀ 

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

found that 56 needed further testing. Over 

the next two months the school has six 

days earmarked to take these students in 

small groups to local optometrists for the 

next phase. 

“Our whanau are really involved, parents 

are volunteering to take students up,” says 

Hawley. “The follow up is a big commitment; 

we need to teach students to be responsible 

about wearing and looking after their 

glasses—it’s a lesson in self-management.” 

The school have also counteracted the 

potential stigma attached to wearing 

glasses at school by making the receipt of 

glasses a celebration. 

“We had kids running out the door yelling 

‘I’ve failed!’ with big smiles on their faces. 

They’re excited about the glasses and the 

support they will receive,” says Hawley. 

The future 

While this has been a great initiative for the 

few schools who have taken part so far, both 

Setty and Wall have bigger goals in sight. 

“I’d like to screen 3,000 students this 

year,” says Setty, who adds that Essilor 

is currently picking up the bill for the 

Foundation’s project. “Louisa is helping 

with her network of MPs to see who can get 

buy-in from their local schools.” 

Wall has also got Massey University on 

board to undertake a study on the impact 

the programme is having. They will be 

monitoring participating schools to see if 

the academic achievements of the screened 

students improve as a result. 

“We need to remove all the barriers that 

impact negatively on our children’s learning 

potential because we need all our children 

to be happy, engaged and fully participative 

members of society,” says Wall. ▀ 

Screening 

MS patients 

A new study published in Lancet 

Neurology concludes the thinning 

of the peripapillary retinal nerve 

fibre layer (pRNFL) can predict the 

progression of multiple sclerosis (MS). 

The two-year study was conducted 

across eight countries and tracked 

879 MS patients who did not suffer 

optic neurosis. The results showed 

a link between a thinner pNRFL and 

a worsening of symptoms, leading 

researchers to recommend MS patients 

be screened yearly. ▀ 

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand 

For general enquiries, please email info@nzoptics.co.nz 

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

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To submit artwork, or to query a graphic, please email kirsten.newton@outlook.co.nz and copy in Lesley. 

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

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

NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the 

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

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

4 NEW ZEALAND OPTICS May 2016

Retina NZ looks to 2018 

NZ short on orthoptists 

Long-serving Retina Society of New Zealand 

President Fraser Alexander has stepped 

down, in part to help plan for the 2018 

Retina International congress—the first such 

meeting to be hosted in New Zealand in the 

congress’ 34-year history. 

“Fraser is keeping his finger in the pie,” said 

Membership Officer Petronella Spicer, during 

Retina NZ’s 20 March meeting. “He is on the 

organising committee for the international 

congress for 2018 and he is still on the 

management board of Retina International. 

“He has been the president now for quite a 

number of years and he has done that job so well, 

so articulately. He has a wealth of knowledge 

about what the professionals are talking about.” 

Vice President Sue Emirali will be acting 

president in Alexander’s stead. 

While the congress is only two years away, it is 

a major undertaking for an organisation manned 

by volunteers. 

“As you appreciate, we are the smallest country 

to take on the assignment of the world congress,” 

Alexander said. “The congress depends on a lot of 

people working together and working efficiently. 

This is a two-year process and this is an exercise in 

coordination.” 

The congress will be held in February 2018 at 

the University of Auckland’s Owen Glenn building. 

More than 100 people are expected to attend. It will 

feature presentations by retinal disease researchers, 

rehabilitation professionals, adaptive technology 

specialists and others. 

The announcement of Alexander’s resignation 

as president came at the end of Retina NZ’s first 

public meeting of the year. The meeting attracted 

dozens of members, as well as a large group 

of student volunteers from the University of 

Auckland’s optometry programme. 

Retina NZ’s public meeting 

Attendees heard presentations from Mary 

Fisher, a 23-year-old Paralympic gold medalist in 

swimming, who was born with aniridia. 

Fisher won several medals at the 2012 London 

Olympics and set a world Paralympic record in 

one of her races. To even-out the playing field, 

competitors of varying low vision wear blacked-out 

goggles when swimming, which must be inspected 

at the end of a race to ensure they had not been 

tampered with to give a competitor an advantage. 

“There’s a wait between the end of race and the 

announcement of the results,” said Fisher, refering 

to these moments as “microwave minutes”. 

“It feels so much longer than it actually is. When 

I was told I won a gold for the last race, it felt like 

all the hundreds of people who helped get me 

there were there. It was the most amazing 

feeling ever”. 

Next, Dr Andrea Vincent gave a summary 

update on advances in gene therapy and gene 

replacement therapy for treating retinal disorders. 

While she acknowledged it is “always an exciting 

time” in retinal therapy research, several gene 

therapies are progressing from Phase I to Phase II 

studies, across multiple conditions. 

This includes use of viruses to correct RPE65, 

the gene responsible for the rare condition of 

amaurosis. A company called Spark Therapeutics 

currently has a patent in front of the FDA in the 

US for the therapy, following a Phase III study. 

“A lot of other genes have been highlighted 

as good candidates for gene therapy or gene 

replacement therapy,” said Dr Vincent. 

This includes a gene therapy for Choroideremia 

now in Phase II, a Phase I study for treating 

retinoschisis and a study proceeding to Phase II on 

the ABCA4-related Stargardt’s disease. 

There have also been important advances in 

using non-embryonic cells from the patient 

herself to be used in gene replacement, which 

negates the need to use immune-suppressants in 

planting donated cells into the retina. 

Finally, University of Auckland student Benjamin 

Wright spoke about his experience in the Retina 

NZ Summer Studentship programme, where 

he conducted research focused on retinitis 

pigmentosa, using a myomicroperimeter to 

determine macular sensitivity. 

He also researched the prevalence of macular 

oedema in New Zealand, as well as the prevalence 

of macular oedema among different genetic 

diagnoses found in the 500+ patient retina 

database. This research showed a 23% prevalence 

rate among all retina patients, but a 41% 

prevalence among retina patients with autosomal 

dominant inherited diseases. ▀ 

While orthoptists are in high demand in 

New Zealand, the country is likely not 

large enough to accommodate a New 

Zealand-based training programme to fill the gaps 

with home-grown practitioners. 

“In New Zealand, we’re all foreigners,” explains 

Sally-Anne Herring, an orthoptist with the Hawke’s 

Bay Health District and an executive member of the 

New Zealand Orthoptic Society. “All of us have been 

shipped over from Europe and Australia. There’s no 

programme here. We have a small population base 

and I don’t think you could sustain the number of 

students [needed] to make it financially viable.” 

Add to that a lack of funding and you get a recipe 

for what New Zealand has now: the low number of 

orthoptists—there are 22 members in the Society— 

leaving geographic gaps in national coverage and a 

full schedule for every practitioner. 

Orthoptists train for four years and tend to 

specialise in children’s vision testing, amblyopia 

and treating anyone with strabismus, plus 

ophthalmic technical skills. They work closely 

with ophthalmologists, especially paediatric 

ophthalmologists, and they run clinics 

independently for amblyopia treatment. 

Eye Doctor’s Dr Shuan Dai, who chairs the NZ 

Paediatric Ophthalmology Interest Group, says our 

orthoptists shortage is a multi-faceted problem. 

“Our orthoptists almost exclusively come from the 

UK and they are very well-trained for the job they 

are required to do.” 

UK-trained orthoptists focus more on ocular 

motility, which is a skill orthoptists must have 

to fulfill their role in helping diagnose and treat 

amblyopia, he says, hence why UK orthoptists are 

favoured in New Zealand as the Australian training 

programme is skewed more towards ophthalmic 

technical skills. 

There is also the question of pay, says Dr Dai. 

“Orthoptists often have remuneration below what 

is expected for their skill-set and qualifications 

compared to the UK and elsewhere. 

“There is also a lack of appropriate recognition in 

contractual negotiations as to where orthoptists 

fit in and as a result there is no appropriate CME 

(continuing medical education) allowance to 

support their ongoing medical education, which is 

vitally important.” 

Herring herself trained in the UK and is a member 

Sally-Anne Herring, secretary of the NZ Orthoptic Society 

of the British and Irish Orthoptic Associations 

as well as Orthoptics Australia and confirms the 

difference between practice in New Zealand and 

other countries. 

“In Europe orthoptists are a key member of the 

allied health professions with additional ophthalmic 

associate roles in the hospital. We do the primary 

care screening like the vision and hearing tests, plus 

diagnosis and treatment in the hospital forum. Here 

it tends to fall on the nurses to do the tests, so our 

allied role, or associate tasks, are done by nurses, 

though there are some of us who do this as well.” 

Orthoptists are squeezed between nurses and 

ophthalmologists in New Zealand, but stretched 

geographically when it comes to handling the 

paediatric side of their jobs, she says. 

Herring is based in Hastings, with the District 

Health Board (DHB) and Eye Surgeons of Hawke’s 

Bay, and covers all the East Coast. Her nearest 

colleague is in Palmerston North. While in 

Wellington there’s only one orthoptist, which simply 

isn’t enough, she says. There is a six week waiting 

list for patients to see Herring. 

The solution to the shortage is not obvious, 

though DHBs are key, says Dr Dai. “The only viable 

option is for DHBs to recognise orthoptists as a very 

special group of clinicians who play a pivotal role in 

the care of children with eye problems and adults 

with ocular muscle imbalance, as it is not viable to 

train orthoptists in New Zealand given the small 

intake numbers. There should also be a formal CME 

allowance built into their contracts so they can 

continue to maintain their professional skills as 

others do, like doctors and nurses.” ▀ 

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8/04/2016 11:24:05 AM 


5

SPECIAL FEATURE: CCLS Conference 

CCLS Conference: a perfect day 

CCLS CONFERENCE 

CORNEA : OCULAR SURFACE : CONTACT LENSES 

WELLINGTON 2016 

CONFERENCE 

KEYNOTE SPEAKER 

Prof Fiona Stapleton, University of NSW 

SUNDAY 20 MARCH 

MAC’S FUNCTION CENTRE 

4 TARANAKI STREET 

WELLINGTON 

Conference and workshop registration opens December 2015. 

For more information visit www.contactlens.org.nz 

ADDITIONAL WORKSHOP 

GLAUCOMA WORKSHOP 

Run by Wellington ophthalmologists 

Jesse Gale, Graham Reeves, with contributions 

from Prof Tony Wells and Dr Chris Murphy 

SATURDAY 19 MARCH 

CENTRAL WELLINGTON VENUE 

CORNEA & CONTACT LENS SOCIETY 

of New Zealand Incorporated 

BY ROBERTA MCILRATIH, 

WITH CONTRIBUTIONS FROM ELEISHA DUDSON* 

The 2016 Cornea and Contact Lens Society 

One Day Conference was held on a perfect 

Wellington day; not a cloud in the sky and 

barely a puff of wind in the air. For our sins we 

were rewarded with an inspiring and eclectic mix 

of speakers inside the Mac’s Function Centre on 

Lambton Quay. 

Professor Fiona Stapleton, head of the School of 

Optometry and Vision Science at the University of 

New South Wales, was this year’s keynote speaker. 

She led us through several informative and clinically 

applicable talks ranging from the current treatment 

trends in contact lens-related corneal infection to 

the genetic factors playing a role in dry eye sufferers 

and the implications of eyelid pathologies on the 

success of contact lens wear or lack thereof. We look 

forward to having Fiona join us in Nelson in March 

next year at our two-day conference. 

Both John Veale and Varny Ganesalingam spoke 

on the use of IPL (intense pulsed light) for the 

treatment of Meibomian gland dysfunction in their 

Christchurch and Auckland practices respectively. 

Both clinicians reported success in around 80% of 

their selected patients and it certainly seems an 

excellent offering for those patients that need a bit 

more than hot compresses and digital massage. 

Dr Reece Hall filled us in on the Wellington 

Keratoconus Study (WelKS), which is an exciting 

initiative between the Lions Club and local eye 

health practitioners, and the benefits (both 

economic and physical) of corneal cross-linking. 

A large van complete with a Pentacam corneal 

topographer is travelling around Wellington 

high schools screening year 11 and 13 students 

Catherine Baxendale, Kevin O’Connor and Jo Arthur 

to find those early cases of keratoconus. So far 

findings suggest a higher incidence of keratoconus 

in secondary school students than previously 

thought. There is a further six months of the study 

to run before the final intake of data is collated and 

from which, hopefully, some good initiatives will 

arise to assist in the early detection and treatment 

Basically, don’t worry, do worry, the world will still keep turning and we 

should probably stick with eyes and not try to become dairy farmers – 

summary of BNZ Economist Tony Alexander’s talk at CCLS. 

of keratoconus. 

We rounded out the morning session with an 

entertaining and informative overview of the 

global and local economies by Tony Alexander, 

chief economist at the BNZ. Basically, don’t worry, 

do worry, the world will still keep turning and we 

should probably stick with eyes and not try to 

become dairy farmers. Although it might be easier 

to purchase a dairy farm than a house in Auckland 

for the foreseeable future! 

After a delicious luncheon and catch-up with 

friends, colleagues and CCLS’s industry supporters, 

we were back into it, with exciting times in the 

world of cataract referral. 

Dr James McKelvie, a corneal fellow at the 

University of Auckland, went through his project 

Unexpectedly 

Better 

The best IOP measurement tool just got better than 

anyone imagined - introducing the NEW 

Icare ic100 tonometer 

Frederick Swain and Grant Watters 

to develop national online referral systems for 

cataract surgery, hopefully reducing wait-time and 

the administration burden, as well as mapping the 

status of cataract cases approaching the threshold 

for care. Electronic referral and real-time audit of 

cataract surgery will also provide a better audit of 

post-operative outcomes and provide risk-analysis 

pre-operatively. The Ministry of Health online CPAC 

(clinical priority assessment criteria) is currently 

being rolled out and James’s system will be 

available soon for clinicians to use. 

Reuben Gordon, a speciality and paediatric contact 

lens optometrist with the Greenlane Clinical Centre 

department and Eye Institute, spoke to us about 

his experiences of fitting scleral lenses. His talk 

dovetailed nicely with Grant Watter’s presentation 

about the oxygen permeability of scleral lenses, in 

particular the matter of the Dk of the post-lens tear 

film. Both presentations provided excellent clinical 

tips and a reminder of the improved comfort and 

stability in vision scleral lenses can provide many of 

our ectatic corneas. 

Independent optometrist Adele Jefferies 

delighted us with her enthusiasm for lid wiper 

epitheliopathy. She reminded us all to get the 

lissamine green out and check for staining along 

the lid margin evident in many of our unhappy, 

and more importantly, our non-reporting-unhappy 

contact lens wearers. To do so may prevent 

avoidable contact lens drop-outs. 

