Nov 2015

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
November 2015

THE FIRST TRIFOCAL DIFFRACTIVE IOL
Far
Intermediate
Near
For more information contact your Bausch & Lomb Territory Manager
or our Customer Services on 0508 375 394
© 2013 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Other product names /brand names are trademarks of their respective owners.
Bausch & Lomb (NZ) Ltd c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT.
2 NEW ZEALAND OPTICS November 2015

Insight Hamilton’s interior
exudes confidence with colour
Dispensing optician Isobel Martinez and
optometrist Wan Syian Yong go way
back, to their days at MySight Vision
Specialists Group.
Yong and Martinez re-established their
professional association last December when
Yong opened her second practice, Insight Eyecare
Hamilton at Te Awa Mall. Yong asked Martinez to
head up the new practice, while she continued
work at Flagstaff Eye Care on River Road.
“When Wan Syian first approached me to see
if I was interested in setting up and managing a
new practice, I said ok, but it has to be different to
anything else we have seen before and seeing as
we are going to be in a mall, we have to appear to
be a bit more retail driven.”
Yong gave Martinez a blank slate, and this trust
led ultimately to recognition in the Resene Total
Colour Awards 2015. Insight Eyecare and the
architects, Ignite Architects, who realised Martinez’s
vision, took the Colour Commercial Interior Retail
and Public Colour Maestro Award, leading to
coverage in several consumer magazines.
“I was given free rein on design, stock and feel,”
“I was given free rein on design, stock and feel, quite the opportunity,” says Isobel Martinez (seated), who joined
Insight soon after its December 2014 opening
says Martinez. “It was quite the opportunity. I
really felt that the fashion side of optics has been
missing now for some time, and I started to put
together a unique collection strongly representing
our NZ designers.”
Insight’s domestic brands include Karen Walker,
Kate Sylvester, Age and Andrea Moore, which
Martinez says are not otherwise available in its
vicinity. Overseas brands include Paul Taylor, Salt,
Moscot and Pared.
As for as the look and feel of the practice,
Martinez had specific ideas in mind.
“I was very clear with Nicole Hamer-Nel (interior
designer at Ignite) that I really didn’t want
another ‘white practice’. I asked her to look at
Rodd & Gunn in Newmarket. I liked the wood/
industrial feel. I mentioned old chemist and
library looks and that I wanted a dispensing bar
rather than individual tables.”
The architects came through, evidenced by the
recognition of winning Resene’s Australia-New
Zealand-wide competition and the comments
of the judges: “strong colour works well with
the strength of the timber for a clinical yet
comfortable and relaxing feel. The confidence of
the colour and materials palette brings with it a
sense of reassurance and trust, with the dark and
light combination providing a balance….The timber
provides a raw sense of honesty. Solid colour blocks
are used with restraint drawing your eyes into the
product showcases.”
Insight Eyecare’s interior will be featured in
upcoming issues of Urbis magazine and
Fashion Quarterly.
The endorsement, to say nothing of the
forthcoming publicity, highlight a strong first year
for the new practice.
Martinez says the practice provides a mix of
eyewear ranges, but she describes the underlying
style motif as “retro.” Customers also range in kind
and geography, with some clients coming from as
far away as Wellington, she adds. ▀
What’s inside
EDITORIAL BY SIMON ESKOW
Is it my imagination or is everyone in vision
health in New Zealand really nice? I know,
people are people, but my first big industry
event, the annual ADONZ conference, allowed
me to meet so many open, friendly and
enthusiastic dispensing opticians, it was almost
overwhelming. You people really know how to
party, at least when it’s a chance to dress up
in 1920s garb. You can read about the ADONZ
annual conference on pages 10-14, with a bit
more to come in the December issue.
While publisher Lesley Springall and I were
busy in Hamilton, our editor-at-large, Maryanne
Dransfield tackled Silmo, and going by her account
on page 8, Paris was burning with innovation.
In this issue, you’ll also read about myopia, a
new textbook on ocular prosthetics, and much
more. I’d also like to mention Eye Institute’s first
ever dispensing opticians and support staff oneday
conference on November 8 in Auckland.
Details inside. ▀
Resene Total Colour Award judges remarked Insight’s
“strong colour works well with the strength of the
timber, for a clinical yet comfortable and relaxing feel.”
An innovative low vision offer for Eye Care Professionals.
More and more people are suffering from low vision as a result of
age-related macular degeneration, diabetic retinopathy, glaucoma,
cataracts and many other conditions.
HumanWare introduce the first one-stop shopping offer to support
Eye Care Professionals wanting to serve this growing segment of the
population. Our offer comprises key aids that will help you address a
vast array of needs including both optical and electronic devices.
More than offering products, our commitment is to offer Eye Care
Professionals the Solutions that will help them grow and develop their
expertise in Low Vision. For more information on how to offer Low
Vision solutions to your patients contact your local HumanWare
Account Manager.
NEW ZEALAND
0508 22 55 734
nz.ecp@vahumanware.co.nz
AUSTRALIA
(02) 9686 2600
au.ecp@humanware.com
November 2015
NEW ZEALAND OPTICS
3

Auckland’s Myopia Lab to
shed more light on “epidemic”
BY SIMON ESKOW
A
research paper published in the Journal
of the American Medical Association in
September riwppled through the global
mainstream media.
Headlines shouted the salubrious effect on the
prevalence of myopia among school children who
spent 40 minutes outside each day for three years.
This observational study included 952 children in
an intervention group from six schools, and 951
in a control group from another six schools in
Guangzhou, China.
“There were some studies suggesting the
protective effect of outdoor time in the
development of myopia, but most of this evidence
is from cross-sectional studies (survey) data that
suggest ‘association’ instead of causality,” lead
Myopia rates are soaring around the world, but especially in east Asia
author Dr Mingguang He of Sun Yat-sen University
told Reuters. “Our study, as a randomised trial, is
able to prove causality and also provide a high level
of evidence to inform public policy.”
According to the study the cumulative
incidence rate of myopia was 30.4 per cent in the
intervention group and 39.5 per cent in the control
group. There was also a significant difference in
the three-year change in spherical equivalent
refraction for the intervention group (−1.42D)
compared with the control group (−1.59D), though
the elongation of axial length was not significantly
different between the intervention group (0.95
mm) and the control group (0.98mm).
The story ended there as far as the popular press
was concerned: more time outside equals less
nearsightedness. But it is really only the beginning
for ocular research into a common condition that
has been rapidly getting worse in the last 60 years.
While it has been observed for more than 400
years, the mechanics of myopia still need to be
investigated, to say nothing of the many factors
that seem to play a part in its development: light
exposure, genetic disposition, near-work, and more
recently, electronic displays, and the time of day we
use them, say other researchers.
“I think people were distracted for many years
by the apparent influence of near work and we
tended to not think of light as one of the potential
factors,” says John Phillips, principal investigator at
the University of Auckland’s Myopia Lab. “I think
probably the first occurrences of myopia were in
people who did a lot of reading. The near work
hasn’t been excluded as a cause, it’s just that
myopia is much more multifactorial.”
The rate of myopia appears to have increased
steeply since about the mid-20th Century.
According to an article in Nature last March, 90
per cent of teenagers and young adults in China
are short-sighted, compared to a range of 10 to 20
per cent sixty years ago. Myopia also affects half of
all young adults in Europe and the US, double the
rate in the mid-1960s.
“It’s good to do studies in schools reassigning
light level empirically, but if we are to advance
properly we need to understand why light affects
myopia development and that’s where the
university research comes in,” says Phillips. “Our
overall aim is to understand the mechanisms of
myopia development and ultimately to control it”.
Phillips says an important step in understanding
myopia development is to conduct a meta-analysis
of several studies of light and myopia in schools,
when there are enough well-structured published
studies to analyse, which still isn’t the case at this
point. The Guangzhou study gives researchers a
good starting point.
“There seems to be something about schooling
in its current form which is myopiagenic,” Phillips
says, and we need to understand what it is about
that environment that is causing children to be
myopic. That might extend to children doing
home-work in the evening under electric light or
with a computer.”
Where to look next
The field is still wide open, and the Auckland lab
is investigating different factors that play a part
in myopia development through clinical and labbased
research projects.
“We’re doing a number of other experiments
relating to light which we think are relevant,”
Phillips says. “One investigated the effect of extra
light presented at different times of the day;
another is looking at the effects of light level on
the blood supply to the back of the eye.
“We think this change in choroidal thickness
is a potential early signal of myopia, and we can
experimentally alter the choroid to make it thinner
or thicker using lenses. So, what we’re now doing
is seeing whether the light level itself can alter the
choroid. If bright light makes the choroid thicker,
and dim light makes it thinner, we can measure
this change over time, and we’re developing this
as a technique for assessing how myopiagenic a
particular stimulus is.”
The Myopia Lab is looking at applying this
method for laboratory experiments in both near
work and light level studies.
Another aspect under exploration is the impact of
atropine eye drops on slowing myopia progression.
A PhD student of Phillips’, Samuel Chiang, presented
a paper to the International Myopia Conference
in China in September investigating the effects
of atropine on the choroidal response to impose
hyperopic retinal defocus.
In the study, which has yet to be peer-reviewed,
Chiang took ten East Asian subjects (five males
and five females) with myopia -1.00 to -5.00D,
age 18 to 24 years. The subjects viewed a video
at 6 meters for 60 minutes on two successive
days, while researchers took swept source OCT
images in both eyes every 20 minutes to monitor
subfoveal and parafoveal choroidal thickness.
The control (dominant) eye was optimally
corrected for distance with a contact lens while
the experimental (non-dominant) eye wore a
“The role that screens play is complex. It has
something to do with exposure, and when
screens get used during the day. If they get
used at night, they could be a culprit in
myopia development,” says Phillips.
contact lens imposing 2.00D of hyperopic retinal
defocus. On the second day, the same procedure
was repeated, but the experimental eye had been
treated with one drop of 0.5 per cent atropine 24
hours earlier.
The result was that the normal thinning of the
human choroid in response to imposed hyperopic
defocus was abolished by use of atropine, which
may either act directly on the choroid to inhibit
thinning, inhibit the generation, transmission or
reception of a signal in response to hyperopic retinal
defocus, which normally causes choroidal thinning.
The Myopia Lab is also preparing for an
observational study of light levels in schools. For
now, they plan to measure light levels in different
schools to obtain preliminary data for measuring
a relationship between the distribution of light in
a classroom (ie. children near windows have more
light than those further away) to see whether that
plays a role in myopia development.
Circadian rhythm
Phillips says another angle to explore is the recent
uptake of digital devices, particularly when used
at night. While the huge increase in myopia
began well before the dawn of smartphones,
tablets and PCs, there is already research building
on the connection between screen use and
disruption of the circadian rhythm, which in turn
impacts eye growth.
“The role that screens play is complex. It has
something to do with exposure and when screens
get used during the day. If they get used at night,
they could be a culprit in myopia development.”
Eye growth accelerates and slows according to a
day-night cycle, that is, when electricity isn’t a factor.
“Once you introduce electric light or lightemitting
screens and start using that during the
evening you upset the circadian rhythm of eye
growth. The possibility is you’ll be making the eye
grow for a longer period,” Phillips says, and this can
lead to myopia development.
Another study published in January gave credence
to the role of screens late at night disrupting
circadian cycles. In the study, evening use of
light-emitting eReaders negatively affects sleep,
circadian timing and next-morning alertness. A
team of Harvard researchers led by Anne-Marie
Chang found that “compared with reading a
printed book in reflected light, reading a lightemitting
(LE) eBook in the hours before bedtime
decreased subjective sleepiness, decreased EEG
delta/theta activity and suppressed the late
evening rise of pineal melatonin secretion during
the time that the book was being read.
“We also found that, compared with reading a
printed book, reading an LE-eBook in the hours
before bedtime lengthened sleep latency; delayed
the phase of the endogenous circadian pacemaker
that drives the timing of daily rhythms of melatonin
secretion, sleep propensity and REM sleep
propensity; and impaired morning alertness.”
The study only involved 12 subjects, however, so
more data, and more studies are necessary. ▀
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 Simon Eskow, editor, at 027 288 5401 or editor@nzoptics.co.nz.
For advertising, marketing, the OIG and everything else, please contact Lesley Springall, publisher, at
027 445 3543 or lesley@nzoptics.co.nz.
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 Limited. 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 optical 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 November 2015

CALLING ALL
UK OPTOMS!
…WANT TO STAY IN
NEW ZEALAND OR AUSTRALIA?
Go to
spectrum-blog.com
for all the current
opportunities!
With a significant shortage of optometrists being
experienced across the optometry profession
in metro, regional and rural areas, we’re calling
all UK and Irish optometrists currently in
New Zealand and Australia to talk to us. We have a
wide range of opportunities for you to consider.
Across the two countries this year we will open
15 new stores and expand a further 65 stores
with additional consulting rooms and the latest
automated equipment – and we need to beef up
our professional team to meet demand, as it rises.
About you
You’re an OCANZ qualified optometrist and already
working (or due to work) for the length of your
current working visa – but you would like to stay
on for longer, or even permanently.
We can help
If that sounds like you, we should talk.
Lately, more and more OCANZ qualified UK
and Irish optometrists are asking us about
staying in either New Zealand or Australia
for the longer term and we have the
roles available to make that goal a reality
in both countries.
Let’s get the conversation started
Whatever your goal, both short and longer
term, now’s the time to talk to our professional
recruitment team members about the options for
employed and partnership roles – they’re ready to
talk to you right now.
In the first instance contact Raj Sundarjee on
0800 773 077 or raj.sundarjee@specsavers.com
NZ Franchise
System of
the Year
2014
Retail
Innovator
of the Year
2014
Multichannel
Retailer
of the Year
2014
Roy Morgan
Research
No. 1 for eye tests
2014
FCA International
Franchisor
of the Year
2014
FCA Social
Responsibility
Award
2014
FCA Established
Franchisor
of the Year
2013
FCA Excellence
in Marketing
Award Winner
2013
Australian
Retailer
of the Year
2013
Australian
Retail Employer
of the Year
2013
Asia-Pacific Best
Retail Training
Organisation
2013
November 2015
NEW ZEALAND OPTICS
5