Greg Nel presented on the topic of myopia 

progression control and the current therapies at 

hand including dilute atropine, orthokeratology 

and outdoor play. Although there is a lot more 

research to be done in the field of myopia 

progression, he reiterated the necessity for the 

current evidence-based therapies to be a part of 

our everyday discussions when managing our 

myopic progressors. 

Dr Sid Orga, a registrar in Wellington, further 

informed us about corneal cross-linking, discussing 

current research and the status of this treatment 

for keratoconus in more detail, building on Dr 

Reece Hall’s talk from earlier in the day. Again 

Sid reminded us how important cross-linking is 

for ocular health care in keratoconus, for both 

preventing patient vision loss and for the cost 

benefits of this ‘ambulance at the top of the hill’ 

treatment. 

Varny Ganesalingam, Richard Newson and Adele Jefferies 

Brian Gifford and Jack Crawford 

Alison Chan, Sarah Lord, Claire Martin, Penny Adams and 

Darryl Eastabrook 

The conference was concluded by Eleisha Dudson, 

who gave a captivating discussion about different 

inflammation cases among her patients; from 

post-surgical to ortho-K and soft contact lens 

wearers. She emphasised the need to keep up with 

current research and the use of this knowledge to 

help make the best management decisions for our 

patients, whether this is therapeutic or not, or a 

combination of both. 

Following an excellent day of high-calibre 

speakers and presentations we retired to the 

bar with many taking the opportunity to enjoy 

some refreshments and chat before making the 

homeward journey. ▀ 

* Roberta McIlraith is a speciality contact lens practitioner with 

Curtis Vision in Christchurch and a CCLS Councillor; conference 

speaker Eleisha Dudson is also a CCLS councillor and specialises 

in contact lens fitting at Stevenson, Sangster & Matthews in 

Wellington. 

• NEW automatic 

measuring sequence 

- series or single mode 

with one button 

• NEW Intelligent 

Positioning assistant 

for correct alignment 

• NEW EasyNav interface 

• NEW ergonomic design 

CCLS 2016: A highly 

enjoyable affair 

BY ANNE MATHESON, CCLS PRESIDENT 

DV805-0416 

1800 225 307 

www.designsforvision.co.nz 

A Paragon Care Brand 

I 

enjoyed both 

the glaucoma 

workshop and the 

one-day conference 

immensely. It was a 

pleasure to be able to 

walk to both venues 

from home in warm 

weather. 

A bonus with the 

glaucoma workshop 

CCLS President Anne Matheson 

was the festive 

atmosphere due to 

Cuba Dupa (Wellington’s annual street festival) 

taking place outside. Drs Jesse Gale, Graeme 

Reeves and Tony Wells present regularly in 

Wellington and have been kind enough to run a 

glaucoma journal club for us so the workshop was 

a summary and update of the last couple of years’ 

content, and it was a really useful exercise for all 

involved to spend a whole day thinking about the 

topic. 

The one-day conference venue, Mac’s Function 

Centre, right next to Te Papa, was attractive, 

light and spacious and the food was excellent. 

Everything ran smoothly, which was a great relief. 

Highlights for me included some of the more 

novel aspects of the programme: Tony Alexander, 

BNZ’s chief economist, on New Zealand’s economy 

and interest rates was fascinating, while James 

McKelvie presentation on modernising the 

cataract referral system was inspirational, and 

I always enjoy other optometrists telling me 

how they get things to work in their practices— 

the talks on myopia control and IPL were good 

examples of that. 

The council, which remains unchanged after a 

successful and supportive AGM, are all very pleased 

with how the weekend went and we’re looking 

forward to seeing you all again in Nelson in 2017. ▀ 


Caterer. Runner. Multitasker. 

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I prescribe NEW ACUVUE OASYS ® 1-Day. 

I know Emma’s day full of activities creates environmental 

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7


Getting to grips with 

glaucoma 

When we were asked to present 

a glaucoma workshop 

alongside the recent CCLS 

Conference in Wellington, we thought it 

was timely because more optometrists 

are taking on the responsibility of 

managing glaucoma in the community. 

We aimed to present ideas around the 

safe diagnosis and management of 

glaucoma and discuss concepts around 

how we could share the clinical risk and 

uncertainty appropriately. 

After some debate about the roles of 

ophthalmologists and optometrists in 

glaucoma care, the word collaborative 

care is often used to suggest a positive 

way forward. In my mind, collaborative 

care refers to safely dividing the tasks of 

glaucoma care in a way that optimises 

the convenience and cost for the patient, while 

protecting the patient from problems of poor 

quality care such as misdiagnosis, over-treatment, 

duplication of tests, unnecessary travel and 

diagnostic confusion. 

There was a great deal of interest in the 

workshop with 40 attendees and others waiting. 

We had, however, not planned for the CubaDupa 

festival happening in the brilliant sunshine outside 

and several attendees were seen joining in with the 

Michael Jackson tribute aerobics dance-off during 

the lunch break! 

Professor Tony Wells, from the Wellington School 

of Medicine, presented on the complex interactions 

between corneal biomechanics and intra-ocular 

pressures and how easy it is to be misguided by 

corneal thickness. I presented on the risk factors 

for glaucoma and tried to open discussion about 

how patients with risk factors for glaucoma 

should be managed both ethically and safely with 

neither unnecessary testing nor delayed diagnosis. 

BY DR JESSE GALE* 

CubaDupa 2016 provided background festivities to the glaucoma workshop 

I also spoke about angle closure with tips on 

gonioscopy and on other non-glaucomatous optic 

neuropathies, some of which cause cupping that 

should not be misdiagnosed as glaucoma. 

Dr Graham Reeves presented on disc assessment 

and imaging in glaucoma; on glaucoma treatments 

including laser and surgery; and on different 

models of community glaucoma care that have 

been tried and studied. While Dr Chris Murphy 

presented on some of the exciting future prospects 

for glaucoma, from new diagnostic tests to new 

drug delivery systems and new biological therapies. 

We were pleased with the encouraging feedback 

and that the material was of interest. We all 

feel that sharing and discussing these ideas is 

important to make sure the future evolution of 

collaborative care enhances the safety of our 

community through higher quality care. ▀ 

* Dr Jesse Gale is an ophthalmologist with Capital & Coast 

District Health Board and Capital Eye Specialists in Wellington. 

He chaired the inaugural CCLS’ glaucoma workshop. 

What’s new... 


The Cornea & Contact Lens Society’s 

mini-conference in Wellington received 

good support from the industry with 

representatives from 10 companies on-hand 

to demonstrate what’s news, discuss what’s 

coming up and to answer delegates questions 

about all the latest equipment and advances in 

optometry. Highlights included: 

CLC’s Whitney Parson, Graeme Curtis and Australian optometrist 

Peter Haman 

Corneal Lens Corporation (CLC) 

Corneal Lens Corporation have a product so new 

to the market that owner, Graeme Curtis, wasn’t 

sure if he was going to be able to show it at this 

year’s CCLS Conference. The sMap3D Precision 

Surface mapping system and fluorescence-based 

structured light topographer is described as a “ 

revolution” in scleral lens fitting. The sMap 3D 

measures, customises, analyses and even orders 

customised scleral lenses. Its widefield view, with 

more than 22mm range and 360° scleral coverage, 

allows you to actually quantify the elevation of 

the sclera and if there’s any toricity, explained 

Curtis. “Because we now have the technology to 

actually map what we’re dealing with, fitting the 

larger lenses will be more accurate and more cost 

effective because there won’t be so much chairtime, 

because this does it all for you.” 

Also on show was the new Menicon Signature 

Pack, containing 4x Menicare Soft Solution and 2x 

Miru monthly disposable lenses, and Macushield, 

the increasingly popular nutritional supplement 

for the treatment of age-related macular 




CONFERENCE 






WELLINGTON 


degeneration (AMD). 

Derived from the Marigold flower, Macushield 

combines three important macular carotenoids, 

Lutein, Zeaxanthin and Meso-zeaxathin, found at 

the macula, where they form the macular pigment 

(yellow colour). Meso-zeaxanthin is particularly 

concentrated at the centre of this pigment. Recent 

studies have shown a direct correlation between 

low macular pigment, a higher-incidence of AMD 

and poor cognitive function, including Alzheimer’s. 

This demonstrates the importance of the three 

carotenoids to our diets, especially as we get older, 

said Curtis. 

Bausch+Lomb 


Radiant’s Yvette Beattie and Craig Dallas 









Bausch+Lomb’s Kiwi representatives from Radiant 

Health, Craig Dallas and Yvette Beattie, attended 

the CCLS conference primarily to let delegates 

know the company’s supply problems were now a 

thing of the past. 

Radiant is in the process of launching a new 

electronic ordering system (see story p3), which 

will ensure a reliable and fast supply service. Once 

this is in place the company will also start taking 

orders for it’s latest product Ultra, a new monthlydisposable 

lens designed to retain 95% of its 

moisture for more than 16 hours of wear a day. 

Also new to New Zealand is the muchanticipated 

presbyopic range for B+L’s premium, 

daily-disposal lens brand Biotrue, which will also 

be rolled out once the new electronic ordering 

system is up and running, 

said Dallas. 

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9


CONTINUED FROM P8 

Alcon 

Alcon’s Caroline Perkinson, Deanne Graham and Roger Te Puni 

Alcon has had a busy 18 months, launching about 

eight new products to the market. But with the 

increasing interest in daily disposable contact 

lenses, top of the pile at CCLS was the company’s 

Dailies Total 1, now available in plus powers and 

(hot off the press) in high minus powers too. 

Dailies Total 1 (DT1) launched in the US in 2013, 

with the plus powers launched towards the end of 

last year and the higher minus powers introduced 

this year. DT1 were designed to mimic the 

environment of the cornea with water content of 

almost 100% at the outermost surface. 

A recent survey by Alcon of nearly 250 contact 

lens-wearers in Australia and New Zealand, found 

that 72% of patients’ experience discomfort in 

their habitual lenses, compared with 86% who can 

comfortably wear DT1 all day long, with nine out 

of 10 patients admitting they preferred their DT1 

lenses to their old lenses. 

According to Alcon, DT1 lenses have a core water 

content of 33% and a surface water content of 

more than 80%. It is now available from -0.50 D 

to -6.00 D in 0.25-D steps, from -6.50 D to -12.00 

D in 0.50-D steps and from +0.50 D to +6.00 D in 

0.25-D steps. 

Ophthalmic Instrument Company (OIC) 

The talk at the OIC stand centred on the latest 

in OCT technology, said Tim Way, OIC managing 

director. The Nidek OCT Retina Scan Duo offers 

extremely high definition anterior and posterior 

OCT and fundus imaging from a single compact 

system. Other items of equipment attracting 

attention included the new Nidek Tonoref III, a 

combined autorefractor, keratometer, tonometer, 

pachymeter, and the new tear film surface quality 

analysis package for the Medmont E300 Corneal 

Topographer. This is a free software upgrade for 

those practices already running their Medmont 

E300 in Medmont Studio 6. 

Medmont’s new tear film analysis software 

allows accurate, quantifiable, identification of 

tear film break up, so it can be used for objectively 

measuring dry eye in patients and allowing 

comparison over time, says Way, adding this is a 

great tool for, among other things, pre- and post- 

IPL treatment (see Dry Eye Technology below). 

Way highlighted a new study by Dr Laura 

Downie from the Department of Optometry and 

Vision Sciences at the University of Melbourne, 

entitled Automated Tear Film Surface Quality 

Breakup Time as a Novel Clinical Marker for 

Tear Hyperosmolarity in Dry Eye Disease, which 

utilised the Medmont E300 to perform dynamicarea, 

high-speed Placido disc videokeratography. 

The study was designed to assess the diagnostic 

performance of a novel, automated, non-invasive 

measure of tear film stability derived from 

Placido disc videokeratography, the tear film 

surface quality breakup time (TFSQ-BUT), as a 

clinical marker for diagnosing dry eye disease. 

It concluded that: “automated TFSQ-BUT is a 

repeatable, non-invasive clinical marker with 

both high sensitivity and specificity for tear 

hyperosmolarity.” Tear osmolarity was measured 

bilaterally from the inferior lateral tear meniscus 

using the TearLab system. 

OIC’s Chris Malicdem and Tim Way 

Abbott Eye Health 

Abbott’s Rachel Haynes with Dr Trevor Gray 

Rachel Haynes from Abbott Eye Health was on 

hand to introduce Abbott’s newly rebranded 

Complete Revitalens Multi-Purpose Disinfecting 

Solution (MPDS) and Blink Intensive Tears Plus Gel 

Drops for patients with severe dry eye. 

The premium Complete Revitalens MPDS has 

been rebranded to bring all Abbott’s contact lens 

solutions under its well-known Complete brand. 

According to recent studies by Abbott, Complete 

Revitalens has a significantly lower (up to four 

times lower) incidence of adverse events; a lower 

rate of solution-induced corneal staining; and, 

perhaps most importantly, is still effective with 

even the most non-compliant patients. 

Abbott took the opportunity at this year’s 

conference to also launch Blink Intensive Tears 

Plus liquid gel drops. Abbott claims this new 

addition to its eye lubricant portfolio provides a 

thicker, visco-elastic formula that adapts to the 

eye’s natural blinking function. It was developed 

to supply maximum viscosity, with minimal blur 

for persistent dry eye sufferers. 

Haynes, however, had plenty of knowledge and 

literature, but no samples to give out to delegates 

as these had not managed to make it to the 

conference, but she says she’s more than happy 

for anyone who was at the conference to contact 

her at Rachel.Haynes@abbott.com and she’ll send 

you a sample directly. 

Dry Eye Technology (E>Eye) 

John Veale, optometrist and director of Merivale 

Optical in Christchurch and distributor of the 

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

to treat dry eye caused by meibomian gland 

dysfunction (MGD), was one of the speakers at the 

2016 CCLS Conference and one of the exhibitors. 

In his presentation he described his experience 

with the E>Eye machine and why he decided to 

distribute it, and the results of two studies: a 

double-blind, placebo-controlled clinical trial of 28 

patients with MGD by Associate Professor Jennifer 

Craig; and one by his own practice, Merivale 

Optical, both of which showed the efficacy of IPL 

in treating dry eye. 

The interest in dry eye and its treatment was 

a key theme of the 2016 conference, said Veale, 

with about a quarter of the presentations 

discussing it in some way, which meant there was 

also a lot of interest in IPL for treating dry eye 

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

modality for assisting people, especially those 

with severe symptoms, and they are severe in 

some cases.” 

Veale’s Merivale study found that more than 

80% of patients who received IPL treatment 

reported an improvement in their dry eye 

symptoms, but Veale said he’s confident by better 

combining IPL treatment with other proven dry 

eye remedies such as diet, blinking and heat 

treatment (using eye wheat bags) he can move 

this into the 90% range. 

Device Technologies 

Device Technologies’ Campbell Gordon and Diego Sonderegger 

Device Technologies was exhibiting a range of 

equipment, but top of the what’s new list was 

the release of OCT angiography for the Topcon 

DRI Triton Swept Source OCT, the latest OCT 

technology available on the market. 

With the new Topcon Triton Swept Source OCT, 

clinicians can do a dye-less OCT-angiography 

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8/04/16 5:22 PM




CONFERENCE 


in less than a minute, said Diego Sonderegger, 

product specialist at Device Technologies. “It 

makes sense combining OCT-A with the Swept 

Source laser because it penetrates deeper into 

the retina/choroid and, due to its high speed, 

it also enables the software to use the OCTARA 

full spectrum analysis to get better results even 

at low flow levels. Also, with Swept Source 

technology you can scan through cataract, 

haemorrhages and sclera as well.” 

Topcon claims to have the world’s fastest 

commercial scanning speed of 100,000 A-scans/ 

second. It also incorporates full-colour, highresolution 

fundus photography. A higher spec 

model is also available offering fluorescein 

angiography and fundus autofluorescence. To 

date this is the only anterior and posterior sweptsource 

OCT on the market. 

Other technology on display and attracting 

attention was the Topcon CA-800 Corneal 

Analyzer, a comprehensive corneal topography 

solution that enables the complete evaluation 

of the anterior corneal surface and total analysis 

of the patient’s corneal surface; and Captiv8, 

a multi-faceted patient communication and 

marketing software tool, that enables users to 

share 3D animations between themselves and 

through social networking platforms such as 

Facebook. Captiv8 is now integrated with Twitter, 

allowing optometrists to monitor and respond, 

with 3D animation content, to any chatter that 

relates to their world, explained Sonderegger. 

Johnson & Johnson 

Acuvue Oasys 1-Day with HydraLuxe technology 

is the newest daily disposable innovation from 

Johnson & Johnson Vision Care. According to the 

company, 59% of patients experience a decline 

in contact lens performance due to performing 

multiple activities in different indoor and 

outdoor environments with a range of humidity, 

temperature and air flow conditions throughout 

the day i . 

Company representatives explained how 

Acuvue Oasys 1-Day complements the natural 

tear film to help with the feeling of dry and tired 

eyes, which can significantly impact a patient’s 

ability to fully engage in activities around them 

and may result in a patient discontinuing contact 

lens wear. 






WELLINGTON 







At the heart of HydraLuxe technology is an 





enhanced moisture network of tear-like molecules 

plus highly breathable silicone that integrates 

with the patient’s own tear film each day. 

This network of tear-like molecules is uniform 

throughout the lens, and works with the key tear 

film components to lubricate and moisturise the 

lens and support the tear film throughout the 

day ii . ▀ 

i. Matthews, K. et al. Exploring variability in soft contact 

lens performance from moment to moment. Optom Vis 

Sci 2015;92:E abstract 44644 

ii. JJVC Data on file Sept 2015 Technology description of 

Hydraluxe technology 

OCT-A now in 

Tauranga 

Tauranga Eye Specialists is the first practice 

in Australasia to use Swept Source OCTangiography, 

reports Diego Sonderegger, 

product specialist at Device Technologies. 

The Topcon Triton Swept Source OCT is now 

in operation at Tauranga Eye Specialists and 

Drs Mike O’Rourke, Sam Kain, Mark Saunders 

and Andrew Thompson are excited to use its 

new functions, including OCT-angiography, 

which allows visualisation of deep retinal 

and choroidal layers without the use of 

intravenous injection of dye in less than a 

minute, he said. ▀ 

Angiography images from the Topcon Triton Swept Source OCT 

SPECIALITY CL FORUM 

SCLERAL LENS FITTING FOR HIGH LEVELS OF REGULAR ASTIGMATISM 

In my February 2016 column, I described how 

mild to moderate levels of regular astigmatism 

can now be corrected with orthokeratology. 

However, for some patients the lifestyle 

consideration of using ortho-K lenses may not 

suit or they may just have too much astigmatism 

to realistically be a good ortho-K candidate. 

Hopefully most optometrists will know a rigid 

lens is the best option for these >3.00DC patients 

to achieve high quality vision. For the majority 

of patients an RGP corneal lens will work fine, 

however for patients desiring comfortable all-day 

wear and stable vision a larger scleral lens can be 

a preferable option in many instances. 

In this example my patient, a 25-year-old 

male, reported to our practice to investigate his 

contact lens options. He is a university student 

in the health area and plays basketball at a 

representative level. Unfortunately, he has high 

amounts of astigmatism (R +5.50/-4.50 x 168, L 

+5.25/-4.25 x 11, 6/5 in each eye) and came to 

his appointment wearing glasses, which he was 

very happy with. He had tried several different 

contact lens options in the past with little 

success. Customised soft toric disposable lenses 

had good comfort but the vision was poor and 

fluctuated. Rigid gas permeable bi-toric corneal 

lenses were tried but were poorly tolerated due to 

comfort despite providing good vision. They had 

also popped out twice during basketball games. 

Discouraged by this our young patient got the 

opinion of a corneal specialist who told him a clear 

lens extraction was the only permanent opinion. 

After discussion of his options we decided to fit 

a toric periphery scleral lens to be used when the 

patient needed to be without his spectacles. 

BY ALEX PETTY* 

Following a delivery and teach appointment and 

some final tweaks to the lens fit during aftercare 

visits (a more detailed report of this case can 

be found at eyespace.com.au/blog) the patient 

returned two weeks after picking up his final 

lenses. He reported vision with his new lenses 

was excellent and comparable with his glasses. 

Comfort was also reported to be very good. Vision 

with each lens was 6/6+2 after 4 hours of wear 

with no significant residual astigmatism or flexure 

in the over-topography. 

Anterior OCT of these lenses showed the central 

apical clearance was measuring in the low 200um. 

This clearance could be further decreased into the 

100-150µm range if desired with the predictability 

afforded to us by modern lathe technology. 

Apical clearance in the new lenses as seen with the slit-lamp and OCT 

The appearance of the lens under the slitlamp 

showed very little conjunctival vessel 

impingement. Upon removal, aside from some 

mild staining atop small pingueculae in each eye, 

there is no evidence of lens impression or abrasion. 

The cornea was also devoid of defect. 

Corneal topographies in Medmont Studio showing the regular limbusto-limbus 

WTR astigmatism. 

The 4 days of Optics 

23 - 26 September 2016 

LIVE THE EXPERIENCE 

silmoparis.com 

Until scleral mapping with technology such 

as the Eye Surface Profiler (Eaglet Eye) becomes 

commonplace in contact lens practices, trial fitting 

scleral lenses is still required. This can be a problem 

in this sort of case however, as a rotationally 

symmetrical trial lenses will rock along the steeper 

vertical meridian of a high WTR cornea. While the 

lens is still reasonably comfortable, a rocking lens 

can allow bubbles under the lens and can increase 

the likelihood of the patient inadvertently blinking 

the lens out during the fit. I have made a request 

that a non-rotationally symmetrical scleral trial set 

be available in the future for just this instance. 

A topography over the EyeSpace Scleral 

(Innovative Contacts) trial lenses I fitted to this 

patient showed significant with-the-rule flexure 

of around 2 diopters after only a few minutes. 

Over-refraction through the lens at this point 

also showed -2.00D of residual astigmatism 

with axis 180. 

Topography over the rotationally-symmetrical trial lenses shows 

significant flex on the toric anterior surface. 

I talked about minimising scleral lens flexure in 

the October 2015 issue of NZ Optics. It is clear that 

a rotationally symmetrical lens would continue 

to rock and cause stability issues in this patient, 

even with a thicker centre thickness. A lens with 

a difference in sagittal height in each meridian 

will stabilise the lens and eliminate flexure much 

better. The lenses were ordered with 500µm 

difference in sag (to account for ~2.50D of flex) 

between the meridians. 

Scleral landing zone profiles of the right lens. Note the lack of 

conjunctival blanching at the lens edge 

Overall the patient was very happy with 

the outcome of his scleral lens fitting. Careful 

assessment of the cornea for signs of hypoxia and 

toxicity is important during his future follow-up 

visits as the thickness of the lens and tear reservoir 

can pose barriers for oxygen to pass to the cornea, 

even with the high Dk materials used in modern 

scleral fitting. A key concept here is that a toric 

cornea can achieve great vision in a scleral lens 

with a spherical back optic zone. The difference in 

sagittal height of the peripheral areas is important, 

as this controls stability and flexure on the eye. 

This case shows that specialty scleral lenses are 

not just reserved for diseased or compromised 

corneas but can be a useful and effective tool in 

treating regular ametropias in practice. 

Stay tuned for the next edition of the Specialty 

Contact LensForum where I will write again about 

my favourite topic orthokeratology and how it can 

be useful to manage the post-LASIK cornea. ▀ 

* Alex Petty is a Kiwi optometrist who 

graduated from the University of 

Auckland in 2010. He has an interest 

in specialty contact lenses, ortho-K and 

myopia control. 



11

NZAO student awards 

Focus 

on Business 

WHAT IS MY PRACTICE WORTH? 

How to prepare a practice for sale 

BY STU ALLAN* 

Planning your exit from your business is a critical process. 

The right advice can make the difference between 

obtaining full value for your business or not. This is a brief 

introduction to how OpticsNZ approaches valuing a practice and 

reaching a successful sale. It is by no means an exhaustive list, as 

each and every engagement is different. 

What is my practice worth? 

There is no, simplistic, one-size-fits-all, rule applied to calculate 

the asking price for an optical business. Historically, the simple 

equation—50% of turnover—was used. But those days are long 

gone, although the myth is still out there. 

Over the years, we have found the best process is to value the 

business using a variety of methodologies. 

EBIT (bottom line earnings before interest and taxation) is the 

most common method used. We then add a multiplier to that 

bottom line figure to arrive at what we perceive to be current 

market value 

When a practice shows little or no profit, we revert to an older 

methodology of plant, stock, assets and whatever we can justify 

for goodwill. 

In the past nobody needed to prepare for sale. Times have 

changed and today our role is very much a case of preparing a 

business proposition, which presents a company in the best light. 

No two practices are exactly alike and no matter what any 

accountant tells you, what you sell your practice for boils down to 

whatever the buyer is prepared and able to pay. 

The process 

The first step is to sign-off on a non-disclosure agreement 

(NDA) between ourselves and the vendor to ensure complete 

confidentiality. 

We then request the information required to create a practice 

profile. This is often a 15 to 20-page document covering such 

things as fees, patient base, marketplace overview, competitor 

analysis and photos. With supportive documents such as floor 

plans, employment agreements, current lease, etc. An essential 

inclusion is where we see opportunities for sales growth, cost 

reductions and/or margin gain. 

Once the practice profile is approved, we then take the practice 

to market explaining to the vendor how and to whom we plan to 

promote the opportunity. 

We handle all negotiations on the practice’s behalf, or with 

them, and when a sale is imminent we prepare a ‘heads of 

agreement’ which the prospective purchaser can then take to 

their solicitors to have a ‘sale and purchase’ agreement drawn up. 

How long do practices take to sell? 

The fastest process we have ever experienced is six months; the 

longest, more than two years. 

Recommendations 

•• 

Potential buyers will be looking at many options, be fair and 

reasonable 

•• 

Have a clear reason for wanting to sell 

•• 

Provide clear proof of profits 

•• 

Be willing to hold hands and work on for a while with the new 

owners to leverage the existing goodwill 

•• 

Be prepared to commit to a location-based restraint of trade 

•• 

Maintain a precise and accurate asset list 

•• 

Keep a clear list of costs that will not transfer to the new 

owner. Often we include some personal costs within our 

businesses such as vehicle expenses, home office costs, 

personal travel, clothing, etc. List them so they can be 

identified as ‘add backs’ to boost the bottom line 

•• 

Present your practice clean, neat and in an appealing manner 

•• 

Never have a full valuation completed. An appraisal (costing 

significantly less) is more than sufficient; there is no need to 

count teaspoons 

•• 

Inform your landlord of your intentions. Landlords can be 

tricky when told late in the game 

•• 

Engage an experienced broker, allowing you to step back 

from what is often an emotional process. Your practice often 

equates to a lifetime’s work. The handling of the value, exit 

planning, marketing and sale of the business should not be 

entered into lightly. ▀ 

* Stuart Allan is director of OpticsNZ, a company 

which specialises in human resources, 

recruitment, practice brokering and business 

development for the optics industry. Over the 

years, OpticsNZ has brokered dozens of practices 

and with each engagement tweaks and refines 

its processes and systems to assist in maximizing 

returns for clients. For more, contact Stu on 027 

436-9091, email stu@opticsnz.co.nz or visit 

www.opticsnz.co.nz 

The annual NZAO 

Student Awards 

Evening, a joint 

venture between the New 

Zealand Association of 

Optometrists (NZAO) and 

the University of Auckland, 

was an upbeat affair that 

attracted a large number of 

students. 

Held at the prestigious 

Langham Hotel in Auckland 

on 17 March, the evening 

recognised not just the 

students who came top of 

their year in 2015, but also 

the work and commitment of the NZAO in 

ensuring New Zealand optometrists, and the 

vital work they do in protecting eye health 

and the wellbeing of the New Zealand public, 

are recognised and respected appropriately 

by government and the wider community. 

Dr Lesley Frederikson, NZAO national 

director, chaired the meeting and provided 

both a history and an update on the 

Association’s ongoing work to protect and 

improve the status of optometrists and 

optometry in New Zealand. Zaria Burden 

and Chelsey Wood, who head the NZAO’s 

New Graduate Liaison Team, discussed their 

transition from university to work and why 

they chose to continue to be members of the 

NZAO, while Janet Chung and Joyce Mathan 

provided a synopsis of their Summer Student 

research projects and the importance of 

NZAO’s continuing support for research at 

the University. The speeches were brought 

to a close by Nikku Singh, the current 

president of the NZ Optometry Student 

Society (NZOSS) and NZAO President Callum 

Milburn, who spoke of the importance 

of learning from optometry’s past while 

working towards to a strong future. ▀ 

Janet Chung, Joyce Mathan, Xheida Mani, Stephanie Wallen, Bianca Davidson, Huria Rahimi and Carla Sy. Picture by Bruce Tetley 

Jackson Harper and NZAO President Callum Milburn 

By Bruce Tetley 

NZAO graduate liaison team Chelsey Wood and Zaria Burden 

New show for Melbourne 

Anew optical industry show called the 

O-Show will be held in Melbourne, 

the fashion capital of Australia, from 

Saturday 21 May to Sunday 22 May, this year. 