News
in brief
DITA GROWS PORTFOLIO
California-based eyewear company DITA Group has acquired
luxury brand Christian Roth. Co-founders Christian Roth and Eric
Domege will remain as creative directors. Christian Roth’s first
post-acquisition collection will be presented at Silmo 2016. DITA’s
brand portfolio includes the licenses for Thom Browne and Dita
Von Teese eyewear, as well as its house-brand lines. Christian Roth
ended its 12-year licensing deal with Charmant in 2010 and retook
control of its trademarks. In 2011, Christian Roth granted Koreanbased
firm BCD Korea the right to produce and distribute its eyewear
throughout Asia.
B+L TACKLES SEVERE OCULAR CONDITIONS
Bausch + Lomb is launching a new division, Bausch + Lomb Advanced
Vision Products, following the merger of its Boston office with
Paragon Vision Science, which it acquired early this year. Advanced
Vision Products will be dedicated to addressing severe ocular
conditions including myopia, irregular corneas, ocular surface
diseases and other visual challenges with custom contact lenses and
other approaches. The work will include ortho-k and scleral lenses,
customised soft lens and lens care categories, training in scleral lens
and ortho-k fitting, development of diagnostic fitting and dispensing
systems and lens care products.
INFECTION LINKED TO GLAUCOMA
A study recently published in Investigative Ophthalmology and
Visual Science shows a significant association between Helicobacter
pylori infection and glaucoma. The meta-analysis of 10 studies
covering 695 glaucoma patients and 1,580 control participants
showed that H. pylori infection was associated with both normal
tension glaucoma and primary open-angle glaucoma, but not
pseudoexfoliation glaucoma.
AUCKLAND FELLOW TO STUDY KERATOCYTE MULTIPOTENCY
Dr Carol Greene is returned to Auckland University’s Department of
Ophthalmology as a research fellow to build on her doctoral research
into keratocyte multipotency. Greene hopes to develop tissue
engineering technology, with initial proof of concept studies in a
large animal model, as a treatment for keratoconus.
FLINDERS DEVELOPING VISION TEST
Flinders University’s year-old Flinders Vision Clinic is expanding
trials of the Flinders Glare test, intended to measure both contrast
sensitivity and glare. In contrast to the usual high-contrast black
letters on a white background method, the Flinders Glare Test uses
“fading” letters—from solid black letters to barely visible gray—and
illumination, to detect early signs of cataract development.
SCLERAL LENS POTENTIAL
A survey from the Gas Permeable Lens Institute in the US indicates
scleral lenses potentially will grow faster than any other segment of
the contact lens market given the increased prevalence of myopia.
Overall, gas-permeable (GP) lens prescribing in the US was down
from nine per cent to six per cent in 2012, but GP button sales have
increased 13.7 per cent from 2013 to 2014. Clarke Newman from the
Institute said: “We’re moving away from corneal contact lenses to
scleral contacts and lenses designed to reduce myopia,” adding there
was potential to use scleral lenses for toric correction.
WEIGH-IN ON PHARMACY PLAN
The Ministry of Health has begun consultation on a plan outlining
the future of pharmacy services in New Zealand. Health Minister
Jonathan Coleman said the plan helps to “set out how we can
make better use of the knowledge and skills of our pharmacy
workforce” and ensure “pharmacy services are better integrated
with other health professionals in multi-disciplinary teams.” The
Draft Pharmacy Action Plan 2015-2020 is divided into five themes:
personal and population health; pharmacist clinical services in
integrated teams; acute demand management; dispensing more
effectively; and prescribing. The draft plan can be downloaded from
the MoH’s web site and is available for feedback until November 23.
VISION, SYMBOLS, MEMORY
Analysis of a proposed license plate format in the US suggests
substituting one number in a six-character line improves shorterterm
recollection compared to strictly alphanumeric-only designs.
Researchers from the New England College of Optometry evaluated
the EZ-ID system, which uses graphics of stars, hearts, basic
geometric shapes in place of one alphanumeric character. The
researchers randomly selected 10 six-character Massachusetts
license plates from a sample of cars. Five were modified to replace
one of the two middle characters with a symbol. 53 per cent of those
with symbols were correctly and completely recalled compared to 33
per cent of plates containing only alphanumerics.
RIVER BLINDNESS WORK WINS NOBEL
William Campbell and Satoshi Omura were jointly named winners
of the 2015 Nobel Prize winner in Physiology or Medicine for work
which led to the development of ivermctin in the treatment of
onchocerciasis, better known as river blindness. They will share the
prize with Youyou Tu for her discoveries concerning a novel therapy
against malaria. River blindness is a parasitic infection that can
cause intense itching, skin discoloration, rashes, and eye disease
that often leads to permanent blindness, and spreads by the
bites of infected black flies that breed in rapidly flowing rivers in
equatorial habitats. ▀
EI attains quality standard
Eye Institute’s new clinic and theatre suites have been accredited
to New Zealand Standards for quality of patient care.
The move to brand new premises at 123 Remuera Road was
the ideal opportunity to formalise Eye Institute’s commitment to
the highest standards throughout the reception, clinic and theatre
environment, said business manager Barbara Hare. So Eye Institute
sought formal assessment by DAA Group and now the high standards
that have been attained throughout the patient care process have
been confirmed, she said.
“The accreditation process has been very worthwhile. It recognises
the terrific efforts by all the staff at Eye Institute who focus on quality
of care every day,” said Barbara.
New Zealand Day-Stay Surgery and Procedures Standard NZS
8164:2005 was developed for organisations providing day-stay and
clinical rooms or office-based surgery or procedures.
Accreditation involves examination of all steps in the patient care
process including aspects as diverse as staff training, infection control,
operating theatre process, data security and assessment of patient
outcomes. Robust protocols are a requisite with confirmation that
these are adhered to through observation, documentation and staff
interviews. Accreditation is an ongoing process with follow-up visits
by the accreditation team performed at regular intervals.
Eye Institute’s facility, which opened at the beginning of this
year, has been designed to optimise the patient’s experience as
well as to create a spacious and pleasant working environment
for staff, combining a relaxing ambience with the latest
technology technology, said Hare. ▀
New conference for DOs and staff
Eye Institute will hold a conference for dispensing opticians and
support staff in parallel with its annual optometry conference
on November 8.
The inaugural Eye Institute Dispensing Optician Conference will be
held at the same venue as the optometry conference, the Waipuna
Hotel and Conference Centre in Auckland, from 8 am to 5 pm.
This is the only conference in 2015 that brings dispensers and
optometrists together under the same roof, says Eye Institute
representatives. “It is an opportunity for practice owners and key
personnel to share in an educational event and to test drive some of
the latest technologies.”
The jam-packed agenda offers DOs tips for frame selection and
spectacle correction for blended vision patients, the meaning behind
floaters, handling emergencies and telephone triage, common post
cataract symptoms—presented by Dr Trevor Gray—and much more
in several snappy 30-minute presentations.
The conference also includes panel discussions and features
three guest speakers: Margaret Lam, from Sydney, Alan Saks and
Grant Watters.
Lam graduated from the University of New South Wales in 2001
and is the founder of Sydney-based theeyecarecompany, a small
group of independent optometry practices. She practices full scope
optometry, with a particular interest in contact lenses and patient
Book drills deep into prosthetics
Vision science has traditionally been silent about ocular
prosthesis for a number of reasons. Before World War II, it was
the purview of glass blowers. Then, with the rise of plastics,
the baton moved to dentists who, after all, were already adept at
creating maxillofacial implants for their patients.
In New Zealand the maxillofacial-optical divide wasn’t really
bridged until Dr Keith Pine decided in 2003 to sell his chain of dental
practices to Lumino, go back to school and earn a Masters and PhD in
optometry, with the specific intent of researching prosthesis from the
perspective of optometry.
“I had provided prosthetic eyes throughout my career, just because
of where I came from,” Pine says. “I went to university and ultimately
suggested we write a book about it.”
The result is Clinical Ocular Prosthetics—arguably the first
comprehensive textbook to provide a comprehensive account of
ocular prosthetics and the evidence underpinning this field of
healthcare. The book is co-authored by Pine’s university supervisors,
Robert Jacobs and Dr Brian Sloan.
According to an announcement, Clinical Ocular Prosthetics
“contains a mix of scientific evidence and clinical experience and
includes inferences based on material from other disciplines that are
applied to the field of ocular prosthetics.”
The book is written primarily for clinicians and caregivers who have
contact with prosthetic eye wearers including ocular, maxillofacial
and anaplastology prosthetists, ophthalmologists, ophthalmic
nurses, optometrists and students of these disciplines.
“The main goal of the book is to bring together everything that
is known about prosthetic eyes into one place,” Pine says. “It’s
comprehensive and evidence-based where it can be. It covers history,
psychology, physiology and socket complications. I would hope that
vision professionals would get an understanding from it, and give
good, sound advice to anophthalmic patients.”
Pine has devoted all of his post-dentistry years to ocular prosthetics.
He founded the New Zealand Artificial Eye Service in 2008, partnering
with optometrists and eye surgeons in Rotorua, South Auckland,
Eye Institute’s Remuera site
The operating theatre
communication, and has extensive experience in specialty contact
lens fitting in corneal ectasia, keratoconus and orthokeratology.
Grant Watters, an educator, researcher and optometrist from
Mortimer Hirst, specialising in paediatric vision and contact lens
fitting, will give a talk on understanding complex contact lens
systems, matching systems to a particular contact lens type and
solving common problems patients experience with contact lenses.
Popular NZ Optics contributor Alan Saks will cover tips for spectacle
correction of blended vision patients. The presentation will include
practical tips for the best matched frame and lens selection and
skills to help patients understand the benefits and drawbacks of
blended vision. Saks is an optometrist and contact lens specialist
with Mortimer Hirst who performs regular clinical trials and premarket
evaluations for a variety of soft-lens and specialty rigid gas
permeable designs for leading manufactures.
Other presentations include a discussion of Meibomian gland
dysfunction with Eye Institute’s Dr Simon Dean; a dispenser’s guide
to glaucoma co-management from Dr Dean Conger; an exploration
of cataract refractive surgery from Dr Nick Mantell; and a look at
periocular skin lesions with Dr Adam Watson.
Registration runs onsite from 8 am to 8:30 am. Light refreshments
will be served and the Eye Institute has applied for CPD for
attending DOs. ▀
Authors Dr Brian Sloan, Keith Pine and Rob Jacobs
Tauranga, Takapuna, Wellington and Whangarei. But, he says, the
patients that need prosthetic eyes or prosthetic contact lenses “is a
small population that is not well promoted or understood.”
“My mission is to wake up vision professionals to this gap in the
services that we provide to patients with disfigured eyeballs. The gap
is the non-treatment and the lack of knowledge of how to go about
dealing with people with missing or disfigured eyes.”
Pine cites research indicating there are about 3,000 people in
New Zealand wearing prosthetic eyes or scleral shell prostheses. He
surmises an even higher number of people could be treated with
prosthetic contact lenses, which, unlike prosthetic eyes, are not
subsidised by the Ministry of Health.
There are a small number of people in New Zealand that specialise
in ocular prosthetics. Pine himself makes regular rounds, lasting a
month to six weeks, of the six clinics working with the Artificial Eye
Service, and may deal with implanting ten prostheses a month.
Clinical Ocular Prosthetics is available as an ebook through the
University of Auckland library system or hardcover from the
publisher, Springer, for $205.18. ▀
6 NEW ZEALAND OPTICS November 2015