Hosted and owned by the Optical 

Distributors & Manufacturers Association 

(ODMA), the O-Show is being billed as a 

new and exciting boutique event that will 

showcase the latest industry technology in 

Australasia. 

ODMA has been planning an event of this 

type in the alternate year to the ODMA Show 

for some years, said Finola Carey, ODMA chief 

executive. “O-Show timing fits perfectly 

well to be run in the alternate year to the 

ODMA Show and will be a great resource for 

the industry. It is a non CPD event with the 

emphasis on hands on demonstrations and 

the opportunity to compare and contrast 

new products and equipment.” 

At the time of going to press more than 30 

exhibitors for equipment, sunglasses, frames 

The coming of Camber 

Younger Optics and 

Independent Lens 

Specialists (ILS) have 

combined forces to introduce the 

latest evolution in progressive 

lenses to New Zealand, Camber 

Technology. 

“It’s simply the most advanced 

technology in optics today; it’s the next 

generation in free-form progressives,” says 

Craig Johnston, Younger Optics’ Australasian 

sales and marketing manager. 

“It is very exciting,” adds Glenn Bolton, 

director of ILS. “It’s another step forward in 

the development of free-form technology. 

And for us, this is an opportunity to offer a 

lens that is going to be significantly better 

for the patient; in a number of cases, quite 

significantly.” 

Developed in partnership with Indizen 

Optical Technologies (IOT), an independent, 

specialist free-form lens design company 

based in Spain and Los Angeles, the patented 

Camber Technology combines complex curves 

on both surfaces of the lens, improving 

visual acuity in all viewing zones. The key 

breakthrough recognises the impact the base 

curve has on visual acuity. 

“The unique, continuously changing surface 

curvature of the lens blank allows expanded 

reading zones and improved peripheral 

vision. When combined with a sophisticated 

back surface digital design, both surfaces 

work together to accommodate an expanded 

Rx range, offer better cosmetics (flatter) for 

many prescriptions and yield user-preferred 

near vision performance,” says the marketing 

material. 

Younger and IOT have been working on 

Camber ever since free-form was launched, 

so it has been in development for a number 

of years, says Johnston. Camber Technology 

2015 student awards 

•• 

Top Maori/Pacific Island entering 

BOptom Part II in 2016 – Jackson 

Harper 

•• 

Most improved student entering 

B.Optom. Part IV – Wanyi Zhou 

•• 

Most improved student entering 

B.Optom. Part V – Huria Rahimi 

•• 

Top Student entering B.Optom. Part 

III– So Yon Shin 

•• 

Top Student entering B.Optom. Part 

IV– Bianca Davidson 

•• 

Top Student (2nd) entering B.Optom. 

Part IV– Carla Sy (an extra award 

presented by Associate Professor Rob 

Jacobs as the level was so high) 

•• 

Top Student (1st) entering B.Optom. 

Part V– Xheida Mani 

•• 

Top Student (2nd) entering B.Optom. 

Part V – Stephanie Wallen 

•• 

NZAO Summer Student Awards 

– Janet Chung and Joyce Mathan 

•• 

Peg Wood Award (Top Student in 

Optom 441: Clinical Optometry) – 

Stephanie Wallen 

and lenses had confirmed their participation, 

with 85% of stand bookings allocated in the 

first three days after launching. Confirmed 

exhibitors include Frames Ectetera, Design 

for Vision, Tiger Vision, OptiMed, BOC 

Instruments, Mimo, Heidelberg Engineering, 

Zeiss and Device Technologies. 

As well as the exhibition, the new event 

will feature free Business Snapshot Seminars. 

Australian raconteur and business adviser 

Mark Davis will explore how to create value 

in order to secure and retain customers 

and how to educate customers, build a 

rapport and create no-risk sales pitches; 

Australian healthcare marketing specialist 

Robert Springer will discuss best practices 

in online marketing and how to master the 

art of personalised patient messaging; and 

optical retail stylist Kerry van Beuge will 

demonstrate what’s hot and why in window 

displays and give attendees some ideas 

about what they can do with all the point-ofsale 

items 

that end 

up in their 

practices. 

The 

organisers 

have also 

included 

a Cocktail 

Party, 

complete 

with cash 

prizes, on 

the Saturday 

night. 

‘’We are simply fulfilling the wishes of 

the members who have been wanting an 

event of this type for some time. This popup-boutique 

industry event will be full of 

energy and surprises and terrific learning 

opportunities,” said Carey. 

For more visit www.o-show.com.au. ▀ 

has been available in the US for the past 18 

months and is going “extremely well,” he says. 

At least one lab has also been accredited by 

IOT to provide Camber in Australia and there 

are a few other Australian labs currently vying 

for the opportunity. 

In New Zealand, for Younger, ILS was the 

obvious lab choice as it’s already well-known 

for free-form lens technology. The new lens 

technology was given a soft launch at ADONZ 

in October last year, but wasn’t readily 

available until now, after ILS completed the 

accreditation process with IOT. 

For optometrists and dispensing opticians 

Camber is an easy concept to grasp so 

Younger is expecting it to be a very popular 

alternative in the premium progressive space, 

says Johnston. “When you explain it, Camber 

makes logical sense, combining the traditional 

laws of optics with free-form technology and 

making the best out of both.” ▀ 


Optometrists 

needed urgently 

Marine Reach, a humanitarian 

organisation that delivers health 

serves to isolated populations from its 

vessel, the MV Pacific Hope, is urgently seeking 

optometrist volunteers to help with its next 

mission in the Pacific in June through to October. 

Marine Reach purchased the Pacific Hope 

and refit the vessel for purpose in 2013. It 

undertook its first clinical voyage, concentrating 

particularly on the outer islands in Fiji and 

Vanuatu, in 2015. Now, with help from 

the Tauranga Rotary Club, which has been 

raising funds and seeking donations to equip 

the Pacific Hope with a fully functioning 

ophthalmic clinic, the group is again seeking to 

bring help to people in need in Vanuatu. 

The ship will be based in Vanuatu for five 

medical outreaches this year, from: 

•• 

June 25 – July 10 

•• 

July 16 – July 31 

•• 

August 6 – August 21 

•• 

September 3 – September 18 

•• 

September 24 - October 9 

Former volunteer, Wanganui optometrist John 

Mellsop said meeting the vision needs of the Ni- 

Van people on the island of Malakulu, Vanuatu 

was a satisfying way to spend two weeks in 

September and October last year. “We worked 

hard and I was well supported by an optometry 

team leader and four others who were able 

to take visual acuities and dispense reading 

glasses. Living on a ship with 50 others has its 

limitations, but gives you an opportunity to see 

places that tourists never see and get to know a 

lot of good people.” 

Marine Reach, part of Youth With A Mission 

(YWAM), has been operating for 25 years and 

has helped more than 500,000 people. If you 

think you could help, please contact them at 

medical@marinereach.com. ▀ 

Pfizer- 

Allergan split 

Grand Round 1: VEGF, Sulcoflex, 

vitamin A and more 

The first 2016 Grand Round seminar evening 

from Eye Doctors took place on 23 March 

at Novotel, Green Lane. Four speakers took 

the stand for the evening, including keynote 

speaker Dr Mark Donaldson, a founding member 

of Eye Doctors and consultant ophthalmologist at 

Greenlane public hospital. He was joined by Eye 

Doctors’ colleagues Drs Penny McAllum, Andrew 

Riley and Shaun Dai. The event was sponsored by 

Radiant Health, distributors for Bausch + Lomb. 

VEGF Inhibitors made easy 

Dr Andrew Riley opened the event with a look at 

VEGF treatments for macular oedema and vascular 

proliferative retinal disease, with a focus on the 

drugs currently used to treat the condition. Eylea, 

Lucentis and Avastin are all prominent treatments 

in New Zealand, with Avastin being the most 

commonly prescribed. Dr Riley presented the DRCR. 

net diabetic retinopathy research presented by 

Dr Lee M. Jambol recently in Colorado. DRCR.net 

has now run 28 open source studies on diabetic 

retinopathy and is now leading research in this 

field. Dr Riley also talked about treatment regimens 

of VEGF injections such as required treat-andextend 

intervals and how optometry practices can 

help patients get better outcomes. Dr Riley noted 

that Greelane spends millions on VEGF treatment 

now with most being spent on the 10% of patients 

who don’t respond to Avastin. 

Managing refractive surprise 

Refractive cataract surgery is one of Dr Penny 

McAllum’s specialty interests, and her talk 

focused on the treatment of refractive surprise 

after surgery. Dr McAllum noted there are a 

number of causes of refractive surprise, including 

measurement inaccuracies in unusually long 

or short eyes and abnormalities of the cornea, 

such as keratoconus or scars. To reduce the risk 

of refractive surprise there are a number of steps 

that can be taken from checking biometry several 

times to treating dry eyes and managing patient 

expectations. Understanding a patient’s needs 

from their post-surgery eyesight can help with 

advising them of the best lens choice to minimise 

the chance of unexpected outcomes. 

There are several options for managing 

refractive surprise. In some patients, simple 

reassurance or a pair of glasses may be the best 

choice. Laser refractive surgery is a good option 

for younger patients, but can sometimes be 

associated with problems like dry eye in older 

patients. Using a sulcus piggyback lens is another 

option Dr McAllum favours. While in the past 

there have been issues around similar lenses, 

like interlenticular opacities and iris chafing, 

the newer ‘Sulcoflex’ lenses produced by Rayner 

overcomes the previous obstacles. Their most 

commonly used product is the Sulcoflex Aspheric 

that is readily available from -5 to +5D and 

custom-made to ±10D. An online calculator assists 

with the decision over what lens to use and 

primarily uses subjective refraction to calculate 

the required lens, avoiding potential biometric 

inaccuracies. These lenses are also available in 

toric and multifocal formats. The implantation 

procedure takes just a few minutes under topical 

anaesthetic and many patients experience an 

almost instant improvement 

in vision. 

Cataract and Glaucoma 

Dr Mark Donaldson provided 

the keynote speech for 

the night on treatment 

regimens across cataract 

and glaucoma patients. 

He noted that contrast 

acuity is an important 

theme in glaucoma, where 

the damaging effects are 

irreversible – unlike cataract 

patients who find relief 

from these symptoms after 

treatment and that, of all 

quality of life measures, 

contrast acuity of glaucoma 

patients is the best correlate. 

The daily comfort of a 

glaucoma patient is affected 

greatly by contrast acuity, with 

one of Dr Donaldson’s patients 

reporting she could not even 

see to eat because her vision 

was so washed out. As a result, 

she was helped by using high 

contrasting utensils in order to 

stay comfortably independent. 

Another example of practical help would be a 

black switch on a white baseboard instead of the 

usual white switch on a white wall plate. 

Dr Donaldson also noted in patients with both 

cataracts and glaucoma, surgery choices need 

to be timed correctly. He suggested waiting 

12 months after phacoemulsification before 

performing trabeculectomy surgery to avoid bleb 

fibrosis and that, in some cases, stenting at the 

time of cataract procedure can give the space to 

operate on a cataract first. 

Unnecessary visual loss in a teenage boy 

The evening ended with a fascinating tale from 

Dr Shaun Dai, who reported on the unusual case 

of a 14-year-old, caucasian boy from the South 

Island who was suffering from low vision with no 

apparent, detectable cause. His family medical 

history was uneventful, but the boy’s vision had 

become so bad he had sought assistance from the 

Blind & Low Vision Education Network. 

On examination the boy was lethargic and clearly 

unwell, said Dr Dai. On further questioning the 

patient reported a severe allergy to dairy products 

and peanuts. He had subsisted on an anxiety-driven 

diet of chips and white bread. The boy was admitted 

to Middlemore Hospital in Christchurch where he 

was diagnosed with a serious vitamin A and B12 

deficiency, which has been associated with optic 

neuropathy in the past. Once the deficiency was 

treated, and he was put on a more nutritional diet, 

some vision was restored, to the point where he 

could return to mainstream education. 

Dr Dai noted that vision problems in adolescents 

related to vitamin A deficiency are becoming more 

prevalent in New Zealand. 

The next Grand Round is on Wednesday 8 June 

at Ormiston Hospital (by invitation only due to 

limited space). ▀ 

Aggressive new US Treasury Department 

reforms have ended the proposed 

Dennis Oliver, Lorraine Beattie and Cecilia Turnbull 

US$160 billion merger of international 

pharmaceutical companies Pfizer and Allergan. 

The proposed reforms target inversions, where 

large US corporations seek to avoid paying US 

corporate taxes by moving their tax residence 

abroad through merger deals. The move was seen as 

a direct attack against Pfizer-Allergan’s plans, which 

would have shifted Pfizer’s official headquarters 

to Allergan’s base in Dublin, greatly reducing its 

tax rate and almost certainly leading to the loss of 

thousands of jobs in the US. The deal would also 

have allowed Pfizer to access what is believed to 

be about US$74 billion in foreign profits offshore, 

without having to pay the 35% US corporation tax. 

Deborah Chan and Vaishna Singavarothayan 

Pfizer announced the deal had been called off on 

6 April “by mutual agreement” driven by the actions 

of the US Treasury. 

“We plan to make a decision about whether to 

pursue a potential separation of our innovative and EyE DOctORS GRAND ROUNDS 

GRAND ROUNDS - 2016 

established businesses by no later than the end of 

2016, consistent with our original timeframe for the 

2016 

We look forward to seeing you. 

decision prior to the announcement of the potential 

Allergan transaction,” said Ian Read, chairman and 

CEO of Pfizer, in the statement. 

8th June - Ormiston Hospital 

Pfizer will pay Allergan $150 million as 

(by invitation only due to limited space) 

reimbursement for expenses associated with the 

transaction, as required under the terms of the 

14th September - Novotel, Ellerslie 

merger agreement. 

President Barack Obama promised to crack down 

No registration fee . cPD points available 

on tax inversions more than two years ago to deter 

Visit our website for more details. 

companies from leaving for tax advantages and 

had repeated that call after Pfizer-Allergan’s merger 

announcement. Following Treasury’s decision, 

Obama urged Congress to close the loophole for 

good by reforming the US tax system accordingly. 

Dr Andrew Riley 

Dr Mark Donaldson 

“Let’s stop rewarding companies that are shipping FRANZCO 

FRANZCO 

jobs overseas and profit overseas and start 

Dr Penny McAllum 

Dr Shuan Dai Ascot Clinic (09) 520 9689 - Botany Junction (09) 277 6787 

rewarding companies that create jobs right here at 

home and are good corporate citizens,” he said. FRANZCO 

FRANZCO 

▀ 

EYE 0765 

Kathryn Bierre, Donald Klaasen, Sue Kanani, Odette Smith and Shookria Ranjaiy 

Dr Shuan Dai, Melissa Lee Sang, B+L representatives Yvette Beattie and Julian Knaggs, and 

Dr Penny McAllum 

Shirley Ip and Wen Li Keng 

www.eyedoctors.co.nz 



13

SPECIAL FEATURE: RANZCO NZ BRANCH SCIENTIFIC MEETING 

Welcome to Dunedin! 

This year’s Royal Australian and New Zealand 

College of Ophthalmologists New Zealand 

Branch Annual Meeting will be in Dunedin 

on the 27-28 May at The Dunedin Centre. 

The theme is The developing eye, developing 

techniques and developing therapies, and the 

organisers are very pleased to be hosting a 

selection of high-profile, international speakers 

around this topic. 

Running alongside the scientific meeting will 

be the NZ Ophthalmic Nurses’ Group meeting, 

which includes Tricia Cairns, from Mercy Hospital 

in Dunedin, on ethics and informed consent and 

Marie Strauss, a designer and owner of Dunedin’s 

OPHTHALMIC INSTRUMENT COMPANY (OIC) 

We look forward to welcoming you onto the OIC stand 

at the New Zealand branch meeting of RANZCO. We 

will have the Nidek RS-330 DUO on display, which 

combines high resolution retinal photography with 

optical coherence tomography (OCT). Also being shown, 

for the first time in New Zealand, will be the Nidek 

RS-3000 Advanced SLO based OCT, which includes 

OCT angiography. The latest release from Nidek is the 

compact HandyRefK, which is a highly portable, handheld 

autorefractor/keratometer, which also has an opacity 

measurement function for imaging, quantifying and 

measuring cataracts with central and peripheral opacity 

indexes. Among the Sonomed Ultrasound devices on 

display will be the Vu-Pad, a compact tablet-based 

ultrasound A/B Scan with optional UBM probe, the 

industry leading Sonomed Vu-Max HD UBM and the USBbased 

Master-Vu A&B Scans. We will also have a large 

range of orthoptic and vision testing supplies with special 

unique and popular Dada Boutique, on eyewear 

fashion. 

As normal the New Zealand branch meeting 

includes a full social programme, including a 

street art and heritage walk on the Saturday 

morning and Saturday evening’s formal dinner, 

to be held at the architecturally-designed Toitu 

Otago Settlers Museum. 

Dunedin itself provides a beautiful setting 

for two days of networking, socialising and 

professional development among our ophthalmic 

community. 

The NZ Optics team look forward to seeing 

you there! ▀ 

The iconic railway station Dunedin 

BY DRS LOGAN MITCHELL, MARY JANE SIME AND 

CASEY UNG, CO-CONVENERS OF THE NZ BRANCH 

RANZCO 2016 MEETING 

The team in Dunedin are pleased to be hosting 

the annual meeting of the New Zealand 

Branch of the Royal Australian and New 

Zealand College of Ophthalmologists for 2016. 

The meeting is entitled The developing eye, 

developing techniques and developing therapies. It 

is hoped this forum will provide an update, relevant 

to a broad audience, on some of the latest advances 

in our specialty from international keynote speakers 

and well-respected local experts. It is also a platform 

for our younger colleagues to present local research 

to a national audience. 

We look forward to welcoming to the conference 

our three keynote speakers, Professor Andrew Lotery 

from the UK, Professor Glen Gole from Brisbane and 

Dr Mark Chehade from Adelaide. Andrew Lotery will 

be speaking on medical retina topics, giving new 

insights into AMD, genetics and gene therapy. Glen- 

Gole is well-known to New Zealand audiences as 

an engaging and informative speaker on paediatric 

topics. Mark Chehade, in addition to his clinical 

interests, has a passion for registrar training and 

will also help us to think outside of the box when 

it comes to developing strategies to overcome the 

challenge of workforce shortages in the face of 

increased workload. 

Ophthalmologists have a two-day programme, 

with concurrent programmes for ophthalmic 

nurses and ophthalmic technicians. Although 

the orthoptists are not meeting this time (after 

meeting at the RANZCO Congress in Wellington last 

November) any orthoptists wishing to attend other 

sessions are still welcome. There is a registrar-only 

training day on Thursday 26 May and a Younger 

Fellows’ Breakfast planned for Saturday morning. 

Dunedin is a city with a proud heritage, 

particularly with its association with the University 

of Otago. The students bring vibrancy to the 

city and, combined with its legendary southern 

hospitality, is a unique place to visit. For those who 

like the city scene, there are good restaurants and 

cafés close at hand. Take time to explore some 

of the fine examples of Victorian and Edwardian 

architecture Dunedin is celebrated for and you will 

find artisans, fashion designers, and vibrant street 

art tucked away in unexpected places. 

For those more intrepid, there are opportunities to 

see wildlife in their natural habitat within easy reach 

of the city, either by land or by boat on the Otago 

Harbour. The albatross colony, yellow-eyed penguins 

and the Orokonui Ecosanctuary are all nearby. 

We invite you to join us, and even if the southern 

temperatures are cool, you can be assured of a 

warm welcome. 

We look forward to seeing you in person in May. 

To view the conference programme and register, 

please visit www.ranzco2016.co.nz. ▀ 

conference pricing. See you in Dunedin. ▀ 

phone: 09 443 0072 

Ranzco NZ 2016 

keynote speakers 

Distributed by: 

email: tim@oic.co.nz 

This year the keynote speakers are Professor 

Andrew Lotery, from the University 

of Southampton in England; Dr Mark 

Chehade from the South Australian Institute of 

Ophthalmology in Adelaide; and Professor Glen 

Gole, from Children’s Health, Queensland and the 

Lady Cilento Children’s Hospital in Brisbane. 

Professor Andrew Lotery 

Professor Andrew 

Lotery is chair of 

ophthalmology at 

the University of 

Southampton in 

England. His clinical 

specialty is medical 

retina with major 

research interests in 

age-related macular degeneration, ophthalmic 

genetics, gene and stem cell therapies. He is 

editor-in-chief of the journal Eye, the official 

scientific journal of The Royal College of 

Ophthalmologists in the UK. He has been awarded 

the Nettleship Award for Research by the Royal 

College of Ophthalmologists and was listed in The 

Times newspaper as one of the United Kingdom’s 

top 100 doctors. He and his team have performed 

over 70 clinical trials and published more than 

166 papers in leading journals including Nature 

Genetics, Nature Communications, The Lancet 

and The New England Journal of Medicine. 

Professor Lotery will be talking on: New insights 

into AMD from genetics, Gene therapy for rare 

and common eye diseases and New therapies for 

non-neovascular macular diseases. 

Dr Mark Chehade 

Dr Mark Chehade is 

director of the Cornea 

and External Disease 

Unit at the South 

Australian Institute of 

Ophthalmology based 

at the Royal Adelaide 

Hospital, a position 

he has held since 

leaving Moorfields Eye Hospital in the UK in 1997. 

His sub-specialty interest is surgical glaucoma, 

choosing a fellowship with Dr Clive Migdal, senior 

glaucoma research fellow at Moorfields, after it 

became evident that many patients with anterior 

segment disease lost their sight to glaucoma. His 

current research interests include the ocular surface 

microbiome, proteomics and tear film compositional 

analysis. Together with Drs Aanchal Gupta and 

Nadia Wittles, Dr Chehade’s unit trains a fellow each 

year, with some staying on for two years to ensure 

competency in treating complex external disease, 

cornea component transplantation, filter and 

implant drainage surgery. 

Dr Chehade is a ‘Sight For All’ visionary to 

Vietnam and Myanmar, where he supervises the 

training of transplant surgeons, and a dedicated 

trainer of ophthalmology registrars. 

Dr Chehade will be talking on: Applying the “good 

enough principle” to potential surgical cases, 

Imparting surgical skills to the ophthalmology 

trainee, and Developing strategies to overcome 

the ophthalmology workforce shortage 

Professor Glen Gole 

Professor Glen 

Gole is director of 

the Department of 

Ophthalmology at 

Children’s Health, 

Queensland and 

the Lady Cilento 

Children’s Hospital in 

Brisbane. He trained in 

ophthalmology under Professor Fred Hollows at the 

Prince of Wales Hospital in Sydney and completed 

a paediatric ophthalmology fellowship at the 

University of Iowa in the USA in 1984. He was on 

the staff of the Royal Children’s Hospital (RCH), 

Brisbane as a visiting medical officer from 1990 to 

2010 and was director of ophthalmology at RCH 

from 2010 to 2014. His research interests include 

retinopathy of prematurity, strabismus surgery and 

amblyopia. He has published more than 100 papers 

and several book chapters. 

Professor Gole will be talking on Managing 

amblyopia, ROP-is it all Retcam and Avastin from 

now on? and Ocular treatments and outcomes. ▀ 


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New Zealand: Abbott Medical Optics (AMO Australia Pty Ltd) PO Box 401, Shortland Street, Auckland, 1140. 

©2016 Abbott Medical Optics Inc. www.AbbottMedicalOptics.com PP2016CT0415 



15

SPECIAL FEATURE: RANZCO NZ BRANCH SCIENTIFIC MEETING 

Discover Dunedin 

ABBOTT MEDICAL OPTICS 

At Abbott, everything we do is 

in service to a simple, but vitally 

important mission: We want to 

help people around the world 

live their best possible lives. 

Our businesses are varied— 

offering both state-of-the-art 

technologies and time-proven 

solutions across the continuum 

of care—but we share an 

unshakable commitment to 

addressing some of the world’s 

most pressing health needs. 

Regardless of the specific job 

each of us does, Abbott people 

understand that our work 

matters in important ways. 

Abbott Vision is focused 

on providing the full range 

of advanced refractive 

technologies and support to 

help eye care professionals 

deliver optimal vision and 

lifestyle experiences to patients 

of all ages. 

Ophthalmic surgical products 

include intraocular lenses, 

laser vision correction systems, 

phacoemulsification systems, 

viscoelastics and related 

products used in cataract and 

refractive surgery. Contact lens 

and eye care products include 

disinfecting solutions, enzymatic 

cleaners, lens rewetting drops 

and dry eye drops. ▀ 

Toitu Otago Settlers museum 

If you’re coming to the conference, why not take 

some time out during your stay to see what 

this heritage city has to offer? 

Visit: 

Toitu Otago Settlers museum, where Saturday’s 

dinner will be held. Spend some time soaking up 

the atmosphere of this beautiful, architecturally 

designed museum that will walk you through the 

history of the region from early Maori to modern 

day. Nearby the iconic railway station is well worth 

the time it takes to appreciate it, while the Dunedin 

Public Art Gallery, on the Octagon, is running 

an exhibition called The Analysis of Billy Apple’s 

Genome, which explores the future of medicines 

through sequencing Apple’s DNA. 

Eat: 

Marbecks Foodstore on George Street describes 

itself as a deli, but it’s more of a curiosity, with 

products on sale from truffle oil to Otago chocolate, 

plus a great ‘eat-in’ menu, it offers food for the 

stomach and the mind. Saturday morning see’s the 

farmers market outside the train station, including 

the Peasant Bakery, with its delightful selection 

of artisan patisseries. Well-known among the 

local student population is Capers café on George 

street, serving a selection of eccentric pancakes at 

a reasonable price. 

Nightcap: 

LENTIS® Comfort 

An advanced extended 

depth of focus IOL for 

new-age cataract patients 

By Emmanuel Calligeros 

oday’s new-age cataract patients, mostly 

Tbaby boomers, are a lot more active and 

demanding than previous generations. Gone 

are the days where good distance vision but 

compromised intermediate and near vision 

are acceptable. This new-age mature 

generation (of which I am a member) has 

more leisure time, is more active and 

technology savvy than their parents. Mobile 

phones and tablets are now part of their 

everyday life. They are also more inclined 

to research their options and demand the 

latest and the best. 

According to research conducted by Market 

Scope, presbyopia correcting IOLs accounted 

for only 2.4% of total IOLs implanted globally 

in 2014, with annual growth averaging 6% 

since 2010. 3 

ue to its aspheric, EDOF design LENTIS 

DComfort provides a range of focus 

from distance to as near as 60cm, reducing 

dependence on spectacles to a pair for fine near 

tasks for those patients who need them. (Fig.2) 

With LENTIS Comfort costing patients little 

more than monofocal IOL options and 

providing a much better lifestyle for patients it 

has the potential to replace monofocal IOLs for 

the majority of cataract patients in the future. 

For further information 

P: 0508 338 423 or 09 913 2000 

W: www.device.co.nz E: sales@device.co.nz 

Clinical & Business Development Specialist 

Ophthalmic Surgical Division, Device Technologies Australia 

Although most often providing excellent 

refractive outcomes, diffractive IOLs are 

associated with dysphotopic symptoms 

such as glare, halos and ghosting. 1 

Oculentis has addressed these limitations 

with the development of the LENTIS Comfort 

(MF15) IOL in both standard and toric form. 

The result is a refractive segmental near 

addition IOL, utilising extended depth of 

focus (EDOF) technology (Fig.1). The blended 

transition zone design delivers patients 

comparable distance vision to monofocal 

IOLs and excellent intermediate vision. 

Patrick Versace (eye surgeon at the Vision Eye 

Institute, Sydney) recently conducted a study, 

on his cataract patients, utilising a subjective 

questionnaire and a halos and glare simulation 

Albar is a cosy, Scottish-style whisky destination on 

Stuart street. They offer tastings, or just enjoy their 

‘malt of the month’ by the fire. During the month 

of May, Albar is also serving many hand-pumped 

beers — its answer to Oktoberfest. 

Ombrello’s on Clarendon Street also serve a great 

range of craft beer and is a good place for a late 

night coffee and cake fix. 

Or for those seeking a little more comfort and 

refuge from the noisier city bars try Pequeno, a 

warm and comfortable lounge bar with leather 

chairs and couches, in the basement of the historic 

Savoy building, which serves a variety of local and 

international wines, spirits, cocktails and Cuban 

cigars! ▀ 

Fig. 1 

Toric LENTIS Comfort IOL 

tool to compare patient satisfaction with 

leading diffractive IOLs versus LENTIS Comfort. 