Optos and widefield imaging: a profile
Famed for its ultra-widefield (UWF), high-resolution retinal
image equipment, Scottish-born company Optos is not new to
New Zealand.
But given its steady and continued growth, its acquisition by
Japanese firm Nikon (keen to expand beyond photography), and
the RANZCO conference’s return to New Zealand, the time seemed
right to project a higher profile in New Zealand, says Jason Martone,
managing director of Optos Australia.
“Given RANZCO’s in Wellington this year, that gave us the perfect
opportunity to further expand our presence throughout New
Zealand’s ophthalmic community.”
Optos arrived in New Zealand in 2011, just under a year after
opening its Australasian headquarters in Adelaide, South Australia.
The company installed its first UWF device at For Eyes Optometrists
in Kumeu, Auckland, and made a splash checking Prime Minister John
Key’s retinas with thew new-to-New Zealand technology.
Although other companies produce and distribute equipment that
can take widefield images, only Optos’ optomap image captures up
to 82 per cent (or 200 degrees) of the retina in a single capture, the
company says, citing more than 300 studies.
Widefield imaging has certainly captured the attention of the
industry, with one researcher referring to more than 75 papers on
the investigational applications of Optos UWF retinal-imaging at the
2014 Association for Research in Vision and Ophthalmology meeting
in Orlando, Florida.
Writing in a special report in Retina Today, Dr Rishi Singh,
assistant professor of ophthalmology at Case Western Reserve
University in Cleveland, Ohio, says from the research and from his
own experience, “it is evident that UWF technology will take a
more prominent role in the clinical care of patients with
retinal disease.”
Singh’s report reviewed research on the uses of Optos UWF retinal
imaging systems, which employs a scanning laser ophthalmoscope
and a unique ellipsoid mirror to create a virtual focal point inside
the eye to enable a single-shot capture of the central retina and
periphery. Though there is some debate about the clinical relevance
of peripheral findings, all the cited studies showed the advantages
of UWF for detecting, evaluating and monitoring the presence and
severity of retinal pathology, especially for diabetic retinopathy and
macular oedema.
Optos’ latest product, the California—a desktop system equipped
with indocyanine green angiography—has earned more positive
feedback on UWF from ophthalmologists.
“Optomap retinal imaging provides me with an unparalleled ability
to permanently document central and peripheral retinal pathology.
This has important benefits in both patient education and disease
monitoring,” says Dr Simon Chen, a retinal specialist at Vision Eye
Institute, Sydney.
Optos was founded in 1992 by industrial design engineer and
entrepreneur Douglas Anderson after his five-year-old son Leif
went blind in one eye when a retinal detachment was detected
too late. The subsequent eye exams his son underwent were
uncomfortable, making it difficult for the doctor to be thorough,
the company history explains. Anderson was determined to prevent
such suffering among other children and, after several years of
development and regulatory hurdles, Optos debuted its first
product, the P200, in the UK and US in 2000.
Optos Australia's Jason Martone
The company’s UWF, high-resolution imaging devices produce
photographs of the fundus for diagnosing, analysing, documenting
and monitoring ocular pathology that may first present in the
periphery. Optos’ equipment range from devices for screening by
optometrists in primary care settings to more exacting imaging in
secondary care practices. It is currently developing an ultra-widefield
retinal imaging device combined with OCT, and it is still striving to
capture a 100 per cent image of the retina.
Martone says a key strength of Optos compared with some
competitors is that it directly controls and manages its own research
and development, manufacturing and the sales and service aspects
Optos’ California indocyanine green angiography (ICG) image showing AMD,
courtesy of Dr Srinivas Sadda
of all its products. Though this is managed from Australia, the
company has staff dedicated to New Zealand, he says.
Optos continues to grow, says Martone, with sales of more than
8,500 products globally and, in its 2014 financial year, reported
revenue of more than US$170 million and profits of US$8.5 million
up from US$159.5 million and US$6.4 million respectively in 2013.
Nikon’s US$397 million acquisition of Optos in early 2015 is likely
to spur that growth,” says Martone. “The resources and technology
Nikon and Optos have combined, builds for a world leader in the
medical ophthalmic space…to accelerate delivery of our vision to be
‘The Retina Company’.” ▀
Crichton joins
Shamir
ADONZ vice-president and well-known dispensing optician
Donald Crichton
has joined
the Shamir team as
New Zealand sales
representative.
Crichton says he is
excited about returning
to the lens side of the
business.
“I love lens technology
and this has got me right
back into it, allowing
me to re-establish
relationships I had in
the past.”
Crichton has almost three
decades of experience in
the optical industry in both
the UK and New Zealand
working in independent
practice, for Specsavers,
as New Zealand sales
manager for Hoya and, most recently, with final year Optometry students
at Auckland University.
In a statement, Paul Stacey, CEO of Shamir Australia added,
“Don’s wealth of experience and industry knowledge has already
made him a key addition to the Shamir Company family. We view
his appointment as a sign of our commitment to our New Zealand
customers and the optical market.”
Crichton will be based in Auckland. ▀
Long-lasting lubrication for dry eyes
that is preservative-free and completely
sterile, delivered through the unique
COMOD ® multi-dose application system.
The systematic approach to eye lubrication
for
Dry Eyes
*Special Authority criteria applies only to HYLO ® -FRESH – please refer to the New Zealand Pharmaceutical Schedule for details.
For severe or
chronic dry eye
Preservative-free and phosphate-free
Can be used for 6 months after opening
Compatible with all types of contact lenses
At least 300 measured drops per pack,
or 150 treatments (both eyes)
FULLY FUNDED
Special authority criteria applies *
For mild to
moderate dry eye
For product enquiries contact:
CORNEAL LENS
CORPORATION N.Z. LTD
www.corneal-lens.co.nz
HYLO ® -FRESH (Sodium hyaluronate 0.1% w/v, 10mL) and HYLO-FORTE ® (Sodium hyaluronate 0.2% w/v, 10mL) eye drops are General Sales Medicines to improve the lubrication of the eyes, in eyes that are dry, irritated and tired from external factors.
Always read the label and use strictly as directed. If symptoms persist see your healthcare professional. HYLO ® -FRESH, HYLO-FORTE ® and COMOD ® are registered trademarks of URSAPHARM. AFT Pharmaceuticals, Auckland. TAPS 1535HA.
Health Headlines
Hartley Atkinson M.Pharm, PhD
Founder & CEO, AFT Pharmaceuticals
www.aftpharm.com
PROUDLY NEW ZEALAND OWNED
22855NZO/HL/FP
November 2015
NEW ZEALAND OPTICS
7

Silmo 2015
BY MARYANNE DRANSFIELD
The weird and the wonderful, the fun and
the funky, the luxurious and the ordinary
are what makes Silmo an exciting show.
Nearly 900 exhibitors participated this year,
with 34,250 professionals attending, up five per
cent on 2014.
International eyewear designers presented
their latest collections, setting the trends with
symphonies of colour, appealing shapes and
superb new materials.
There was an obvious move away from black
frames and a move toward a variety of shapes.
Geometrics are taking hold and the classic cat’s
eye is back, as are round frame styles to take
into account today’s facial proportions. Retro is
in, or out depending on who’s talking.
Fabric-covered frames, multi-layering
techniques, crystal and transparent material,
wood and stone, 3D printing and scanning
fabrication and other impressive technologies
stood out in the crowd. Designers are pushing
the limits of what can done with acetate to
achieve different frame finishes to give frames
that spark of something new and different.
Highlights
Iconic French frame design house Lafont Paris
featured an exhilarating palette, having one
of the most eye-catching stands at the show.
The company has revamped the process it has
used for 20 years, laminating Liberty Art Fabric,
a London-based firm known for its paisley
and floral variations reminiscent of an English
country garden. Lafont’s Raphael Rambeau
says Liberty’s fabric, which is inserted between
sheets of acetate, is ideal for frames, with colour
combinations softening the look of the face, and
with polka-dots and stripes used in the men’s
collection. Lafont debuted its sunglasses line,
with a similar approach.
First-time Silmo exhibitor Falvin hit the
jackpot when its Rock Star model was
nominated for the sunglass category in the
Silmo d’Or awards. The changing light on a
diamond-shaped building in Copenhagen
inspired former jewellery designer Birgitte
Falvin’s Black Crystal collection.
Birgitte Falvin designer of Falvin Eyewear with the
sunglass model, Rock Star, which was nominated in
the sunglass category of the Silmo d’Or awards
“I wanted to design something that really had
a purpose, an accessory people needed so it was
a perfect switch from jewellery to eyewear,”
Falvin says. “I like to make a statement; my
design to have edginess and sophistication.”
Frame house Morel showed off its
collaboration with Ora ïto, applying the
designer’s concept of ‘simplexity’ to spectacles
and sunglasses in the Lightec collection,
launched at Hotel Odyssey (whose interior ïto
designed). ïto has been involved in creating 400
products—from automobiles to shoes—and
loved the challenge frames presented. Lightec
features a patented spring-less/screw-less flexhinge
system.
“I’ve enjoyed working on this collection and
am very committed to eyewear now,” ïto says.
“I wanted to incorporate lightness with comfort
and Lightec was the perfect collection for me.
An ultra-light polyamide known as Lunamide is
used to inject complex, futurist bevelled shapes
around a slim-line, stainless steel core.”
It would not be Silmo without Oliver
Goldsmith, now licensed to Fabris Lane, which
also carries the newly—launched Ben Sherman
brand along with Hook LDN, Accessorize and
American Freshman. Goldsmith and Fabris
Lane debuted their first collaboration, the
Photograph Collection, a line of 14 designs
hand-crafted in Italy. Photograph adjusts or
reduces shapes intentionally reminiscent of
vintage styles, with a modern, fused-acetate
twist. Photograph will eventually expand to 36
models to appeal to all market segments. Two
special numbered Oliver Goldsmith editions
will be launched each year in buffalo horn or
similar material and are destined to become
collector pieces.
Oliver Goldsmith (centre) with his daughter Alex and
grandson Zac. The 1967 portrait on the wall depicts Oliver
and his father Charles Oliver Goldsmith
Blake Kuwahara, an American designer with
an artistic talent and an optometry degree from
the University of California, began designing for
other companies after three years in practice.
He established his brand in 2014, drawing on
his Japanese heritage, and that culture’s “keen
ascetical awareness.”
Claudio Arena and Geraldine Booth from Wellington with
designer Blake Kuwahara
“The osmosis of this has played into how
I design which is efficient so there are no
extraneous elements, it is very pure,” says
Kuwahara.
Kuwahara’s standout “frame within a frame”
concept incorporates a 45-degree angle mitre
(a technique derived from architecture) which
hides the hinge-break away when the temple
is closed. The “inside-” and “outside-” frames
are constructed separately, in different styles
and dimensions, giving the whole a unified,
but different personality at distance, using the
space between the frames as a design element.
The frames are fused in a curing process that
can take up to two months. The Blake Kuwahara
collection is made in Japan, distributed by
Eyemakers in New Zealand. Kuwahara says he
partners with professionals who take the time
to understand his design concepts.
Max Neubauer (centre) from Eyemakers with New
Zealand’s own Alan Saks (left) and Reiner Kuske
“It’s all about communication. In this industry
you can’t be one dimensional. It’s not just
about good quality product, marketing and PR.
We have to have all engines firing on the same
cylinder, that’s why we chose to partner with
Max Neubauer whom I’ve been working with for
20 years,” he said.
Caroline Abram, another vision professional
turned designer, started her career as an
optician in the family practice. Abram was raised
in Dakar, Senegal, and she takes her inspiration
from that and her diverse origins (Caribbean,
Indian, French, and Polish). She incorporates
diverse materials—acetate, metal, wood, stones
and Swarovski crystal—in elegant, innovative
shapes that challenge the imagination without
losing its femininity. Abram’s unique approach
Eric and Linda Bleakley from Image Optics with designer
Caroline Abram, Steph Cawte and Reiner Kuske
was particularly embodied by the Pandora
sunglass range launched earlier this year for the
European summer and now available in New
Zealand, featuring textured acetate and metal
temple detail.
Abram’s Silmo stand showcased the 2016
ranges, which add new palettes to her popular
metal and acetate frames, and include an
optical take on Pandora. Abram also released
a number of new styles of optical acetate
frames, and new children’s frames to add to the
collection that won her an award at Silmo 2014.
A real find at Silmo was TAVAT Eyewear,
a company geared to independent optical
professionals, with its founder, I. Jeremy Baines,
applying a business model he says he wants
independents to embrace.
“There has to be a way to differentiate
between chains and good independents,” says
Baines. “The truth is that the average consumer
believes there is no difference between optical
stores because in this industry the discounters
and chains have monopolised the distribution
channel.”
“Selling nice frames is not enough—you need
to build a brand around excellence of eyecare
and eyewear.”
TAVAT debuted its Soupcan collection at Silmo,
with its round and panto shapes finished in
metal, and a variation with acetate rims. The
company bypassed traditional manufacturing
techniques using frames made from “coined”
Alpacca and assembled and finished by hand.
Their sunglass lenses are infused synthetic
melanin in three bronze, bronze with gold
mirror coating, or bronze with silver mirror
coating. A feature of the optical and sunglass
range is the ex-cam hinge—a highly engineered
concept producing a fluid motion from opening
to closing.
The composition of eyewear in the Soupcan brand
2015 Silmo d’Or winners
Jono Hennessy Sceats and wife Louise Sceats with his
new Zeffer range
Jonathan (Jono) Hennessy Sceats is
synonymous with Australian eyewear and has
exhibited at Silmo for several years now. This
year he launched his Zeffer, a collection uniting
titanium and High Density Cellulose Acetate
(HDCA), three years in development.
“The technology involved in the construction
of this brand meant it did not fit into our
existing brands,” Sceats says. “The HDCA
material is super strong and super light and
its flexibility meant it could be milled down to
2mm. Also the design is such that no nosepad is
required,” he said.
Mark Collman of Phoenix Eyewear brought the
entire sample set of 19 models in 69 SKUs back
to New Zealand with him.
First-time Silmo exhibitor Michael Crawley
from Valley Eyewear was overwhelmed with
interest in his optical and sunglass collection.
The professional photographer launching into
the industry after working for a major surf label,
when he was asked to critique a sunglasses
range. His employer flew him to France where
he learned the skills needed to design and he’s
never looked back. Opting to go out on his own,
he found a factory to manufacture his sunglass
designs and teamed up with Carl Zeiss for
the lenses.
First time Silmo exhibitor Australian Michael Crawley
with his new brand Valley Eyewear
Crawley hand-draws all his designs and oversees
the production process, visiting China five times a
year, splitting the rest of his life between the Gold
Coast and Los Angeles.
“Sunglass sales over my website from New
Zealand have gone crazy,” Crawley says.
“Working with distributors now, the collection
has gone global. There has been massive
interest in my collection here at Silmo so I
expect even wider distributor now.”
Silmo 2015 coverage will continue in the
December issue, with more about 3D printing,
Danish eyewear, and other exhibitors from
Australia, North America and around
the world. ▀
The annual Silmo d’Or 2015 winners were announced at a ceremony at the Maison de la Radio. The
awards recognise creativity, originality and innovation across all categories. Awards were presented by
Emmanuel Gallina, renowned designer and teacher.
Vision Category:
Essilor Eyezen
Contact lenses:
Johnson & Johnson for 1-Day Acuvue Moist Multifocal
Equipment:
Luneau Technologies for Attitude by Briot
Low Vision Category:
Visiole for Blaze Ez
Children Category:
Minima Junior Hybrid (see ADONZ What’s new story)
Optical Frame: Masunaga for model GMS 106
Sunglasses:
W-Eye for model Aifir
Sports Equipment:
Seiko Optical Group for Seiko X Changer
Frame Technology/Innovation: Blackfin for Shark-Lock
Special Award:
Factory 900 for model FA-087
Japanese company Factory 900 took the Special Silmo
d’Or award for its model FA-087, known as “The Six Eyes”
8 NEW ZEALAND OPTICS November 2015