Dr Versace found that patient satisfaction with 

the LENTIS Comfort IOL was the highest of any 

multifocal included in the study. 2 

LENTIS Comfort also provides excellent 

contrast sensitivity (with 95% light transmission) 

for improved twilight vision as well as 

minimising glare and halos. 2 

LENTIS Comfort is available in an extensive 

range of parameters including custom torics in 

0.01D steps. (Table 1) 

Comfort Sports (lifestyle) Vision 

LENTIS COMFORT 

LENTIS COMFORT 

LENTIS COMFORT LENTIS COMFORT TORIC (Standard) LENTIS COMFORT TORIC (Customised) 

OPTIC SIZE 6.0mm 6.0mm 6.0mm 

OPTIC DESIGN Aspheric Aspheric toric Aspheric toric 

posterior, sectorshaped nearvision seg. posterior, sectorshaped nearvision seg. posterior, sectorshaped nearvision seg. 

anterior: +1.50D anterior: +1.50D anterior: +1.50D 

POWER RANGE -10D to -1D (1D), 0D to +36D (0.5D) SE: +10D to +30D (0.50D) sph:-10D to +35D (0.01D) 

cyl: +1.50, +2.25,+3.00, +3.75, +4.50, +5.25 cyl:+0.25D to +12.0D (0.01D) 1 deg steps 

REFRACTIVE INDEX 1.46 1.46 1.46 

Table 1 

References 

Fig. 2 

1 Alio JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Moreno LJ, Pinero DP “Comparison of a New Refractive 

Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular 

Lens.” Ophthalmology. 2012 Mar; 119(3): 555-63 

2 Versace P. Photic phenomena of different multifocal IOL designs.” The Oculentis Toolbox for Lens Surgery; 

Cataract & Refractive Surgery Today, Europe January 2015. 

3 Smolinsky, M. “Looking Deep at Extended Depth-of-Focus IOLs”. Eye on Innovation Newsletter, Nov. 3, 2015. 

DEVICE TECHNOLOGIES 

Proudly supporting RANZCO 

2016, Device Technologies will 

showcase: 

Oculentis Comfort IOL: 

With the toric version of our 

unique LENTIS Comfort lens 

—the pioneer in modern EDOFlens 

technology (extended 

depth of focus) — you now 

have the perfect tool to correct 

astigmatism. 

RANZCO: Choosing wisely 

The Royal Australian and New Zealand 

College of Ophthalmologists (RANZCO) 

issued five recommendations for its part in 

Choosing Wisely Australia. 

Choosing Wisely is a multi-disciplinary, global 

initiative to identify medical procedures that 

clinicians and consumers should know are of 

proven low value or carry an unnecessary risk, 

and so avoid wasteful or unnecessary medical 

tests and treatments. RANZCO was among 13 

health and medical associations and colleges 

participating in the second Choosing Wisely 

Australia round. 

The recommendations, along with explanations 

and supporting evidence, include: 

1. In the absence of relevant history, symptoms 

and signs “routine” automated visual fields and 

optical coherence tomography are not indicated. 

2. AREDS-based vitamin supplements only have 

a proven benefit for patients with certain 

subtypes of age-related macular degeneration. 

Topcon Triton: 

Swept Source “Deep Range 

Imaging” OCT and latest full 

spectrum OCT-A technology; 

DRI OCT Triton, anterior and 

posterior Swept Source OCT, 

with multi-modal true fundus 

imaging. 

•• 

More confident initial 

diagnosis and ability to track 

change over time 

•• 

Greater clinical efficiency 

•• 

Greater patient comfort 

•• 

Single scan capture of 

comprehensive data 

The Device Technologies 

team—Diego and Campbell— 

provide a complete business 

partnership by discussing 

your needs and helping you 

discover what best suits your 

practice. ▀ 

There is no evidence to prescribe these 

supplements for other retinal conditions, or for 

patients with no retinal disease. 

3. Don't prescribe tamsulosin or other alpha-1 

adrenergic blockers without first asking 

the patient about a history of cataract or 

impending cataract surgery. 

4. Intravitreal injections may be safely performed 

on an outpatient basis. Don't perform routine 

intravitreal injections in a hospital or daysurgery 

setting unless there is a valid clinical 

indication. 

5. In general there is no indication to perform 

prophylactic retinal laser or cryotherapy to 

asymptomatic conditions such as lattice 

degeneration (with or without atrophic holes), 

for which there is no proven benefit. 

For more information, including explanations for 

patients on each of the five recommendations go 

to: https://ranzco.edu/media-and-advocacy/blog/ 

ranzco-choosing-wisely-messages ▀ 

New in cataract surgery 

Two major challenges have troubled 

surgeons and patients since the dawn of 

cataract surgery. The first is how to correct 

presbyopia to improve near vision; the second is 

increasing resolution capacity to allow the patient 

to perceive a distinct image. 

Now, Neuchatel-based company, Swiss Advanced 

Vision (SAV) have launched a new product that 

it says could solve both these issues—the InFo 

Instant Focus intraocular lens. The product is the 

first implant able to correct optical capacity without 

interfering with resolution, instantly, the company 

claims. By applying state-of-the-art optical physics 

to ophthalmology, it allows perfect vision, whatever 

the distance or light conditions, without halos or 

ghost images. 

“We launched IOL InFo Instant Focus at the 

beginning of January 2016,” says Jean-Baptiste 

Marceau SAV sales and marketing manager. 

“Patient and surgeon feedback has all been very 

positive so far. We are currently distributing in 

Europe and looking to expand to the rest of the 

world.” 

It is estimated that 18 million people globally 

will need to replace their natural lens or face the 

prospect of going blind. InFo is the first and only 

replacement solution that offers the acuity of 

a 20-year-old, SAV claims, releasing data which 

shows that four years after surgery 98% of 

patients report completely distinct vision. 

“For patients, it’s life in real time again,” says Max 

Boysset, SAV chief executive. “The brain loves it: 

patients adapt to InFo almost instantly. Our mission 

is to restore their original vision after (cataract) 

surgery through a unique solution, without 

compromise on image quality or resolution.” ▀ 

To restore the gift of sight through vision research. 

Capital Vision are proud to announce the extension of 

our world-first, Wellington Keratoconus Study 

(WELKS) being conducted in secondary schools. This 

Research Project, now extended to the end of 2016, 

will expand its screening programme to the greater 

Wellington Region and beyond, to ensure the most 

accurate and scientific data results. 

As a registered charity, Capital Vision needs your 

support to expand our programme of critical scientific 

research and succeed in our mission “to undertake 

world-class scientific research to develop and enhance 

methods of treating and avoiding blindness”. 

For more information, please feel free to visit our 

website www.capitalvision.nz or you can contact us 

direct at: info@capitalvision.nz. 


with 

Prof Charles McGhee 

& A/Prof Dipika Patel 

Series Editors 

“Engineering the Cornea in vivo” 

BY DR CAROL ANN GREENE 

AND A/PROF. TREVOR SHERWIN 

In the last decade there has been an emphasis on finding 

new therapeutic interventions for tissue engineering and 

regeneration. Although current tissue regeneration technology 

holds considerable promise it is yet to deliver in the clinical 

setting. The introduction of cell reprogramming via the production 

of induced pluripotent stem cells has heralded a new revolution 

and has further fuelled the development of the ultimate tissue 

regeneration treatment. However, before genetically induced cell 

reprogramming based methods can be successfully translated 

from the laboratory to the hospital problems such as the low 

efficiency and safety issues concerning such technology first need 

to be addressed. 

The cornea in particular presents a challenge to tissue engineers. 

This small, transparent tissue is the major refractive element 

of the eye. Corneal damage and diseases are the second largest 

cause of vision loss and affect more than 10 million people 

worldwide. Currently, the most successful treatment for corneal 

blindness is full-thickness replacement of damaged corneal 

tissue with human donor cornea. Apart from drawbacks such 

as complications arising from immune rejection, donor-derived 

infection, and the high cost of pretransplant screening, the major 

problem with this approach is the severe shortage of donor tissue. 

It is increasingly difficult to keep up with the demand for donor 

corneas; therefore new avenues which include the generation 

of artificial corneas and stem cell therapy to regenerate the 

individual layers of the cornea are being explored. Although we 

have seen significant progress in both of these areas, corneal 

transplantation using cadaveric donor corneas has largely 

remained irreplaceable. Keratoconus, an ectatic corneal dystrophy 

affecting approximately 1 in 2,000 individuals worldwide, is one 

of the main indications for corneal grafts carried out in New 

Zealand owing to its particularly high incidence and severity. The 

progressive thinning of the corneal stroma typically occurs over 

decades and results in a conical shaped cornea that then impairs 

vision due to irregular astigmatism and myopia. It has been 

established that the corneal thinning is a result of the loss of corneal 

stromal extracellular components including collagen 1-3 . Currently 

there are no treatments available which address the problem 

of corneal thinning and interventions are mainly focussed on 

Fig 1. A: Cross section of the cornea. B-E: Immunohistochemical labelling of reprogrammed cells and matrix deposition. 

Human keratocytes in culture (B) and in ex vivo corneal culture (C) secrete collagen type II when treated with chondrogenic 

differentiation factors (green labelling; nuclei are stained with DAPI and appear blue). D: human keratoconic corneas treated 

in vitro also express collagen type II (green). E: Rat corneas treated in vivo and later removed for immunohistochemical 

labelling express collagen type II. 

stiffening a weakened cornea or improving the visual acuity rather 

than stopping disease progression. 

The replacement of damaged tissue with engineered tissue has 

been a successful method for the epithelial and endothelial layers 

of the cornea 4, 5 . The corneal stroma, however, has proved to be 

more of a challenge owing to the fact that it comprises about 90% 

of the corneal tissue and has a highly organised microstructure. 

Traditionally, tissue engineering has encompassed in vitro 

techniques that involve the utilisation of cells and extracellular 

matrix scaffolds to produce substitutes that could replace 

wounded or diseased tissues. So far, it has not been possible to 

engineer clinically viable corneas mainly because classical tissue 

engineering methods, based on a scar model, do not support the 

production of a highly organised tissue such as that produced 

during normal stromal development. Current efforts in this field 

are focussed at defining the physiologically relevant in vitro 

microenvironments and using a more developmental approach for 

building stromal tissue. Alongside the progress made in the fields 

of biomaterials and tissue engineering, there has also been some 

progress made towards understanding the effect of different 

microenvironment conditions on cells and their potential to selforganise 

and produce useful proteins in these altered conditions. 

The in situ induction of tissue resident cells can be used to drive 

tissue repair and regeneration; however, such a strategy when 

employed in the cornea would lead to the activation of corneal 

keratocytes into the undesirable wound healing fibroblast 

and myofibroblast phenotypes. Corneal collagen is composed 

of heterotypic fibrils consisting of type I and type V collagen 

molecules. Although it is possible to induce keratocytes to 

secrete these collagens via activation into a fibroblast, such an 

induction would lead to the production of a fibrotic scar rather 

than organised collagen fibrils. Therefore, if such an approach is 

to be utilised it would need to be done in a way that bypasses the 

normal wound healing pathway. It appears, for the corneal stroma 

at least, that traditional tissue engineering methods do not 

currently provide a viable solution. 

In our lab we have taken an in vivo approach to corneal 

regeneration. Corneal keratocytes are extremely difficult to 

culture due to their phenotypic instability and therefore our in 

vivo approach allows us to circumvent difficulties associated 

with the in vitro manipulation of corneal keratocytes. We have 

shown that adult cells in the human body are far more plastic 

than previously thought and that specific cell lineage defining 

Fig 2. Permanent reshaping of the cornea by combining 

in vivo cell reprogramming with a rigid contact lens to 

hold the desired corneal shape during treatment. 

combinations of exogenous factors can direct cells to change 

into required types 6, 7 . Specifically, our research has shown that 

keratocytes are induced to secrete collagen type II, a cartilage 

matrix specific collagen, when treated with chondrogenic 

differentiation factors. We hypothesised that this approach could 

potentially be used as a treatment to increase corneal integrity of 

a cornea weakened by keratoconus, or as a therapeutic approach 

to correct myopia induced vision defects, by inducing keratocytes 

to secrete extracellular matrix components in conjunction with a 

method for reshaping the cornea. 

Initially in our human ex vivo culture experiments using normal 

as well as keratoconic corneas the chondrogenic differentiation 

factors led to the uniform deposition of type II collagen along the 

stromal lamellae. Furthermore, in vivo treatment of corneas in 

rats also resulted in the deposition of type II collagen in a manner 

similar to that seen in ex vivo culture (Figure 1). Collagen type 

II, a fibrillar collagen, is very similar to collagen I in function and 

is thought to be the cartilage analogue of collagen I in other 

tissues. Collagen type II is also expressed during development of 

the chick corneal stroma. It is only later replaced by type I in the 

mature chick stroma 8 . An advantage of inducing the secretion 

of a non-stromal collagen by the keratocytes is that this new 

collagen would be less prone to degradation by native degradative 

enzymes which are known to be upregulated in keratoconus 9 . 

The induction of type II collagen enables development of a novel 

stromal tissue regeneration method without compromising 

corneal integrity or transparency. Data from in vivo rodent and 

ex vivo human studies have both shown that the deposition 

of collagen II can be stopped upon withdrawal of the cell 

differentiation factors and that deposition results in a transparent 

more elastic and stiffer cornea. 

We propose a unique treatment by combining in vivo tissue 

engineering with prescription contact lenses to permanently 

reshape and stabilise the cornea in an effort to demonstrate the 

applicability of taking an in vivo approach to tissue regeneration 

(Figure 2). Our research is now focussed at building upon our 

human corneal tissue experiments and in vivo rodent studies 

to demonstrate therapeutic proof of concept. We aim to 

demonstrate the deposition of corneal tissue matrix and also the 

subsequent reshaping of the cornea in a large animal study in 

partnership with collaborators at Lincoln University. This stage 

of the project includes an ex vivo sheep eye study to confirm 

treatment efficacy and optimum dose, an initial in vivo sheep eye 

test for adverse reactions (if any), and the in vivo proof of concept 

demonstration of our technology’s potential for treatment of 

human ocular disease. 

We believe that our method of in situ modulation of the cells 

of the corneal stroma to affect extracellular matrix deposition 

is a viable approach for stopping the progression of corneal 

thinning and could provide a long term solution for correcting 

corneal ectasia. The development of such a treatment would 

pave the way for the use of biochemical and biological molecules 

that effectively provide signalling to stimulate the self-healing 

potential of the patient’s own cells thereby ushering a new 

frontier in regenerative medicine. ▀ 

References 

1. Chang, C.-Y., et al., Acute wound healing in the human central corneal 

epithelium appears to be independent of limbal stem cell influence. 

Investigative ophthalmology & visual science, 2008. 49(12): p. 5279-5286. 

2. Rabinowitz, Y.S., Keratoconus. Survey of ophthalmology, 1998. 42(4): p. 297- 

319. 

3. Patel, D. and C. McGhee, Understanding keratoconus: what have we learned 

from the New Zealand perspective? Clinical and Experimental Optometry, 

2013. 96(2): p. 183-187. 

4. Pellegrini, G., et al., Long-term restoration of damaged corneal surfaces with 

autologous cultivated corneal epithelium. The Lancet, 1997. 349(9057): p. 

990-993. 

5. Ide, T., et al., Structural characterization of bioengineered human corneal 

endothelial cell sheets fabricated on temperature-responsive culture dishes. 

Biomaterials, 2006. 27(4): p. 607-614. 

6. Greene, C.A., et al., Cells from the adult corneal stroma can be reprogrammed 

to a neuron-like cell using exogenous growth factors. Experimental cell 

research, 2013. 322(1): p. 122-132. 

7. Greene, C.A., C.R. Green, and T. Sherwin, Transdifferentiation of chondrocytes 

into neuron‐like cells induced by neuronal lineage specifying growth 

factors. Cell biology international, 2015. 39(2): p. 185-191. 

8. Linsenmayer, T.F., J.M. Fitch, and D.E. Birk, Heterotypic collagen fibrils and 

stabilizing collagens. Annals of the New York Academy of Sciences, 1990. 

580(1): p. 143-160. 

9. Kenney, M.C. and D.J. Brown, The cascade hypothesis of keratoconus. Contact 

lens and anterior eye, 2003. 26(3): p. 139-146. 

About the author 

* Dr Greene completed her PhD on keratocyte 

multipotency at the Department of 

Ophthalmology in 2014. In October 2015 she 

started a Postdoctoral Fellowship that has 

allowed her to ‘pick up where she left off ’ at 

the end of her PhD and pursue translational 

research. Her mentors at the Department of 

Ophthalmology are Associate Professor Trevor 

Sherwin and Professor Colin Green. The team 

recently received Return on Science funding to 

work on the development of a novel treatment 

for regenerating the corneal stroma. 



17

ANZ Cornea Society report 

Challenges 

One of the things we’re sometimes 

faced with is dealing with challenging 

patients. Some patients simply have 

tricky personalities. They can be combative 

in nature, withdrawn or disinterested with 

a variety of other personality traits that are 

difficult to deal with. Many have already been 

through the mill with a history of seeing a 

variety of optometrists, ophthalmologists, 

dispensers and other medical practitioners. 

They’re often frustrated by having less than 

optimal outcomes. Some are what are known as 

‘doc shoppers’, hoping to have a better resolution 

to their problems by seeking the opinion and 

services of yet another professional. Others are 

referred by specialists or colleagues who hope 

that our particular skill-set and management 

strategies will lead to a better solution. 

In some cases, other practitioners are simply 

trying to get rid of what they regard as an 

impossible patient! 

We will all come across a few of these in our 

professional lifetimes but more often than not, 

careful attention to detail and application of the 

right optical appliances and tools will provide the 

desired outcome. 

Of course there is often a financial aspect with 

some patients having spent thousands of dollars 

and much valuable time, effort and travel in the 

pursuit of happiness. No one likes wasting money 

and some see such things as ‘grudge purchases’. 

When one does, however, solve the problems 

you often end up with a loyal patient for life and 

a great source of referrals for their friends, family 

and colleagues. 

On the other hand, for some practitioners, the 

hurdles seem insurmountable, or they simply 

don’t have the passion, interest or compassion 

necessary for dealing with such cases. 

Secrets of Success 

So what are the secrets to success in such cases? 

To me the cornerstones of dealing with these 

patients are the basic fundamentals of good 

practice. 

Passion and confidence are critical aspects. 

A great chair-side manner also makes all the 

difference. 

Getting the patient onside, in that initial 

encounter, usually smoothes the way to getting 

the job done to everyone’s satisfaction. 

Ideally one would have obtained previous 

records, reports, prescriptions and what 

spectacle and contact lenses have already 

been tried. In most cases there’s no point in 

prescribing the same lens designs and expecting 

to reinvent the wheel and obtain a different 

outcome. Such foresight can help steer you in 

the right direction and avoid repetition. 

Having caring, efficient staff and colleagues 

who have dealt considerately with the patient 

in terms of making contact and booking the 

appropriate appointment also helps us start off 

on the right foot. 

Listen Carefully 

Our first patient contact should involve an 

empathic, careful and detailed history as the 

starting point. Digging deeper and using detective 

skills to draw out unmentioned or undisclosed 

aspects or issues that may affect the outcome and 

solution need to be extracted. In some cases the 

patients will not tell you all the facts—some want 

to almost trick you to see if you can determine 

what these issues are. It may be a previous 

history of LASER Vision Correction or there may be 

medications that are aggravating things. Patients 

often don’t regard some pills as medication: one 

may need to ask “are you taking any pills, drugs, 

medicines, skin treatments or oral contraceptives?” 

which will elicit a very different answer to “are 

you taking any medication?” Looking up the side 

effects then and there (or better still being able to 

roll them off your tongue), helps get the message 

across. Getting patients to take ownership of their 

issues is helpful as opposed to them thinking we 

are magicians that will miraculously make all their 

problems disappear. 

They may waffle on for 20 minutes on the case 

history alone. If so, let them get their story across. 

Too many practitioners cut them off and miss out 

on critical information. One can of course deduce 

that those wanting to complete a whole patient 

exam in a quickie 20 minute consultation, are 

not going to have much chance of getting results 

in these cases. For that reason, people practising 

in such environments are often some of our key 

referrers or at any rate the source of many such 

challenging patients. 

I’ve had a number of such cases of late. The 

occasional interjection or probing question will, 

however, often help focus you and the patient 

on what the issues are, which options are likely 

to work and which one’s are not. A recent case 

involved someone with a history of major 

problems relating to a choroidal melanoma. One 

possible solution was enucleation of the eye. They 

made it abundantly clear that was an option they 

were violently opposed to and was not up for 

discussion. 

Focus 

Letting patients know you’re on their side, have 

their best interests at heart and a strong desire 

to solve their problems is also helpful in winning 

them over. 

Once we have all the basics out of the way, we 

can then direct our diagnostic tests in the area that 

is going to provide us with the fastest way to zero 

in on the problem and potential solutions. This 

may involve topography or OCT on the high-tech 

end, or be as simple as picking up your retinoscope 

or direct ophthalmoscope—these two centuryold 

tools can in an instant diagnose a previously 

missed keratoconus, early PCO or cataract. 

We then collate all our data and in as simple 

terms as possible—ideally with the aid of 

diagrams or Google—demonstrate and explain the 

problem and possible solutions. 

Fortunately we have access to the most fantastic 

spectacle and contact lens technology we’ve ever 

had. Applying the correct occupational lens, prism 

or contact lens—as we’ve discussed in recent 

columns—can often be a quick and easy fix. 

Of course for some of these patients we need 

to do a lot more. We may need to work through 

a myriad of options and trial or fine-tune 

increasingly complex solutions. 

My philosophy is to start with the simplest 

options and slowly work through ever more 

complex alternatives. For example, we may 

start with a soft contact lens and then move 

onto a corneal RGP. When all else fails, we may 

need to look into a scleral contact lens. In turn 

we may need to refer to a colleague with more 

specialised skills than ours or seek appropriate 

referral to an ophthalmologist for a surgical 

solution. It’s all about having the necessary 

skills to make the optimum decisions and seek 

the most appropriate management for the 

particular case we are involved with. 

Don’t let ego be a barrier. 

By applying the above philosophies—over my 

three decades of practice—there are only a few 

cases where I’ve not been able to break down the 

barriers and find a satisfactory outcome. ▀ 

Modern classic from Bon Vivant 

Ogi brand Bon Vivant 

have just announced 

the launch of their new 

eyewear collection. A classic, cateye 

shape given a modern twist, 

the Noelle range offers a trendy 

stainless steel frame in four 

matte, autumnal colours, with 

adjustable nose-pads for comfort. 

Inspired by French glamour but 

with a durable, contemporary 

feel, Noelle is designed to appeal 

to the interlectual and lover of 

haute couture. Ogi is distributed 

in New Zealand by Whakatanebased 

distributor BTP. ▀ 

Delegates at the 33rd Annual Cornea and Eye Bank Meeting in Melbourne 

The 33rd Annual Cornea and Eye Bank Meeting 

was held in Melbourne from 10-11 March. 

Organisers Associate Professor Mark Daniell 

and Dr Jacqueline Beltz reportedly arranged an 

excellent scientific programme, which ran very 

smoothly and was enjoyed by all. 

Professor Massimo Busin from Italy presented 

engaging lectures on corneal transplantation and 

actively took part in discussions. In particular, he 

spoke about his modifications to DMEK surgery, how 

to standardise DALK surgery and how to choose the 

best surgical procedure for patients with corneal 

endothelial failure. 

Professor Kerryn Williams from South Australia 

delivered the Coster lecture. It was excellent to hear 

from Professor Williams just prior to her retirement 

after an amazing career researching and reporting 

on the immunobiology of corneal transplantation 

and her involvement in setting up and continuing 

the Australian Corneal Graft Registry. 

Professor Barry Jones AC gave a wonderful 

lecture entitled Science and Politics, captivating 

the audience with his musings on politics, policy 

and science. In a day when politicians might be 

promoted for loyalty rather than thinking, and 

political processes are often driven by opinion rather 

Snowvision 

sells fast 

Interest in the 11th Snowvision conference being 

held in Queenstown from 3-6 August has been 

phenomenal. 

In true Snowvision style, 75% of the 100 available 

delegate places were taken within the first week of 

registrations opening. 

Organisers Grant Watters, Catherine Small, 

Hamish Caithness and Dave Robinson said the 

conference appeals to those optometrists who 

wish to combine a learning experience with 

pleasure. “It’s great that our event still has 

momentum after establishing it 20 years ago. It is 

a truly special event and provides the perfect blend 

of education, social events and winter outdoor 

activities in the most stunning action-packed 

centre in the country,” they said. 

The conference is being held at the Crowne Plaza 

Hotel. At the time of going to print there were 10 

places available. 

Industry support is always a key feature of 

Snowvision and greatly appreciated. Sponsors 

include, Ophthalmic Instrument Company (OIC) for 

loaning and setting up all the equipment for the 

workshops; Hoya for the opening cocktail function; 

Corneal Lens Corporation for the BBQ lunch at 

Coronet Peak; Independent Lens Specialists for 

the golf at The Hills; and CR Surfacing for the Go- 

Karting championship 

To view the programme and to register go to 

www.registerhere.co.nz. ▀ 

than evidence, many were left wondering how we 

might be able to encourage more politicians who 

believe in evidence-based policy. 

Other speakers included Dr Enrique Graue 

Hernandez from Mexico who spoke about 

combined treatments for keratoconus; Professor 

Charles McGhee who outlined what we can learn 

from corneal transplantation in New Zealand; 

and Professor Stephanie Watson from New South 

Wales, who brought us all up to date with stem cell 

therapies for corneal disease. 

A video competition was run in which presenters 

had five minutes to present a video related to eye 

banking or corneal surgery. The presenters provided 

live commentary and the session was engaging and 

fun. Dr Simone Beheregaray from Brazil, currently 

working as a corneal fellow in Sydney, won the 

competition with her video entitled Artificial Iris. 

Overall, the Cornea Society and Eye Bank Meeting 

was well attended and included content that was 

informative and of high quality. Participants are 

looking forward to the 34th Meeting in Brisbane 

next year on 4 February, just prior to the ASIA-ARVO 

meeting, also in Brisbane. ▀ 

Edited from an original article supplied by the ANZ 

Cornea Society 

Hywel Bowen 

retires 

Hywel Bowen is 

retiring after 43 

years. He has had 

a long and distinguished 

career as an optometrist, and a long association 

with Thames, where he owned and operated a 

practice for 23 years before joining the Paterson 

Burn Thames practice six years ago. He lectured 

at the optometry school for 20 years and has 

been an examiner for five years. He was also on 

the NZAO Council, was NZAO Waikato Branch 

chair, and he’s undertaken more than 60 trips as 

a VOSO volunteer. Paterson Burn held a farewell 

function for Bowen in April to celebrate his 

retirement, his contribution to optometry and to 

wish him well. ▀ 

How’s your 

Macula? 

This year Macular Degeneration Awareness 

Week runs from the 23-29 May and will 

ask the public, “How’s your Macula?” to 

encourage people to test their vision with a 

simple test. 

The Amsler grid test gives Kiwi’s an indication 

of whether they need to seek specialist help, as 

caught early the disease can be slowed and even 

halted, but vision lost cannot be restored. 

“Time lost is vision lost. Research shows 50% 

of people with wet macular degeneration will 

lose vision within three months,” said Dr Dianne 

Sharp, MDNZ chair. “Early recognition is essential 

now that treatment options are available.” 

MDNZ will be distributing materials to 

optometrists at the start of the month, 

including posters and Amsler grids to help 

raise awareness among their patients to 

encourage regular eye tests. 

For more information, visit www.MDNZ.org.nz. ▀ 


Focus on 

Eye Research 

Age Related Macular Degeneration 

REVIEWED BY NADEEM AHMAD* 

COMPARISON OF RETINAL PIGMENT EPITHELIUM- 

CHOROID GRAFT SURGERY AND ANTI-VEGF THERAPY 

IN PATIENTS WITH WET AMD 

van Zeeburg EJT, Cereda MG, Amarakoon S, van 

Meurs JC 

OPHTHALMOLOGICA 2015;233:134-45 

Review 

The purpose of this study was to investigate whether 

patients with exudative age-related macular 

degeneration and a sub-macular hemorrhage, retinal 

pigment epithelium (RPE) tear or non-responders to 

anti-vascular endothelial growth factor (VEGF) benefit 

more from a free RPE-choroid graft transplantation 

surgery than from (continuation of) anti-VEGF 

treatment. 

A total of 20 patients were included in this 

prospective, international, multicenter, randomised 

intervention study. Patients were randomised into 

6 groups based on the presenting abnormality (sub 

macular hemorrhage, RPE tear, or non response to 

Anti VEGF) and the intervention (surgery vs anti VEGF 

therapy). 

The change in the mean number of Early Treatment 

of Diabetic Retinopathy Study (ETDRS) letters in the 

graft group 1 year postoperatively was -15 (range 

-54 to +26), whilst 2 patients experienced a gain of 

>10 letters. The median preoperative visual acuity 

(VA) was 0.75 logMAR (range 0.46-2.8), and the mean 

postoperative VA was 1.48 logMAR (range 0.14-2.8). 

The change in the mean number of ETDRS letters 

in the anti-VEGF group was -8 (range -26 to +6); no 

patients experienced a >10 letter gain. The median 

preoperative VA was 1.36 logMAR (range 0.58-1.6), and 

the median postoperative VA was 1.42 logMAR (range 

0.44-1.66). 

The authors concluded that the included patient 

group was far too small to draw conclusions. However, 

both gain and loss of VA may be experienced by 

patients undergoing either treatment method; more 

gain might be possible for patients with a graft in the 

absence of complications. 