HumanWare offers low vision sales option
Kiwi optometrists are being offered a potentially lucrative
opportunity to provide additional resources and care to their
low vision patients.
The Australian head office of HumanWare—one of the world’s leading
providers of high-tech assistive technologies for people who are blind or
have low vision—has joined forces with its majority shareholder Essilor in
New Zealand to offer (in the first instance) Essilor’s 100 Platinum Partners
the opportunity to become resellers for HumanWare.
Jason Abrahams, Australasian general manager for HumanWare,
says current knowledge about the type of tech available to help low
vision sufferers is quite low. “The cut-through is only about five per
cent of the population who know about assistive technology for low
vision. We wanted to be able to provide those with low vision more
opportunity to know what’s out there. So we’re going with a low vision
strategy to eye care professionals in New Zealand.”
Currently most optometrists simply refer low vision patients, where
lenses or surgery are no longer an option, to the Blind Foundation,
says Abrahams, and though the
Foundation does a terrific job,
its resources are limited and
advice can be variable when it
comes to understanding hightech
opportunities for low vision
patients.
HumanWare will be working with
Essilor, which bought a majority
share of the former New Zealand,
now Canadian-based company two
HumanWare’s Jason Abrahams woos
Kiwi ECPs
years ago, because it makes sense
to leverage the strong relationships
Essilor already has with optometrists in New Zealand.
“[Essilor NZ] is very strategic and can see the benefits of HumanWare as
an additional solution for its Platinum Partners,” says Abrahams.
Kumuda Setty, Essilor’s New Zealand marketing manager, says low
vision is a growth area. “The relationship the patient has with their
eye care professional can be extended further since tools like Prodigy
and other HumanWare products can easily be used.”
The decision to extend the reseller offer to Essilor’s Platinum
Partners first is because they are committed to change, says Setty.
“They are willing to go beyond and want to differentiate themselves
in the marketplace.”
One of the first to sign up is Curtis Vision’s Chris Clark in Christchurch.
“We’re excited about the HumanWare products and they’re a natural
fit for our practice as we continue to strengthen our speciality areas.
One of our senior optometrists, Nicola Bolton, has recently become
highly involved with low vision work in the Canterbury area so the new
relationship with HumanWare is an ideal extension to this.”
Abrahams says select optometrists (starting with Essilor’s Platinum
Partners) will be offered the choice of two reseller tiers in key
geographic areas. The first tier focuses on HumanWare’s personal
digital vision assistant Prodigy range. Prodigy resellers will be
offered training, a Prodigy demonstration unit and 15 per cent of
the sale on any Prodigy products they sell. The second tier will offer
HumanWare’s entire low vision catalogue of more than 30 products,
including Prodigy, they will be able to buy a Prodigy system at cost
and make 20 per cent on any HumanWare products sold. Both tiers
will be supported by HumanWare’s New Zealand distributors Vision
Associates, based in Christchurch, which will also be providing
training and ongoing technical support to resellers and their patients.
However any Kiwi eye care professional who’d like to be able to
offer more to their low vision patients can benefit from HumanWare’s
referral programme, says Abrahams. This offers a 10 per cent referral
fee to eye care professionals whose patients purchase HumanWare
products after being referred to Vision Associates. This option is also
available for those resellers who wish to just focus on Prodigy and not
come to grips with the rest of HumanWare’s product range. ▀
HumanWare’s Kiwi ancestry
HumanWare was founded as Pulse Data in Christchurch in 1988 by
electronics engineer Dr Russell Smith. The company grew to become
a multimillion-dollar poster child for Kiwi R&D and export potential,
fawned over by a succession of politicians. It won a series of export
awards and acquired its California-based distributor HumanWare and
Canadian competitor VisuAide in the early 2000s, changing its name to
the more internationally-known HumanWare in the process.
Plans to move the company’s headquarters to North America were in
discussion when Smith and his wife Marian D’Eve died in a light plane
crash off the North Canterbury Coast in August 2005.
The company went through a period of turmoil with a succession of
overseas managers before the majority was sold to Australian privateequity
firm Jolimont Capital in 2007 for $35 million. Former VisuAide
founder and HumanWare director Gilles Pepin stepped into his current role
as CEO of HumanWare in 2008 moving the company’s headquarters, R&D
and centre of operation to Canada in 2009. Today the company has sales in
more than 72 countries, managed from four international hubs in Quebec,
the US, the UK and Australia; it employs more than 150 people; and it has
revenues of more than US$35 million. Vision Associations was founded
by former Christchurch-based HumanWare senior staffers to continue to
supply and look after HumanWare’s customers in New Zealand.
Zeiss NZ comes
together
Lens and ophthalmic equipment manufacturer Zeiss has combined
its New Zealand Medical Technology and Vision Care offices into
one new office in Avondale, Auckland.
Previously its lens business was based in New Lynn and its medical
team in Henderson, but by bringing them under one roof Zeiss New
Zealand can significantly improve cost and customer care efficiencies,
and respond better to crossover requirements within the industry, says
Quinn Bent, Zeiss Vision Care’s Australasian regional sales manager.
“We are signalling that Zeiss has one presence in the market and that
we function as one, so wherever there’s a crossover we can explore the
opportunities and bring these together…and build a true Zeiss culture
here, which is all about supporting each other and our customers.”
Taking pride of place in the new office on the lens side is a MeiEdger
671 edging machine. This and other new equipment, and given the
new space the lens team now enjoy, means there’s plenty of room for
growth in the lens area in New Zealand, says Bent.
GRAND OPENING – 23 SEPT. 2016
Quinn Bent, Auckland branch manager Hermi Hidalgo and Mark Gaunt in Zeiss
new combined office
“With the brand we have, we feel it suits what a lot of the
independent practices are doing as they are increasingly positioning
themselves at the more mid to high-end of the market.
“We pride ourselves on our technology as we put a lot of unique
technology into our lenses. For example, we have a new progressive
range, called the Precision range, which includes patented
technology—digital insight technology, which caters for progressive
lens wearers who use digital devices.”
Bent estimates Zeiss has about seven per cent of the New Zealand
lens market, so it is still small. But it’s growing, he says, with the
company employing two additional staff (one more technician and one
more customer service representative) last year and reporting 30 per
cent year-on-year volume growth.
“Yes, we are still quite small in Australia and New Zealand on the
lens side—not on the equipment side–but we pride ourselves on
being able to provide a very personable service to practitioners,”
Bent says. “All our Zeiss reps are qualified dispensers…we even have
a qualified dispenser working in customer service, and we’ve made
a huge investment in technology. We wouldn’t have moved and
invested in this if we didn’t see the growth.”
Mark Gaunt, Zeiss NZ business development representative, says
given Zeiss manufacturers and sells both diagnostic equipment and
lenses, the combined knowledge and synergy can help optometrists
structure what they need in terms of equipment and, perhaps more
importantly, how they might finance those technology needs.
The financing packages, offsetting technology costs through lens
spend, were introduced almost three years ago and are proving
increasingly popular among independents, adds Bent, making the
recent move make even more sense. ▀
REINVENTING BUSINESS.
23> 26 SEPT. 2016
PARIS NORD VILLEPINTE
Conception : CARLIN
SILMOPARIS.COM
November 2015
NEW ZEALAND OPTICS
9

SPECIAL FEATURE: ADONZ Conference
ADONZ delivers cpd, networking and fun
If you were in need of a dispensing optician
over the weekend of October 9 to October 11,
statistically speaking, you’d have to be in Hamilton.
That’s because a good number of the country’s
registered DOs attended the ADONZ 2015 National
Conference at the Novotel Hamilton Tainui, where
they were able to earn up to 14 CPD points, meet
more than a dozen Kiwi-centric wholesalers,
suppliers and lens makers and celebrate the 20th
Italia Independent are distributed in New Zealand by Euro Optics who
can be contacted at marketing@optiumumeyewear.co.nz
year of OptiBlocks at a fun-filled costume dinner
party with a roaring ‘20s theme.
“It’s been wonderful. It’s a really nice
atmosphere,” ADONZ President Peggy Savage told
NZ Optics near the end of the weekend. “We’ve
had a bit fun. The standard of education has been
high; the conference in its entirety has been very
well done.”
Savage helped keep the pace through the
three-day event, presiding over
the AGM and paying respect to
key people in the association,
organisers and the top-notch
cadre of presenters, including
ABDO’s Elaine Grisdale, Dr
David Wilson, Steve Daras,
Serah van Haeftan, Dr Richard
Johnson, Mariska Mannes,
Stephen Guest, Andrew
Swensen and amusing MC
Stephen Caunter from ANZ.
The Sunday night gala
evening was a fitting
punctuation for the close-knit
DO community, celebrating
20 years of OptiBlocks, the
ADONZ-owned provider of
practical training blocks for New
Zealand’s dispensing opticians.
Celebrating the 20 year birthday,
the gala dinner at The Verandah,
Hamilton Lake, was awash
with 20s spirt with flappers,
gangsters, sophisticated
socialites, golfers, G-men, and
even an Amelia Earheart.
Wholesalers and frame
vendors were also well
represented in the tight
exhibitor space at the
conference venue with
all New Zealand’s leading
lens manufacturers, frame
distributors and leading
accessory companies
represented (see ADONZ:
What’s new story).
INNOVATIVE LENS COATINGS
Now Available in Australia!
Glacier Plus UV
Comprehensive UV
protection including
back surface reflection
at no extra cost.
Glacier
Blue-Shield UV
Effective protection
against the harmful
rays of artificial light.
Glacier
Achromatic UV
A crystal clear
coating, keeping eyes
bright with no
reflective bloom.
Glacier Sun UV
Designed for sunwear,
leaves sunglass lens tint
unchanged and protected
from fading.
Glacier Anti-Fog
Rear surface of the lens
repels fogging during
strenuous activity.
No special sprays
or cloths needed.
GLACIER PLUS UV AND GLACIER BLUE-SHIELD UV
MADE IN AUSTRALIA.
Glacier Blue-
Shield UV
and Glacier
Plus UV stock
lenses also
available!
Education changes afoot
for Kiwi DOs
A significant development to emerge from the
conference was ADONZ’s decision to actively
explore a domestic education partner for a New
Zealand qualified, diploma-level dispensing
optician programme.
Representing ADONZ, Savage says the
organisation is in the “very early stages” of
working with WinTec (the Waikato Institute of
Technology) to apply for qualification for a DO
programme with the New Zealand Qualifications
Authority (NZQA). Should the programme happen,
and many hope it will, it will replace the general
DO blocks now delivered by Australia-based Open
Training and Education Network (OTEN) and
ensure Kiwi DOs are better qualified than their
Trans-Tasman counterparts, as OTEN consolidates
Australia state standards into a national DO
standard.
The move from OTEN to a domestic qualified
distance learning course stems from the
imminent changes to the standards in Australia,
admits Savage.
“We’ve had a good relationship with them for
a very long time and we will still have a good
relationship with OTEN…but we’ve never had
NZQA qualified recognition, and that’s really what
we’d like to do now. We’ve been in the industry
long enough for us to say, ‘hang on let’s look at
how we can do this better’.”
An NZQA qualification would also provide
a safeguard of independence from private
corporations exercising undue influence on some
teaching facilities, added Savage.
Interest in DO education appears to have
increased over the past four years, with the
number of ADONZ students increasing from 8 in
2011 to 58 this year, which ADONZ leaders see as
another sign of the need for good DO education
in New Zealand.
In a presentation, WinTec representative Sara
Towers explained the process of setting up a new
DO education programme in New Zealand.
“We’re probably looking at a diploma level
qualification, so either a level 5 or level 6 diploma
depending on the level of learning outcomes that
come through in the actual qualification design.”
Towers said they will be looking for input from
ADONZ members and asked for their response
to a simple online survey to demonstrate their
support for the qualification’s development in
New Zealand.
The programme would also have to gain
approval from the Optometrists and Dispensing
Opticians Board to ensure the training continues
to protect public safety.
WinTec intends to finish consultation with
ADONZ members and other education entities
by the end of the year to expedite approval
from NZQA. The goal, Towers said, is to have a
programme in place for the first semester of
2016.
“What this all means is we will end up with a
good academic qualification. We want to make
sure it is the best we can, so we provide the best
service.”
Like OTEN, the New Zealand programme will be
delivered as a distance learning course to service
students throughout the country, and it will
continued to be administered by OptiBlocks.
From the technical
to the ethical
Lecturers from New Zealand, Australia and the
UK covered a range of topics, providing attendees
with 13 CPD points (with an extra CPD point for
attending a workshop) in sessions that sparked
both interest and debate.
Serah van Haeften, legal counsel for Specsavers
Australia, led a presentation on the murky waters
of conflict of interest.
“Under the law you are required to avoid
conflict of interest situations. What that actually
means is putting your patients first,” van Haefetn
said. “You have to have proper skills to make the
right kind of referral and on occasions when there
are things beyond your expertise you have to
make the right kind of referrals. Public health and
safety has to be paramount.”
The simple summary, however, does not tell the
entire story, and van Haeften later admitted that
in any situation, the decision on what is or isn’t
ethical is highly subjective.
“It goes beyond the profit margin,” she said.
“What should you do if you have a conflict?
Transparency, openness and honesty are the keys
to managing conflict. In everyday life we have
this. The idea is not to stop living life or avoiding
things, but to ensure that everyone you work with
is aware of it.”
The presentation led to a lively discussion
exposing the occasional difficulty in determining
what defines a conflict of interest and contrasting
it with customary business practice.
Lens supplier sales incentives, staff discounts
to family, patient-referral incentives and other
scenarios discussed all require finesse to maintain
professional integrity, said van Haeften.
“The questions you should ask yourself are do
my actions feel right? Do they reflect what people
generally think is right and wrong? It’s better
to err on the side of caution so you can sleep at
night and to make sure the values you represent
are in line with the values your serve.”
Joanna Murray, John Ruby and Steph Cawte were
among the first people to go through OptiBlocks when it
launched in 1995
Angela Mitchell as Amelia Earheart
Jennifer Mae Castillo took the First in Class student prize,
sponsored by Essilor
Pene Leadbeater and Jacquie Ellis getting into the spirit
of the ‘20s
Shamir Glacier Coatings Ad - NZ Optics.indd 1
10 NEW ZEALAND OPTICS November 2015
13/10/2015 10:29:58 AM

Get to the main
cause of dry,
irritated eyes*
4UP TO
HOURS
RELIEF 2
CLINICALLY PROVEN
Optrex ActiMist – clinically proven to work
How does Optrex ActiMist work?
ActiMist liposomes
Natural lipids
Optrex ActiMist contains
liposomes (tiny bubbles fi lled with
moisture) that migrate across the
surface of the eyelid and collect
at the edges of the eye.
These liposomes mix with natural
lipids on the eyelid.
ActiMist liposomes
When the eyes are open the new
lipid mixture spreads over the
whole tear fi lm, and helps fi ll the
gaps to restore the damaged
lipid layer.
Hygienic. Can be used
by multiple people
Lasts 6 months
after opening
Won’t smudge
make-up
Convenient and
portable
Suitable for use
with contact lenses
Order stock for your practice today
FREE CALL 0800 393 564 EYELOGIC
www.optrex.co.nz optrex@eyelogic.com.au
Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. †When wearing make-up, it is recommended to apply from 20cm. *Due to disturbed lipid layer of the tear fi lm. References:
1. Lee S et al. Klin Monatsbl Augenheilkd 2004; 221:1–12. 2. Khaireddin R, Schmidt KG. Klin Monatsbl Augenheilkd. 2010; 227: 128-134. 3. Pult H et al. Contact Lens Anterior Eye 2012, 35:203-207. November Reckitt Benckiser, 2015 NEW Auckland. ZEALAND TAPS DA1541 OPTICS
11

SPECIAL FEATURE: ADONZ Conference
Man versus machine
Steve Daras gave a bird’s eye view on the current
state of Digital Measuring Systems (DMS),
emphasising the need for staff training.
The technology of DMS has generally moved
from tower units to desktops to tablets with
the capability of replacing some or all of the
traditional hand held tools: pupil distance rulers,
marking pens, pupilometers, millimetre rulers,
Fresnel split prisms and vertex callipers.
“These systems have been out a while and
they’re improving,” Daras said. “When they first
came out the images weren’t quite so good, so
they improved the lenses to take better pictures
and better fields of view. The fitting jigs are finer
Steve Stenersen with OptiBlocks providers and
conference presenters David Wilson, Steve Daras and
Mike Firmston, who kept the ball rolling during the
lectures and at the dinner event
and they are improving their targeting systems.”
The original towers also had a problem with
accommodating and converging, because their
design required the patient to stand too close
to the lens, but all in all, the technology has
improved, Daras said.
“These tools make our job a lot easier and make
the patient’s experience a lot better,” he said.
New tablet systems have the advantage of
mobility, freeing up space that would otherwise
be occupied by a dedicated machine.
But, with the technology’s advantages come
drawbacks. Daras emphasised the need to
prepare, to make sure a frame is sitting in the
exact position on a person’s face for accurate
measurement.
“Even with digital technology you still need to
fit that frame correctly and comfortably and in its
final position, so when you put the jig on top, it
doesn’t change anything.”
Aside from taking the PDs, centration
measurement, the pantascopic measurement and
the vertex and face forming measurements in one
process, DMS technology can also now measure
the frame for accurate heights and some have the
ability to take behaviour into consideration, such
as head-eye movement.
Daras says the high-end towers and desktops
are often technically difficult to operate and
require training, preferably on-site from the
manufacturers, with one person in practice
recruited as resident expert and written operation
material for reference.
“Finally, all tools are accurate, including your
ruler, it does nothing wrong,” Daras said. “But
it’s the operator, the human interface that’s the
problem. If the operator doesn’t get it right, that’s
where the error comes from so we have to be on
top of it and practice our skills.”
History lessons
Other presentations gave attendees a look back at
the progress vision science has made.
Dr David Wilson, an OptiBlock teacher from the
University of New South Wales, discussed the
development of eye-charts, in and out of clinical
settings and the rationale behind them.
Most visual acuity tests, he said, are based on
discernment at one minute of arc, tracing its roots
back to 1703 when the English scientist Robert
Hooke determined that the eye could distinguish
between two paired stars at one minute of arc.
Danish ophthalmologist Marius Tscherning in
1898 argued that one minute of arc was not
sufficiently small to measure vision as people
could do better than that, which Wilson said is
borne out by the fact that a 6/6 visual acuity
doesn’t actually translate to “perfect” vision.
Nevertheless, most vision charts are based on
one minute of arc from Herman Snellen’s first eye
charts, to the LogMar chart, which as the name
suggests is a logarithmic, as opposed to a ratio or
decimal measure.
In future, new charts may no longer be based on
the 6 metre distance reading.
“If the aperture is small relative to the distance
of the source, the light passing through the
aperture can be considered to be parallel. For the
human eye, that is generally considered to be a
distance of 6 metres. That’s not necessarily an
accurate assumption,” Wilson said.
In the US, researchers are using a four-metre
chart, with an adjustment of -.25D to account for
distance, the benefit of which is the four metre
chart uses a compensating power standard in
an optometric trial set (which is not the case
for the other alternative five metre set). The
big consideration is having a patient stand four
metres instead of five metres away saves on real
estate.
Another history lesson came with Richard
Johnson’s presentation on contact lens
complications.
“Leonardo da Vinci theor ised if you put your
face in a bowl with curvatures you can negotiate
different powers,” Johnson said. “He made
excellent clinical notes.”
Rene Descartes and Thomas Young centuries
later used tubes of water in contact with a person’s
eye to negate problems, while Sir John Herschel,
more famous for astronomical work, identified the
problem of corneal scarring in keratoconus.
In Germany in the 1880s, various scientists
developed the first scleral contact lenses, which
were made from blown glass and of such a
size that the eye would swell, giving patients
about two hours of clear vision each day. Things
improved in the 1930s with smaller, glass/PMMA
lenses. But it wasn’t until 1949 that techniques
improved to provide oxygen through the glass to
the ocular surface allowing wearers clear vision
for eight hours a day. After another few years soft
contact lenses made from plastic (Hema lenses)
arrived on the scene and finally, in 1985, the first
bio-compatible material was developed, but
the holy grail of contents, said Johnson, was the
advent of silicon-hydrogen daily lens in 2012. ▀
What’s new: ADONZ exhibitors
It may be the quieter year (the year ADONZ
doesn’t combine its annual conference with
the New Zealand Wholesalers Association
conference and exhibition at Visionz) but ADONZ’s
exhibitor space at Hamilton’s Novotel was abuzz
with networking and news.
The social mood was helped by the relatively
tight exhibitor space, which formed a corridor
to and from the main meeting room and food
areas, allowing for plenty of opportunity for
delegates to catch up on what’s new for this
summer and next year.
Leading the charge as you entered ADONZ
2015 was Fortune Technology Corporation,
a company more at home in New Zealand’s
casinos than Kiwi optical circles, which was
testing the waters for its SuperSelfie Digital
Mirror Kiosk, a distinctively designed touchscreen
display stand allowing patients to see
how they look in various frames.
Brad Boult, Petra Hewitt, Angela Mitchell, and Tom Frowde
12 NEW ZEALAND OPTICS November 2015
Ph 0508 FRAMES (372 637)
Debra and Peter O’Sullivan with Karen Walton and
Shelley Endacott
Independent Lens Specialists
(ILS) was sandwiched between
Phoenix Eyewear and Euro
Optics/Elegance in Eyewear,
with Dynamic Eyewear not far
away, which was appropriate
as ILS has partnered with
Phoenix, Elegance in Eyewear
and Dynamic over the past
couple of years to offer a
competitive SunRx programme
to independents, with direct
ordering through the ILS website
www.sunrx.co.nz.
Phoenix Eyewear
SunRx was definitely one of the
main topics of conversation at
ADONZ 2015, says Phil Wilson,
business development manager
at Phoenix Eyewear.
Phoenix was showcasing some
of its latest frames from Radley,
CAT, Kate Sylvester and O’Neill
as part of its 2015/2016 SunRx
programme, which it offers in
partnership with ILS and Essilor.
Jono Hennessy’s new releases,
featuring pearlescent colours
and marble colouring in larger
sizes, appealing to the current
fashion for deeper, bigger
Bill Devereaux with Elena Zvyagina
frames for women, was also attracting interest,
while Phoenix’s popular William Morris Black Label
range was completed by the quintessentially-
English frame designer’s new retro-inspired
collection. It harks back to the 50s and 70s with a
lot of antique pewter, metal bridges and double
rivets, says Wilson.
Also attracting interest was Radley’s third
release, which continues to push the mould
in its petite sizing range with bright, vibrate
frames, made from acetate and the increasingly
popular TR90, a thermoplastic material that’s very
lightweight, durable and flexible.
“It’s fantastic because more people are going for
colour, which is about time…though we’re still a
fairly conservative country as a whole,” says Wilson,
hinting there’s even more to come from Phoenix
later this year after a successful foray to Silmo.
“We have a new range coming, which we can’t talk
about it at the moment, but watch this space; it’s
very exciting.”
Euro Optics/Elegance in Eyewear
Carl Doherty, general manager of Euro Optics was
showcasing his new brand Italia Independent.
Donned by the likes of Lady Gaga and Rihanna,
Italia Independent is a great and natural addition
to Euro Optics brands as it will be producing
another Euro Optics’ brand, Adidas Originals—
Adidas’ street-wear range, as opposed to its more
sport-orientated Adidas Performance, made by
Silhoutte, says Doherty.
Rihanna wearing Italia Independent’s brown velvet frames
Gary Edgar, Brian Dover and Carl Doherty
“It works well for us because we wanted to
keep Adidas together and we were also looking
for another brand. Italia Independent is probably
one of the most innovative companies in Italy and
it’s very popular in Europe, so it allows us to offer
something different and doesn’t cannibalise any
of our other brands.”
Created in 2007 in Italy by three
flamboyant founders, Lapo Elkann, Andrea
Tessitore and Giovanni Accongiagioco, Italia
Independent rose to fame as one of the first
sunglasses manufacturers to use carbon fibre
for fashion’s purposes. The company prides
itself on its innovative credentials, using unique
technologies such as thermosensitive fibre and
microfiber linings.
Using a special heat-creating machine, Doherty
was able to demonstrate Italia Independent’s
I-Thermic sunglasses, which are characterised
by a particular enzyme treatment that reacts by
becoming transparent when the sunglasses are
exposed to 30° temperatures thus showing the
colour or pattern underneath.
I-Thermic from Italia Independent and Euro Optics
Though Italia Independent was the focus of
Doherty’s stand, a number of delegates were also
keen to know about the latest additions to his
SunRx programme from Adidas and Silhouette, as
well as the latest from the two popular European
brands. Due out in January, Silhouette’s new range
features innovatively striped-colouring technology
and is made from a very light weight material
called SPX, designed to be both flexible and
maintain its shape for a long time.

Prescription
sun protection
campaign
Instant
prizes
Tropical holiday
for two in
Hawaii
$10,000
worth of cash
vouchers
$6,000
worth of
travel
vouchers
Between 1 st November 2015 to 31 st January 2016, every pair of HOYA Transitions ® Signature VII
and HOYA NuPolar ® purchased will give you and your patients chances to WIN a series of great prizes,
including over $15,000 worth of cash vouchers and a tropical holiday for two in Hawaii! *
How does it work?
Simply register with a HOYA Representative or email us at: hapl_marketing@hoya.com
*Terms and conditions apply. You MUST register to be part of the promotions. Transitions, the swirl and Transitions Signature are trademarks of Transitions Optical, Inc. ©2015
Transitions Optical, Inc. All rights reserved. Other trademarks or service marks included are property of their respective owners. Photochromic performance is influenced by temperature,
UV exposure, and lens material. NuPolar ® is a trademark of Younger Optics.
November 2015
NEW ZEALAND OPTICS
13