Comment 

This study looks at a particular sub group of patients 

that traditionally carry a poor prognosis for vision. 

Continuation of anti VEGF therapy has limited 

benefit in this group, and this was also confirmed in 

this small study. The use of RPE-choroid graft shows 

promising results with >10 letter gain seen in 2 

patients. However the surgical group was also likely 

to lose more vision when unsuccessful, and major 

complications (recurrent retinal detachment with 

proliferative vitreoretinopathy, severe hypotony etc) 

were also only seen in the surgical group. Refinements 

in tissue culture techniques and the improvement in 

controlling proliferative vitreoretinopathy may help 

improve outcomes in future. 

A COMPARISON OF SAME SETTING VERSUS DELAYED 

VITRECTOMY IN THE MANAGEMENT OF RETAINED 

LENS FRAGMENTS AFTER CATARACT SURGERY 

Orlin A, Parlitsis G, Chiu Y, et al. 

RETINA 2014;34:1969-76 

Review 

This retrospective non-randomised study looked at the 

outcomes of vitrectomy for retained lens fragments 

from cataract surgery complicated by capsular rupture 

based on the timing of intervention (early or same 

setting, vs delayed). 

The authors reviewed outcomes for all patients 

undergoing pars plana vitrectomy for retained lens 

fragments after cataract surgery from 2007 to 2012 in 

their centre. Outcomes included visual acuity and the 

development of various complications such as retinal 

detachment, elevated intraocular pressure >30 mmHg, 

and cystoid macular edema. Multivariate analysis 

was performed to adjust for potentially confounding 

variables such as age and preoperative visual acuity. 

Twenty-eight consecutive eyes (13 same setting, 

15 delayed setting) were included in the analysis. 

Patients in the same setting group were older than in 

the delayed group (81.00 vs. 72.87 years, P = 0.053). 

No other preoperative differences existed between 

the groups (axial length, preoperative vision, and 

intraocular pressure). The mean time to pars plana 

vitrectomy in the delayed group was 26.6 days (range, 

1–91 days). 

No significant differences existed in mean vision 

between the same setting (logMAR, 0.42) and the 

delayed group (logMAR, 0.57) (P = 0.132). Multivariate 

analysis showed no difference in final vision when 

adjusting for age and preoperative vision. Although 

there was a trend for eyes in the same setting group 

to obtain good vision (≥20/40) faster, a higher 

percentage of eyes in the delayed group obtained 

better vision at the most recent follow-up (66.7 vs. 

23.1%, P = 0.02). More eyes in the delayed group had 

an intraocular pressure >30 at any point (P = 0.055). 

There was no significant difference between the 

groups in any other complications such as retinal 

detachment, choroidal detachment, and cystoid 

macular edema during the follow-up. 

Based on their findings, the authors concluded 

that same setting pars plana vitrectomy offers no 

significant visual acuity advantage over delayed 

pars plana vitrectomy in patients with retained lens 

fragments. 

Comment 

The timing of intervention following dropped lens 

fragments from a complicated cataract operation is 

an important discussion point. Several meta-analyses 

have looked previously at this question, and there is 

no consensus on the best approach given the number 

of confounding factors (e.g. immediate management 

of the complication by the operating surgeon, 

control of intraocular pressure and inflammation 

etc). An early vitrectomy, especially a same setting 

procedure done as an extended operation following 

the complication, is possible only when vitreoretinal 

expertise is available at hand. This is only possible in 

a tertiary care unit as peripheral/smaller units either 

do not have a vitreoretinal surgeon, or the vitrectomy 

equipment may not be available. This study therefore 

helps in evaluating if a delay in the second procedure 

is detrimental for the patient. Given that this is a 

relatively rare complication, the study is limited by 

the small number of patients included. The results 

however are reassuring for surgeons and patients alike 

in the peripheral units that the visual outcomes will 

not be adversely affected if the secondary procedure 

is not done during the same setting. These patients 

however should be referred promptly for assessment 

in a vitreoretinal unit. 

25-GAUGE PARS PLANA VITRECTOMY FOR RETAINED 

LENS FRAGMENTS IN COMPLICATED CATARACT 

SURGERY 

Scupola A, Abed E, Sammarco MG, et al. 

OPHTHALMOLOGICA 2015;234:101-8 

Review 

This study was conducted to verify the efficacy 

of 25-gauge pars plana vitrectomy (PPV) for the 

management of posteriorly dislocated lens material 

after complicated cataract extraction, and to determine 

in which patients this would be the optimal approach. 

Forty eyes of 40 patients with retained lens 

fragments undergoing early (within 1 week) or late 

(within >1 week) 25-gauge PPV were retrospectively 

reviewed. The amount of dislocated nuclear material 

was graded by the surgeon intraoperatively, and the 

patients were divided into two groups accordingly: 

group A (≤50% dropped nucleus) and group B (>50% 

dropped nucleus). The presence of brunescent 

nuclear pieces was noted. 

The outcomes measured included bestcorrected 

visual acuity (BCVA) and postoperative 

complications such as retinal detachment, cystoid 

macular edema (CME) and postoperative ocular 

hypertension or hypotoy. 

A significant positive correlation was found between 

nuclear material grade and PPV duration (R2 = 0.81, 

p < 0.0001). None of the patients had brunescent 

nuclear pieces. There were no cases of ocular 

hypotony. Retinal detachment developed in 4 patients 

(10%), occurring only in patients of group B (p < 0.002). 

Four patients with late PPV developed postoperative 

CME, with no case of CME among patients with early 

vitrectomy (p = 0.014). 

The author concluded that removal of dislocated 

lens fragments after complicated cataract surgery can 

be effectively managed with 25-gauge PPV, although 

it appears to be most efficient for cases with a limited 

amount of dislocated lens material. In consideration 

of the higher rate of retinal detachment observed in 

cases of prolonged PPV time, the expected duration 

of surgery should be taken into account when 

choosing the best surgical approach. Visual outcomes 

were not affected by the timing of PPV, whereas 

early vitrectomy seemed to prevent the onset of 

inflammatory macular edema. 

Comment 

The introduction of small gauge instruments in 

vitreoretinal surgery has seen a significant evolution 

of surgical techniques, with an ever increasing list of 

indications. Initially used for technically easier ‘routine’ 

cases, the improvement in instrument designs, 

cutting rates and aspiration pressures, and availability 

of a variety of instruments means that more 

complex cases are now performed with small gauge 

instruments. The study looks at the use of 25G cutter 

in removing retained lens fragments and supports 

the view that softer/limited lens material can be 

safely dealt with 25G vitrectomy. For larger/harder 

fragments, use of a phacofragmotome is required 

– this instrument is not yet available in a small 

(sub 20) gauge, and these patients will require an 

additional larger port for inserting this instrument. 

The study is however limited by the subjective 

assessment of retained nuclear size, unavailability 

of pre-operative cataract grading, and a lack of 

comparison with larger gauge instruments. ▀ 

* Dr Nadeem Ahmad is a consultant 

ophthalmologist working for both 

the ADHB and CMDHB, with private 

sessions at the Milford Eye clinic. He 

specialises in management of medical 

and surgical retinal conditions, as well 

as cataract surgery. He completed his 

ophthalmology training in the UK, 

with further fellowships in Sheffield, 

Southampton, and Moorfields Eye 

Hospital, London. He has worked as an 

ophthalmic consultant since 2008. 

MORE CLASSIFIEDS PAGE 20 

CLINICAL OPTOMETRIST REQUIRED- 

BRISBANE, AUSTRALIA 

Do you want to work in a vibrant, independent optometry practice, 

with flexible working hours? Somewhere your clinical skills are 

highly valued and you’ll be able to use your therapeutics? Eyecare 

Plus at Alexandra Hills in Queensland, Australia is seeking a full 

time optometrist. The position is suitable for a caring, enthusiastic 

person with good communication skills, who is passionate about 

providing a high standard of care and is eager to learn new skills. 

We have been established for over 27 years and are Brisbane’s 

only Colour Blind Sight Centre. There is no Sunday work and an 

excellent salary is offered, with a wage range between $80,000 to 

$150,000 per year, commensurate with experience. 

To apply call Aphrodite Livanes on 0407 585 952 or email 

apli2@bigpond.com 

EQUIPMENT FOR SALE 

Topcon IS700 Chair and Stand, Magnon SL350 Slit Lamp, Reichart 

Keratometer, Righton NP36 Projector. All in good condition. 

Contact c/- info@nzoptics.co.nz, Code: EQFS12 

PART-TIME DISPENSER / OPTICAL 

ASSISTANT, AUCKLAND 

I am looking for a part-time Dispenser/Optical assistant to fill a 

weekdays only position at my premises in Auckland. 

Please email your CV and contact details to Donald Klaassen at 

eyeweardirect@xtra.co.nz. 

PART-TIME DISPENSING OPTICIAN / 

OPTICAL ASSISTANT, TAKAPUNA 

We are looking for a dispensing optician/optical assistant to 

join our independent, high-end optometry practice in Takapuna, 

by the beach. The position is for 50-60 hours per fortnight – 

including alternate Saturdays and Mondays. 

The successful applicant will: 

- Be a qualified Dispensing Optician or Optical Assistant with 

dispensing experience. 

- Display exceptional customer service and sales skills. 

- Have a passion for fashion eyewear and leading edge lens 

technology. 

- Have some social media skills – e.g. Facebook, online customer 

communications. 

- Have flexibility to provide leave cover for our full-time 

Dispensing Optician. 

- Be a good team player. 

If this sounds like you, please email your CV to 

david@haydons.co.nz 

OPTOMETRIST 

WITH PARTNERSHIP OPPORTUNITY AT LEADING 

DUNEDIN INDEPENDENT 

Stewart Caithness Gray Optometrists is a well established 

independent practice in the city of Dunedin with branches in 

Mosgiel and Gore. We provide a high level of professional care 

and service to our patients and are looking for an experienced 

optometrist to join our team. The position is full time, although 

part time may be considered and there is a partnership 

opportunity for the successful applicant. 

We have a wide range of patients of all ages and therefore, 

communication and interpersonal skills must be excellent. You 

need to have a passion for independent optometry and ideally 

an interest in fitting speciality contact lenses. You should be TPA 

endorsed and have at least 2-4 years experience. Salary will be 

reflective on your experience. 

We have a fantastic support team and diagnostic equipment 

includes OCT, corneal topographer, fundus and slit-lamp cameras 

and both Matrix and Medmont VFA’s. 

We pride ourselves in providing excellence in eye care, eyewear 

and service and are excited to be able to offer this opportunity to 

join our great team. 

Please email Brian Stewart brian@scgeyes.nz for further details. 

CLASSIFIED ADVERTISING 

Looking for staff or a new position? Want to buy or 

sell some equipment? Place a classified! 

Email editor@nzoptics.co.nz or use the form online at 

www.nzoptics.co.nz 



19

MORE CLASSIFIEDS INSIDE 

ON pAgE 19 

Need a locum? 

Call Bharat Raniga, locum optometrist, on 

021 424 253 or email: bharatranlga@yahoo.com 

SPECIALIST SHOPFITTERS & dESIgnERS TO THE OPTOMETRIC PROFESSIOn 

TEL:(09) 486-2070 MOB:(0274) 798-798 

Email: tony.maddocks@xtra.co.nz 

oPtoMetriSt PoSition, 

PatterSon Burn thaMeS 

Paterson Burn Optometrists is one of the largest independent 

optometry practice groups in New Zealand. We have eight 

practices, are totally independent and Waikato owned, and 

have maintained our independence in the ever changing 

environment of New Zealand optometry. Our core purpose is 

to improve people's lives by providing the best visual solutions 

available. Paterson Burn Optometrists value respect, integrity, 

accountability, enjoyment, continuous improvement, freedom for 

initiative and teamwork. 

We are currently looking for a passionate Optometrist to join our 

team in Thames. 

Working with Paterson Burn Optometrists will offer you the 

ability to develop your clinical skills to its full potential and the 

opportunity to specialise in your desired field. You will have 

the ability to work independently and, with fourteen other 

optometrists in the group, you will be part of a larger group of 

highly qualified, experienced and dedicated optometrists. Our 

Optometrists have special interests in Low Vision, Children's 

Vision, Ortho K, Specialised contact lens fits, Dry eye and Irlen 

lenses. You will also have the opportunity to meet regularly for 

peer review sessions while gaining CE points within our practice 

As an Optometrist working with Paterson Burn Optometrists you 

will be able to provide exceptional patient care with access to the 

most up to date technology and state of the art equipment. (OCT, 

Corneal Topographer, Medmont VFA's, IPL etc. ) 

The successful applicants must be available to work full-time and 

some Saturdays. 

If this sounds like you, please send your CV with a covering letter 

to: sandri@patersonburn.co.nz 

Applications close 5pm Monday 30st of May 2016 

Practice for Sale 

Get double-digit earnings without the sweat and toil of a CBD 

location. Enjoy the superior work-life balance of the countryside, 

while still within an easy drive of civilisation in downtown 

Auckland. Ideally suited to an optometrist breaking out on their 

own, or breaking back into the business after maternity leave or 

OE, or a dispenser-optometrist team. Yes, double-digit earnings, 

and potential for even more growth. If this sounds like something 

you’d like to pursue, please apply in strictest confidence c/- NZ 

Optics, info@nzoptics.co.nz Code PFSS1. 

equiPMent for Sale 

Zeiss Visucam Pro Retinal Camera, Topcon IS-80 Chair and Stand, 

Topcon SL3F slit lamp, Topcon OM-4 Keratometer, Nidek CR690 

Projector Chart (with screen and mirror), Trial Lens kit ,GFC Frame 

heater. 

All offers considered. Contact michael@eyestyle.co.nz 

diSPenSing oPtician/oPtical 

aSSiStant, Wellington 

Total Eyecare is an independent optometry group with practices in 

Lower Hutt, Johnsonville and Wellington CBD. 

Our Wellington practice, Designed for Vision, needs a dispensing 

optician/optical assistant. 

This is at times a sole charge position working with a number of 

part-time optometrists, so you’ll need to be able to work with 

minimal supervision and cover all the admin duties as well. 

If you - 

- Are confident and a self-starter 

- Have a real flair for sales and fashion 

- Show exceptional customer service skills 

- Have experience in optical dispensing or as an optical assistant 

- Have a basic grounding in accounts and admin 

- Are reliable and versatile 

- Can use a data base to help promote future sales opportunities, 

then this could be a great opportunity to put your own stamp on 

a position. 

This is a full-time placement, Monday to Friday. 

Please email a cover letter and CV to jane@totaleyecare.co.nz 

20 NEW ZEALAND OPTICS May 2016 

May 2016 classified 3 

NEW ZEALAND 

1

May 2016

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