SPECIAL FEATURE: ADONZ Conference
MSO
Mike Sladen from Mike Sladen Optical was showcasing the
latest looks from Face à Face, which featured a new innovative
colour range and the latest from its popular Bocca range,
characterised by the playful trademark footwear designs,
coloured to match, at the end of the frame arms. “They are
the most beautiful quality acetate frames,” says Sladen, who
represents Eyes Right Optical in New Zealand.
Prodesign’s new range was also doing well, despite only being
available for a week, says MSO’s Rae Long. “They always do
their colour combinations so well.” Prodesign has also released
sunglasses again, the first time in four years, she says.
Another MSO Eyes Right brand not on display though
attracting attention and discussion was Zac Posen, which
rose to fame on the US show Project Runway. The optical and
sunglass collection was launched at ODMA 2015 and apparently
the feedback on the range has been amazing, says Long.
Also attracting attention was MSO’s Jos.Eschenbach range, a
new eyewear brand launched by Eschenbach Optik, Germany’s
leading supplier of eyewear and magnifiers. Priced from $110
to $165 wholesale, 90 per cent of the range is titanium for light
weight, allergy-free comfort, with the rest made from high
quality acetate. Other Eschenbach products on display included
the latest range from Titanflex, that’s a third lighter than
conventional materials and 10 times more flexible and its latest
low vision aids.
Minima’s 10 year-warranted, super-flexible, super-tough
children’s rimless frames were also on display. Very popular
in Europe, they are just gaining attention here, says Sladen.
Minima’s “Junior Hybrid” range, took home the 2015 Silmo d’Or
award in the children’s frames category.
Essilor
Essilor’s stand focused on its Transitions promotion, featuring
Canadian Actress Laurence Leboeuf wearing Transitions
Graphite Green lenses, an alternative to the more common
brown and grey options.
Chris Aldous, Essilor’s business development manager, was
also on hand to explain Essilor’s “Power of 3” promotion for kids,
though it’s attracting attention from adults too. Crizal Prevencia
Kids is designed to protect kids’ eyes from blue-violet light
emitted from digital devices and UV, including the reflection of
UV from the back of the lenses. The lenses themselves are also
made from Airwear, a shatter-proof polycarbonate material,
which is scratch resistant, durable and lightweight.
Though it’s relatively new here, Crizal Prevencia is proving
popular in Asia with more parents purchasing coated plano
lenses to protect their children’s eyes, says Aldous. “Traditionally
it’s been about helping people see, but now it’s about having
healthy eyes as well. For the first time the child who is the
spectacle wearer has an advantage over non-spectacle wearers.”
ILS/Younger Optics
Causing a significant stir at ADONZ was the pre-release of
Camber, the latest lens innovation from Younger Optics which
offers a new front surface innovation known as a variable base
curve to increase acuity across all viewing zones. Once all the
qualifying steps have been taken, the lens will only be available
from Independent Lens Specialists (ILS) in New Zealand.
Though details were limited at this time, Younger Optics’
Australasian sales and marketing manager Trevor Inglis was on
hand to support ILS introduce Camber and promote Younger’s
NuPolar Gradient lens, now available in polycarb for both single
visions and progressive lens wearers. Another Younger patented
technology, NuPolar is the first polarised lens available in a
gradient tint. “As it’s built into the lens film it’s not going to
fade,” explains Glenn Bolton, ILS director.
Inglis was also on hand to introduce his replacement Sam
Crooke who will be replacing him at the end of this year (see
story p22).
Hoya
Hoya continued the rollout of its new line of vocational lenses,
Workstyle V+, designed to give presbyopic patients a better
option if they frequently switch focus from screen to desk to
general office.
Looking ahead to 2016
New Zealand’s answer to ODMA, Visionz, will run alongside
the ADONZ annual conference once again in 2016.
The fourth bi-annual Visionz will run at the Ellerslie
Events Centre from October 14 to October 16, with the ADONZ
annual conference, and for the first time in New Zealand, the
International Opticians
Association meeting.
The New Zealand
Wholesalers Association
(NZOWA) syncopates
its biannual show with
ODMA’s Australia-based
biannual expos. NZOWA
President Gary Edgar says
he was disappointed that
despite several months
of discussions the New
Zealand Association of
Optometrists (NZAO),
that organisation decided
Gary Edgar
to hold its annual 86th
Any new product takes about three months to roll out, says
Hoya’s country manager Stuart Whelan. “ADONZ is a great event
to reach those DOs who weren’t able to come to the Auckland or
Wellington launch events.”
As well as explaining Workstyle V+, Whelan was also taking
registrations for Hoya’s just-launched, new prescription sun
protection campaign, offering practices and consumers the
opportunity to win prizes worth more than $20,000, including
a five-day trip to Hawaii for two. The campaign runs from 1st
November to 31st January 2016 (see Hoya’s ad this issue for
more information).
Others exhibiting at ADONZ included General Optical which
was focusing on the varied assistance programmes it runs for
customers, its SunRx programme, which it handles through its
own labs in Australia and its Nike Performance and Rewards
programmes. With more than 40 brands in its portfolio and a
host of new initiatives for customers, there was a lot to talk
about at ADONZ says Genop’s New Zealand general manager
Brent Rushworth and customer service manager Richard Tooby.
Tools galore at Eyeline Optical
Dynamic Eyewear’s Paul Beswick attracted some positive
attention by handing out hangover packs featuring, among
other goodies, a can of Red Bull, designed to make you feel a
better and promote Red Bull’s new super light Racing eyewear
range, which is new to Dynamic and new to New Zealand. Other
brands featured included Australian-designed Charlie Brown
and Nicola Finetti.
Eyeline Optical exhibited a host of fascinating gadgets and
optical accessories, several of which featured as must have
pieces of equipment for dispensing opticians, such as a facial
gauge, in key note speaker Elaine Grinsdale’s talks.
While others exhibiting included Misty Optics, which shared
a stand with CMI Optical; Optique Line; Little Peach, which
was showcasing some intricate lace-inspired clips-ons from
Face&Cie; Allied Health Aotearoa and the ODOB; and Optica
Life Accessories, which was showcasing its Peeps eyewear and
sunglass cleaner as well as other accessories which can be
branded with customers’ own logos. ▀
Taking care of
business
The Association of Dispensing Opticians NZ made
several appointments at the AGM part of its
October conference in Hamilton: Vineet Chouhan
was reappointed to a two-year term as treasurer; Lynette
Hunter was reappointed to the executive council; Lucie
Single was elected to an open seat; Steph Caute and
Sarah Bycroft were re-elected to the continuing education
committee; and Emmaleen Sherriff was elected as a
new member.
Annual Conference over the same dates in New Plymouth.
Edgar says NZAO had wanted NZOWA to underwrite the costs
of NZAO’s part of the conference, which its members weren’t
prepared to do, and was concerned about the overlap between
ADONZ and the NZAO parts of the conference, meaning
practices could have both their optometrist and DO away on the
same day.
Callum Milburn, the new NZAO president says he thinks Visionz
is a great endeavour. “We gave serious consideration to the
option of holding our 2016 conference at Ellerslie to coincide with
Visionz, but our association was already well down the path of
setting our 2016 conference in New Plymouth. As a significant
proportion of our members are employed practitioners, with little
or no influence on the purchase of product, their motivation,
interest for trade displays is not great. We had to consider if
the lure of Ellerslie (lovely suburb that it is) would be enough
to fill the auditorium for educational sessions and enable our
conference to pay its way? In the end it will be a Visionz-ADONZ
event and I am delighted for ADONZ that they are hosting the
International Opticians Association. This is a tremendous honour
and they should be very proud.” ▀
Focus
on Business
ARE YOU SURE OF WHAT
YOU HAVE SIGNED?
To operate a business you
have to make certain
commitments, many of
which involve signing documents
that bind you to a course of action–
and if circumstances change and
the goal posts shift there can be
significant consequences.
We’ve seen numerous instances
of this occurring in the optometry
sector over recent years, stories
that illustrate why it’s critical
to fully understand the current
and ongoing implications of the
commitments you are making–and
why taking appropriate legal and
business advice is essential.
A number of years ago, several
aggregators of optometry practices
were active paying good money for
successful businesses.
In many cases, the aggregator
retains the previous owner (who
is paid a market salary) to provide
continuity and patient retention.
With the completion of the
contract, the new owner is entitled
to operate the business as they see
fit: the previous owner may or may
not be consulted. In some cases,
a joint ownership arrangement is
implemented with the associated
parties have an ongoing working
protocol put in place.
Some of the aggregators, though,
have subsequently decided to
sell-up and exit the market, leaving
the original owner to deal with a
new organisation, and different
philosophies. Compatibility issues may
arise particularly if there is a different
business focus. The only avenue
available is to accommodate the
changes, or to exit the organisation,
discontinuing the association with
what has been their “life’s work”, and
seeking opportunities elsewhere.
Ultimately, good money was paid and
ownership changed.
The lessons
Read the fine print. Where
a practice has entered into a
franchise arrangement, a full
understanding of the implications
of the legal documents is essential,
particularly the fine print. You need
to comprehend the requirements
around the supply chain, reporting
(financial and other), branding
and marketing, training and
operational matters.
Sale/exit provisions. Of special
interest will be the provisions
concerning who you might be
able to sell your practice or share
of the practice to. Constraints
may result in a disappointment in
the price achieved. Alternatively,
the franchisor may assist in a
significantly improved price in terms
of perceived value by the purchaser.
This may be a good result but the
overriding issue will be the ability to
sell to the most suitable party.
This is of interest where
a practice owner might be
withdrawing from a partnership
arrangement for good reasons.
The ongoing partner(s) may wish
to take the business in a different
direction, possibly outside the
franchise arrangements. The legal
documents signed will dictate the
steps the must be taken to achieve
the separation sort.
Compliance with the prescribed
course of actions in most cases will
BY DAVID PEARSON*
be mandatory particularly if the
franchisor perceives a disadvantage.
Invariably, the level of detail involved
can become extreme ranging from
major items to minor and even
trivial matters. This process can
become very frustrating requiring
patience and negotiation to achieve
the desired outcome. Significant
costs may be incurred as well if legal
advice and activity is required.
With the passage of time, the
persons previously leading the
organisation may no longer
be doing so. This may result in
different interpretations and
expectations being applied or
different approaches being used.
The ability to achieve a seamless
transition may be hindered thereby
slowing the process down.
Arm yourself with the facts. In
these situations, being prepared
and arming yourself with a good
understanding of the facts will pay
dividends in achieving your goals.
Also, allowing a reasonable period
of time is important to avoid the
possibility of delays and potential
cross over periods with ensuing
additional costs.
Loan and guarantee documents.
In previous articles, we have
covered the need to understand
loan agreements and guarantee
documents that may have been
signed. An understanding of those
commitments should be reviewed
annually. Increasingly suppliers
are asking for personal guarantees
before supplying products and
services. A register of guarantees
granted should be maintained to
ensure full visibility of the extent of
the commitments made.
Talk to your bank. Similarly,
banks and lending institutions
are requiring more security to
support their lending. As loans
are repaid, borrowers should
review the securities given for
appropriateness of quantum.
Wherever possible, a discussion
with your lending manager should
occur annually to signal that
you are serious about achieving
reduction, particularly where
security might be over property. If
a personal guarantee is involved,
ensure you can limit the extent.
Assess all documents Other legal
documents which may have been
signed and therefore requiring
analysis will be property lease,
optical and other equipment leases
and contract for services, including
employment contracts.
Hindsight is a luxury unavailable
at the time commitments are
entered into. Thinking carefully
about the arrangements you are
entering into contractually is crucial
to your success and wellbeing. Time
needs to be taken to evaluate the
opportunities and risks involved
in the fullness of time. Being in
business involves risk; it is a question
of how that risk is managed. ▀
* David Pearson is
managing partner with
BDO Napier and has a
specialty interest in
advisory services to
the optometry sector.
For more information
contact David at david.
pearson@bdo.co.nz or
visit www.BDO.co.nz.
14 NEW ZEALAND OPTICS November 2015

SOME SURFACES ARE
WORTH PROTECTING
THE OCULAR SURFACE IS ONE.
The SYSTANE ® portfolio Protects, Preserves and
Promotes a Healthy Ocular Surface 1–5 . See eye care
through a different lens with our innovative portfolio.
Surface protection and more
ALWAYS READ THE LABEL. USE ONLY AS DIRECTED. IF SYMPTOMS PERSIST OR YOU EXPERIENCE SIDE EFFECTS, SEE YOUR HEALTHCARE PROFESSIONAL. KEEP OUT OF REACH OF CHILDREN.
References: 1. Christensen M, Blackie CA, Korb DR, et al. An evaluation of the performance of a novel lubricant eye drop. Poster D692 presented at: The Association for Research in
Vision and Ophthalmology Annual Meeting; May 2-6, 2010; Fort Lauderdale, FL. 2. Christensen, M, Martin, A, Meadows, D. An Evaluation of the Efficacy and Patient Acceptance of a New
Lubricant Eye Gel. Presented at American Academy of Optometry 2011, Boston, MA. 3. Davitt WF, Bloomenstein M, Christensen M, et al. Efficacy in patients with dry eye after treatment
with a new lubricant eye drop formulation. J Ocul Pharmacol Ther. 2010;26(4):347-353. 4. Aguilar A. Efficacy of a Novel Lubricant Eye Drops in Reducing Squamous Metaplasia in Dry Eye
Subjects. Presented at the 29th Pan-American Congress of Ophthalmology in Buenos Aires, Argentina, July 7-9, 2011. 5. Geerling G, et al. The International Workshop on Meibomian
Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. IOVS. 2011;52(4):2050-2064. Alcon Laboratories (Australia)
Pty Ltd. 10/25 Frenchs Forest Road East, Frenchs Forest NSW 2086. Distributed by Pharmaco (NZ) Ltd in New Zealand, 4 Fisher Crescent, Mt. Wellington , Auckland. Ph 0800 101 106.
POPH.15104. TAPS.PP6717. NP4.A21507352604.
November 2015
NEW ZEALAND OPTICS
15

Focus on
Eye Research
Cornea Review
DOES CORNEAL COLLAGEN CROSS-LINKING
REDUCE THE NEED FOR KERATOPLASTIES IN
PATIENTS WITH KERATOCONUS?
Sandvik GF, et al. Cornea.
2015;34(9):991-5.
Review
Crosslinking is the creation of bonds that
connect one polymer chain to another.
This review evaluates the effect of collagen
crosslinking (CXL) treatment on long term
keratoplasty rates in keratoconic patients.
Corneal collagen crosslinking is a technique
used to strengthen corneal tissue utilising
riboflavin (vitamin B 2
) as a photosensitiser
and Ultraviolet-A (UVA) to increase the
formation of intra and inter-fibrillar carbonylbased
covalent bonds through the process of
photopolymerisation. The authors report the
frequency rate of keratoplasty in keratoconic
patients in a 12-month window before and
after the introduction of CXL treatment in a
single center.
The total number of keratoplasties performed
for keratoconus during period 1 (before the
introduction of CXL) was 55. The corresponding
numbers in period 2 (after the introduction of
CXL) was 26. The difference in the number of
keratoplasties for keratoconus in both periods
was statistically significant. There were no
significant differences in the distributions of age
and gender between both periods.
Comment
CXL treatment was heralded as having the
potential to reduce the need for corneal
transplantation in keratoectatic patients by as
much as 50% shortly after it was first reported
on in 2003. More than a decade after being
introduced this minimally invasive treatment
modality is now fulfilling the promise of treating
keratoectasia at an earlier stage, preventing the
morbidity associated with disease progression,
and precluding the need for the more invasive
keratoplasty procedure.
CORNEAL CROSS-LINKING AS AN ADJUVANT
THERAPY IN THE MANAGEMENT OF
RECALCITRANT DEEP STROMAL FUNGAL
KERATITIS: A RANDOMISED TRIAL
Uddaraju M, et al. Am J Ophthalmol.
2015;160(1):131-4.
Review
Fungal keratitis is an important cause of ocular
morbidity, especially in developing countries.
Fungal corneal infections often carry a worse
prognosis compared to bacterial keratitis
cases. A recent study found that 16% of eyes
perforated or required therapeutic keratoplasty.
Uddaraju and associates investigate the effects
of CXL treatment on recalcitrant deep stromal
fungal keratitis. The authors used the Dresden
protocol settings (riboflavin 0.1%, ultraviolet A
[UV-A] 370 nm at 3 mW/cm2 during 30 minutes)
as an adjunct to antifungal treatment on culture
positive fungal keratitis patients not responding
to appropriate medical therapy for a period of 2
weeks. The pre-specified primary outcome was
treatment failure at 6 weeks after enrollment,
defined as perforation and/or increase in ulcer
size by ≥2 mm.
The trial was prematurely stopped before full
enrollment because of a marked difference in
the rate of perforation between the 2 groups.
Of the 13 cases enrolled in the study, 6 were
randomised to the CXL group and 7 to the non-
CXL group. Five eyes in the CXL group and 3 eyes
in the non-CXL group experienced treatment
failure by 6 weeks. In a secondary analysis, the
CXL group experienced more perforations than
the non-CXL group (4 vs 0, respectively). The
authors conclude that CXL used as adjuvant
REVIEWED BY DR MOHAMMED ZIAEI
therapy for recalcitrant deep stromal fungal
keratitis does not improve outcomes.
Comment
This randomised controlled trial has several
deficiencies including a small heterogeneous
patient population and the use of a Dresden
treatment protocol (developed for treating
keratoectasia cases) rather than newer protocols
such as PACK–CXL (photoactivated chromophore
for infectious keratitis). This paper does however
highlight the fact that conventional Dresden
CXL protocol is not designed to target microbial
keratitis and that new and more effective
antimicrobial CXL protocols are required to treat
difficult cases of deep corneal keratitis.
COMPARISON OF CLINICAL OUTCOMES
OF IRIS FIXATION AND SCLERAL FIXATION
AS TREATMENT FOR INTRAOCULAR LENS
DISLOCATION
Kim KH, Kim WS. Am J Ophthalmol.
2015;160(3):463-469.
Review
Intraocular lens (IOL) dislocation is a known
complication of cataract surgery, with an
incidence ranging from 0.2% to 3%. Given
the ageing population and the increasing
number of cataract surgeries performed
worldwide there may well be an increasing
trend in IOL dislocation in the coming years. The
authors evaluated he surgical outcomes of 78
consecutive patients who underwent surgical
repositioning of dislocated intraocular lenses
using suturing to the sclera or iris. Forty-four
eyes of 44 patients underwent scleral fixation
and Thirty-five eyes of 34 patients underwent
iris fixation of dislocated intraocular lenses.
Corrected distance visual acuity (CDVA)
improved significantly1 month postoperatively
in both groups and remained stable for 12
months. The authors found that Iris fixation and
scleral fixation techniques had similar efficacy
in the repositioning of dislocated intraocular
lenses. Although operation time was shorter
for iris fixation, it had several disadvantages,
including induced astigmatism, immediate
postoperative inflammation, earlier recurrence,
and less stable refraction. The recurrence rate
of dislocation in this study was similar in both
groups (~15% at the one-year time point) but
the recurrences occurred significantly earlier
in the iris fixation group, with all recurrences
observed within 3 months after surgery.
Comment
The ophthalmic surgeon has limited options
at their disposal when dealing with a case of
late IOL dislocation. This article highlights the
shortcoming of current surgical techniques
currently available to secure unstable IOL’s.
Novel surgical techniques such as intrascleral
haptic fixation and new suture material such
as GORE-TEX (a microporous, nonabsorbable
monofilament suture) may well improve long
term outcomes of patients with IOL dislocation
after cataract surgery.
ABOUT THE AUTHOR
* Dr Mohammed Ziaei
is a cornea & anterior
segment fellow at
Greenlane Clinical Centre
and the University of
Auckland who completed
his ophthalmology
training in the UK.
BDV: Step-by-Step
BY DR ROB WEATHERHEAD*
John Veale, an optometrist and friend in
Christchurch, casually approached me in April
about providing “some oculoplastic teaching”
at a charitable clinic in Cambodia. I knew John
had shared his expertise there before and, as it
happened, I’d found myself with spare annual
leave I’d hoped to spend away from the frosty
Christchurch winter.
I had never been to Cambodia and the idea of
teaching in an unfamiliar, perhaps challenging
clinic appealed to me, especially with the
possibility of adding on a tour of Angkor Wat
afterwards.
I agreed to help for a week in July, with little
idea of what specific things the clinic director
wanted from me. I learned the clinic was
supported by Rose Charities New Zealand,
was dedicated to helping the poorest folk
with visual disorders and was located on the
outskirts of the capital Phnom Penh.
From a historical viewpoint, I knew of Pol Pot
and the Khmer Rouge’s genocide activities of
1975 to 1979 and how two million people were
slaughtered in the “killing fields”. I would learn
later that Vra, the ophthalmologist I worked
with, had two older brothers killed by the
regime when he was a child.
Weekend Working
I landed in the capital on a Saturday morning.
I was met by Mike Webber, an experienced
optometrist from Wanganui (who has been
involved with Rose Charities for many
years), and Dr Hang Vra, the clinic’s main
ophthalmologist. They escorted me to a small
hotel in the city. In the afternoon, Mike and
I went on a brief sight-seeing tour, but the
32ºC heat and full-on humidity was draining,
explaining why July is Cambodia’s low season
for tourism.
Vra, 50, undertook his medical training in
Moscow, where he met and married Natalia, a
fellow medical student from Donetz, Ukraine.
She is now a third-year ophthalmology resident
in a teaching programme in Phnom Penh. The
couple have spent the last 20 years in Vra’s
native Cambodia, raising their three sons,
working at the clinic, and running their own
“new” private practice on weekends. My focus
for the week was to help upskill Natalia, and
another male third-year resident, in oculoplastic
surgery.
By Sunday morning, we were hard at work
at Vra’s’ new clinic, seeing private patients.
I instructed the ophthalmic assistants on the
use of the Goldmann applanation tonometer,
rather than using the Schiotz tonometry. They
managed it, but longevity? In the afternoon
Natalia did two cataracts using Alcon AcrySof
IOLs, and several pterygia excisions with
conjunctival autografts (but without using
MMC). The private practice charges for cataract
surgery are about half the price of rival city
practitioners.
On Monday morning we went to work at
the old charitable clinic in the northeast area
of the city. In addition to the Saturday and
Sunday weekend work at the new private
practice clinic, Vra, Natalia and the ophthalmic
technicians work Monday to Friday at the
charitable clinic. Natalia also attends clinics at
the teaching hospital in the city. I commented
to them about burn-out, but it never appeared
to have crossed their minds that spending seven
days a week working was odd.
Morning at the old clinic
The charitable programme runs with minimal
administration out of an old school building
that Vra converted to an ophthalmology clinic
in 2003. The building is rent-free (governmentowned)
but water and electricity are paid for
by Vra. Rose Charities Canada underwrites
Vra’s salary, along with the 20 staffers working
there. Rose Charities New Zealand initially paid
for clinical gear and continues to donate about
$23,000 a year to fund the three residents in
training from the Preah Ang Duong Hospital
(PADH) training programme—including Natalia.
Two senior ophthalmologists also perform
cataract surgery at the clinic. I observed one
doing an ECCE +IOL and he was very slick. The
procedure was 10 minutes long from start
to finish.
The clinic sees up to 120 people on any given
Monday and by 8:30am on my first morning
there, 50 or so people were already awaiting
their turn in a covered, outdoor reception area.
Dr Weatherhead at work
Dr Weatherhead at work
The recovery area
In the operating theatre
Inside, residents were busy at the slit-lamps in
the open-plan examination area, cooled by two
ceiling fans.
A very brief history, Natalia’s imperfect English
translations, and only a momentary slit-lamp
view, made it difficult for me to make an
accurate diagnosis for each patient. The most
common presentations, however, were visual
loss from bilateral cataracts, refractive errors,
pterygia and uveitis.
Together, Natalia and I started with two cases
of dysthyroid orbitopathy (one active case
with corneal ulceration), childhood allergic eye
disease (vernal), and then three cases of severe
conjunctivitis in one family from suspected
pollutant-induced chemical conjunctivitis.
This was followed by a case of severe dry eye
with filamentary keratopathy from probable
Sjogren’s syndrome, an exposed evisceration
implant, another patient with conjunctival
symblephara formation from probable OCP, a
unilateral traumatic cataract with asymmetric
palpebral apertures, a 25-year-old girl with
a unilateral ptosis following an evisceration
for trauma, visual loss from Herpes simplex
keratitis scarring, a corneal FB, and a 15-yearold
lad with a corneal ulcer and hypopyon from
a superficial scissor injury two weeks earlier.
A 19-year-old lad with uveitis with secondary
glaucoma OU came to us later that morning.
A year before, he was HM HM. but the status
was now NPL 6/24, as he had no money for
medications. He had a negative CXR, tuberculin
test and ACE test.
Blurred vision from myopia, an epidermal
cyst under the lateral eyebrow (not a childhood
dermoid cyst), a vertical diplopia one month
after blunt trauma to the eyebrow – probably
a right fourth nerve palsy, a maculopathy
following cataract surgery, and a woman with
new-onset decreased vision. The latter case had
bilateral trabeculectomies a year earlier. She had
developed cataracts. The prognosis for visual
improvement with cataract surgery is variable in
such a case.
We finished the clinic at about 1:40pm, having
seen 126 patients.
16 NEW ZEALAND OPTICS November 2015

Operating Conditions
We spent that afternoon in surgery on the cases
diagnosed before lunch (no waiting lists here):
11 cataracts, two trabeculectomies, six ptergia,
one levator aponeurosis repair, one evisceration
implant exposure repair, one lateral tarsorrhaphy,
one bilateral lower eyelid entropion repair, one
brow cyst, one lower eyelid Z-plasty vs FTSG, and
two lower punctual closures (with a flame-heated
metal probe for cautery).
The main source of funding for the ophthalmic
surgery at the clinic is from ABC Tissue Vision,
who pay US$40.00 for each completed surgery.
The man behind the surgical funding is a
Chinese Cambodian businessman who resides in
Australia (think of Quilton toilet paper products).
Our first case was a young girl with a four-tofive
mm upper eyelid anophthalmic ptosis. Socket
sutures needed to be removed, and her prosthesis
was not custom-made. The antibacterial prepping
immediately wiped off my pre-op skin crease
marks (a Sharpie from the local market was the
standard pen available). The unipolar cautery
didn’t work. The bipolar version, when trialled
at the end of the case, did work. Ultimately,
we didn’t need to use the cautery on the case.
Natalia had placed a 20mm implant during the
evisceration two months earlier (the minimal size
needed to avoid post-op volume under-correction)
and there was good volume correction. A totally
disinserted levator aponeurosis was found at
exploration and was re-attached.
We then closed a lacrimal fistula, did two cases
of bilateral lower punctual cauteries, a lateral
tarsorrhaphy and repaired a bilateral senile
lower eyelid entropion (LLR surgery and LTS).
Then back to the hotel in the tuk tuk with
Mike, for a much needed Angkor beer at the end
of the day.
A week of it
Though we spent much of the week at the
clinic, I made time to give a lecture on common
orbital conditions at the training hospital, the
presentation geared toward the third and fourth
year registrars. My impression afterwards was
that this subspecialty presentation was a little
over the heads of the 12 residents who attended.
At least it introduced them to disorders they
will encounter clinically, even if they do not
manage them at present. Ophthalmic teaching in
Cambodia, therefore, needs to be for educating
and upskilling in general ophthalmology.
The development of subspecialties will
probably not occur until there are at least
300 ophthalmologists working in the country
(currently 74).
On a practical level, I felt I was able to teach
Natalia and the other residents a few things
during the surgical sessions—nasociliary
blocks, the lateral tarsal strip procedure,
lower eyelid retractor identification and
advancement, a better external DCR technique,
an external levator aponeurosis approach, a
direct browplasty technique and upper eyelid
blepharoplasty.
And the title of this article? “BDV” stands
for blurred distance vision, the most common
presenting symptom and patient note entry.
And “Step-by-Step”? It appears that there is no
equivalent Cambodian or Ukrainian translation
of the word “gradual”, so everything was “stepby-step”.
▀
Full-on in Fiji for ophthalmic volunteers
A group from Volunteer
Ophthalmic Services
Overseas (VOSO) provided
surgery, exams and scrips
at the Labasa Hospital
from June 27 to July 11.
VOSO TEAM MEMBER REUBEN GORDON*
REPORTS.
Flying over the sugar cane fields of Vanua Levu,
the team came in to land at Labasa Airport
where we were greeted by 26°C heat and a
very warm welcome from the Labasa Lions Club.
Our team included ophthalmologists Rebecca
Stack, Genevieve Oliver, ophthalmic nurse Marie
Taylor, optometrists Michael Brown, Ravi Dass,
Marika Fiolitakis, Karen Moulton and myself,
as well as Neil Pugh and Jennie Vowles, both
members of the New Zealand Lions, a crucial
VOSO supporter.
We went straight to Labasa Hospital from the
airport to deliver supplies and prepare for the
work ahead. The optometrists set up testing
stations and a glasses dispensary, while the
surgical squad familiarised themselves with the
operating theatres.
The next morning, we broke into action.
Michael, Marika and Karen worked the refraction
and screening stations, while Jennie gave out
prescriptions at the dispensary table. In the
theatres, the team adapted to performing
small incision cataract surgery in an unfamiliar
environment. They dealt with white cataracts, a
black cataract and an Argentinian Flag all on that
first day.
Meanwhile, Ravi, Neil and I brought our services
to the small, remote village of Coqeloa, seeing
those who couldn’t travel to Labasa. And every day
we worked a pair from our team would bring the
same services to a different village.
The Labasa Lions extended their hospitality to us
The team: optometrist Michael Brown, Dr Rebecca Stack, ophthalmic nurse Marie Taylor, Dr Genevieve Oliver, Lions member
Jenny Vowles, optometrists Karen Moulton, Marika Fiolitakis, Ravi Dass, and Reuben Gordon, and Lions member Neil Pugh.
throughout the week with after-work dinners, cohosted
by the Labasa Rotary Club and the hospital
board. Michael also arranged interesting tours
through a sugar cane field and a plywood factory
and by the end of that busy week we enjoyed a
getaway to Savusavu. We spent the weekend in the
markets, looking around the town, exploring the
resorts, snorkelling and taking in the epic Super15
final. A well-needed weekend to recover before
getting back into it.
The last week went way too quickly. I was
staggered to hear that we had performed 2,370
eye screenings and distributed more than 2,000
pairs of glasses. The surgical team performed 77
procedures, including 73 cataract removals and a
penetrating eye injury.
Labasa Hospital has improved immensely from
what I had been told to expect, testament to the
hard work of the local team led by ophthalmologist
Dr Uyanga Enebish.
It was an amazing experience and the VOSO team
were humbled by the hospitality of the Labasa
Lions. We all worked hard throughout the trip, had
interesting interdisciplinary chats and had a great
time socially. I am keen to return in the future and
Getting down to cases
would recommend it to all.
Anyone keen to volunteer should email
visionzsecretary@gmail.com. ▀
* Reuben Gordon is an optometrist at the Greenlane Eye Clinic
in Auckland and works for Shanu Subbiah at Eye Institute
Maui Jim training an amusing spectacle
He called himself “Chad from Texas” and
though he said he was tired, he came off as
the indefatigable life of the party.
At least that’s how Maui Jim’s travelling trainer
Chad Smith presented himself at a recent education
session for New Zealand’s dispensing opticians.
Smith intermingled personal anecdotes with
sales tips, technical information and company
history, in a Lone Star State drawl that made
earning CPDs a breezy night out.
“I got into this business by accident,” Smith said.
“I was going to university, and after six weeks my
dad called me on the phone and said, ‘I got your
credit card bill’.” Smith said his father gave him an
ultimatum: get a job, or lose his car, a virtual death
sentence for a college student at the time. The
following Monday Smith landed an assistant role
with a practice through a friend of a friend and the
rest is history.
More than 30 dispensing opticians and others
attended the September evening session at the
Sofitel Hotel in Auckland. Attending DOs qualified
for CPD points for the hour-long session, which
was the first the company has made available in
three years, according to Maui Jim’s New Zealand
sales executive Mark Buist.
Maui Jim is one of the last privately-held
sun glasses manufacturers to avoid a merger,
according to Smith, who joined the company
14 years ago from Luxottica, a perennial name
circulating the rumour mill as a potential buyer.
The company launched in 1988 in Hawaii, where
it still maintains offices. It has a lab in Texas and
a distribution centre in Illinois. The brand is sold
through 15 optical practices in New Zealand.
But virtually no consumers know the brand,
said Smith, quoting research revealing only seven
per cent of the American public knew what
Maui Jim was and three per cent of Australians.
Nevertheless, by some measure, the company has
made inroads, he continued.
“In 2007 we became the number-three brand
in America (after Ray Ban and Oakley) and we’re
the number one premium polarised brand. Not
because we advertise, but because of you guys:
people come into your practice and you give them
Maui Jim. That’s what made all those conversions
because you know if you sell to one, you’ll sell to all
their family members.”
Maui Jim sells a limited range of sunglasses—150,
crafted and refitted exclusively in its Texas labs—
with or without prescription, using polarised lenses
in a selection of tints the company says combine to
relax the eyes and make colours come alive to the
wearer.
Maui Jim’s approach has earned it a seal approval
from the American Cancer Society for protecting
the area of the face people forget to apply
sunscreen.
This December, Maui Jim will roll out its first
blue mirror lens, called Blue Hawaii, making its
world debut in time for the southern hemisphere
summer. The company has also introduced a
new display unit. It lambasts the idea of
spinning displays.
“Spinning is for strippers,” said Smith. “Not for
glasses.”
Attendees found Smith’s presentation
entertaining and informative, Buist says.
Most of Maui Jim’s products in New Zealand are
sold through optometrists, but 10 per cent are sold
through sunglass stores and pharmacies. ▀
* Rob Weatherhead attended medical school in Dunedin.
After graduation, he worked as an RMO in Brisbane and
then travelled to Britain to start vocational training in
ophthalmology. Two years were spent at Kings College
Hospital in London followed by an appointment on the
training scheme at Moorfields Eye Hospital. At the time,
this was the main route for New Zealanders to learn
ophthalmology. After completing the FRCS (Ophthalmology)
and a Higher Surgical Training Certificate, he attempted
to return to New Zealand, but had his arm twisted to work
in Saudi Arabia at the King Khalid Eye Specialist Hospital.
After 11 years as Chief of the Oculoplastic Division, he
finally made it home. He has been working in Christchurch
(private and public) for the last 15 years, including ten
years as an examiner for the RANZCO RACE exam. He has
three sons who are all on lower golf handicaps than he is,
an indication that he is working too hard.
Alley Bissett, Pene Fox and Christine Rae of Orewa Optics,
with Maui Jim’s Mark Buist
Zoe Ross, Susan Cathersides and Naomi Bicheno
Alex Bicheno of Mortimer Hirst with Graham Jenkins and
Tania Forde from Howick Village Optometrists
November 2015
NEW ZEALAND OPTICS
17

Nanosecond laser therapy for dry AMD—Part 2
BY DAVID WORSLEY, HAMILTON EYE CLINC
In the first part of this article in the July edition of
NZ Optics I introduced you to the 2RT laser (Ellex
Medical Lasers) which delivers a low-energy
nanosecond laser pulse that specifically targets the
retinal pigment epithelium (RPE) without damage
to the overlying neuroretina. We saw how studies in
AMD rodent models demonstrate regeneration of
RPE cells, re-activation of retinal microglial cells and
thinning of Bruch’s membrane with normalisation
of transmembrane transport—reversal of three key
pathological features of early AMD 1 . Furthermore,
histological examination of human early AMD
macula treated with 2RT demonstrated translation
of the animal model findings 1 .
At Hamilton Eye Clinic I have a 2RT laser as part
of an international ‘early adopter’ group tasked
with developing clinical protocols, providing real
world data and undertaking further research.
I now have two years experience with 2RT and
have treated over 360 eyes with dry AMD. I plan to
commence an interventional study later this year
using protocols based on this experience.
In this article I will discuss how to select patients
suitable for referral, the referral process, laser
treatment, results and risks.
The principle aim of 2RT treatment is to reduce
vision loss from early AMD by reducing disease
progression to late AMD
Drusen, and more specifically drusen volume, is
recogn ised as the most important risk factor for
progression to late AMD, either geographic atrophy
(GA) or neovascular AMD (nAMD). New vessels
and GA usually arise at the site of a soft drusen.
As GA forms there is a concomitant resolution
of the underlying drusen. In contrast, with this
process, 2RT laser leads to drusen resolution
with the crucial difference of resolution without
concomitant development of GA. The pilot clinical
study of patients with early AMD resulted in an
approximate 40% reduction in drusen volume
and an 80% stabilisation of drusen volume at 24
months 1 . The phase III LEAD study (NCT01790802)
is a multi-centre random ised trial of 2RT
treatment of early AMD that is fully recruited and
expected to report in 2018.
Early AMD is a slowly progressive disease.
Therefore a clinical program to assess the efficacy
of 2RT using reducing progression to late AMD as
the outcome measure will require up to 18 years
duration 2 .
The optometrist is the primary point of contact for
the vast majority of people with early AMD. Therefore
it is important for optometrists to be skilled in the
identification of the specific features of early AMD
that confer high risk of progression to late disease.
This will then provide the earliest opportunity to
commence AREDS supplements , provide dietary
advice and consider referral for 2RT laser.
There are several easily identifiable macular
factors assessable with a slit lamp and
fundus lens:
••
Drusen size. The AREDS study showed a
higher risk with any soft drusen that are
larger than 125μm (approximately the
diameter of a temporal retinal vein as it
crosses the optic disc margin)3 (Figure 1A).
These are termed large drusen. A drusen
>250 μm is termed a very large drusen
and is associated with a much higher risk.
(Figure 1B). The larger the total drusen area
and height (drusen volume) the greater the
risk. Fundus photography and/or OCT make
this assessment relatively easy.
••
Drusen proximity to the macula centre. The
closer, the higher the risk.
••
Pigment changes.
••
Late AMD (nAMD or GA) in the other eye.
Additional non-ocular factors:
••
Age
••
Family history of late AMD
••
Smoking
So, for many patients the risks mount up. But
how can you put all these factors meaningfully
together to get an idea of the risk facing your
patient? I recommend you use the online Casey
AMD risk calculator for risk of progression of
early to late AMD 4 . This can be open as a tab on
your web browser in the clinic room. There is an
instruction guide. The data listed in the bullet
points above is all that is required to calculate
risk. The section on genetics isn’t a requirement.
It is important to note that the calculator doesn’t
give a personalised risk of progression, but rather
provides an estimate of the proportion of patients
sharing the same characteristics who are likely to
develop late AMD in the specified time interval.
Figure 1A. A Large (125um diametre) drusen
(AREDS image). This is the threshold of
high risk. 1B. Large, Very Large (>250um),
confluent drusen and pigmentary change
indicate this eye is very high risk.
It is a logical extension of the rationale for
treatment of early AMD that 2RT may be beneficial
for late AMD with non-central GA. The fundamental
2RT-induced changes in the RPE, retinal microglia
and Bruch’s membrane in early AMD may also be
beneficial for GA. These eyes retain good central
vision but are at very high risk of GA progression to
the macular centre—progression to the centre is
considered to be inevitable should longevity permit.
2RT, by delaying or preventing central progression
may thereby preserve central vision.
A clinical study of 2RT for non-central GA would
be problematic. A clinical trial to provide an answer
to the whether 2RT reduces progression to centre
involvement would need to be many years long and
potentially need large numbers. This isn’t peculiar
to 2RT. Assessing treatments for GA is recogn ised
as facing many hurdles due to its slow progression
and our limited understanding of disease
progression 5,6 . At this point of time, we have only a
rudimentary understanding of how to predict the
rate of GA progression. Progression to the macular
centre is considered to be inevitable, longevity
permitting, but progression is very variable and for
an individual patient realistically all we can say is
that it is ‘high’. There is some recent, albeit early,
progress toward a useful clinical classification of
GA into subtypes with differing risks of progression
to central visual loss, but these are in need of
further definition before being of use 2 . There are no
known near-term markers that would allow us to
determine that progression of GA has been altered
by a treatment. The key near-term marker for 2RT
early AMD treatment, drusen reduction without
developing GA, can’t be used as a measure of
treatment effect for GA, as explained earlier.
The rationale for 2RT treatment of early AMD
can logically be applied to non-central GA. The
aim of treatment is to slow progression to central
involvement. 2RT’s simplicity, low cost and low risk
makes it an attractive consideration for an otherwise
untreatable condition with a very high risk of central
vision loss. On this basis I am comfortable providing
treatment for non-central GA.
Early to moderat cataract doesn’t prevent 2RT
treatment
Coexistent cataract is common in older patients.
Early or moderate cataract is usually not a
problem, the only modification required is a higher
laser power.
2RT TREATMENT PROTOCOL
For treatment of early AMD I use a protocol based
on that used in the pilot study and the LEAD study.
2RT is delivered by a slit-lamp system and
contact fundus lens. It is painless. The first step is
to determine the laser threshold. Beginning with
a moderate power setting, single applications at
progressively increasing powers are made outside
the temporal vascular arcades until a subtle
graying of the RPE is observed (threshold). The
treatment is approximately 30-40 applications
with an outer arc using 80% of threshold power
and an inner circle just outside the macula using
50% of threshold power (figure 2). The treatment
applications must cause no visible reaction; if they
do the power is further reduced.
Threshold can be very subtle and difficult to
observe and therefore, for safety, I never treat
above 0.30 mJ for the first treatment. If the result
is inadequate, treatment can be repeated at a
higher power.
Immediately after treatment there will be no
visible retinal lesion, nor will there be anything
detectable on OCT or fundus autofluorescence.
Figure 2. My current protocol. Approximately 30-40
laser applications. Green: outer arc at 80% threshold
power. Grey: inner circle, just outside the macula, at 50%
threshold power.
Figure 3. Autofluorescent imaging of the RPE. A. pretreatment.
B. Two months post-treatment Optimal RPE
‘footprints’ indicate that RPE repopulation and the other
treatment effects have occurred.
My experience treating GA is that a far lower power
is required and threshold is very difficult to determine
by looking for a graying of the RPE. There is a risk of
over-treatment which could lead to complete loss
of RPE at the treatment spot and potentially lead
to a new focus of GA. I have developed a treatment
protocol for GA eyes that avoids this trap. Briefly,
treatment is divided into two sessions. At the first
session, three laser spots at each of five progressively
increasing powers are placed well away from the
macula. Should RPE graying (threshold) be observed
then no more spots are applied. Six to eight
weeks later, fundus autofluorescence imaging will
determine the power setting that leads to an optimal
RPE footprint. Treatment is then completed at this
power. Laser spots are only placed outside of the
macula, near to the arcades and avoiding all potential
areas of RPE stress - margins of existing GA and areas
of very abnormal autofluorescence. By this protocol
over-treatment of stressed RPE, which might risk RPE
loss and GA at the treatment spot, is avoided.
A
B
Figure 4. A: Fundus aurofluorescent image showing noncentral
geographic atrophy and B: Yellow outlines geographic
atrophy (demarcated non-fluorescence) and red outlines the
area of surrounding stressed RPE (patchy hyperfluorescence).
My protocol is to keep 2RT applications outside of the blue
line to avoid treatment within areas of ‘stressed’ RPE.
FOLLOW UP
It takes approximately 6 to 8 weeks for the
adequacy of the laser applications to be
detectable by autofluorescent imaging. At the
first follow-up visit a top-up treatment is given if
the RPE ‘footprints’ are inadequate.
It is my experience that when treating early
AMD that drusen volume stabilisation or
reduction take at least 6 to 12 months to be
evident. In fact, drusen may continue to enlarge
in the first few months post treatment before
beginning to stabil ise. Macular sensitivity
improvements follow a similar time course.
2RT TREATMENT DEMONSTRATES REDUCTION
OF DRUSEN LOAD AT 12 AND 24 MONTHS
As discussed, it will take perhaps many years to
know how successfully 2RT treatment lowers the
risk of early AMD progression to late AMD or slow
down progression of non-central GA. In the interim,
the current benchmarks for treatment of early AMD
is the 12 and 24 month results of the pilot study;
75% stabilisation and 35% reduction in drusen load
and no incidence of nAMD at 24 months 1,6 .
At the time of writing I only have one early AMD eye
with 24 months follow-up. The pre-treatment and 24
month follow-up is illustrated in figure 5. This patient
demonstrates a remarkable and dramatic response to
treatment, however this should not be considered to
be the typical outcome. Interestingly, as this eye had
stable drusen volume at 12 months a re-treatment
was given and drusen reduction occurred after that.
Forty-five eyes have completed the 12 month followup.
Figure 6 is a patient treated in August 2014 with,
again, a remarkable improvement seen at 12 months.
I have not yet completed the full analysis of my 12
month results; however Table 2 summar ises the
primarily brief analysis of the drusen volume changes.
Figure 5. Left macula of 55 year old male. A-D: baseline
colour photo, drusen volume map, macular microperimetry
and hOCT. E-H: 24 month post-treatment. Note OCT post
treatment shows preservation of outer retinal integrity.
The remaining drusen are nearly all stable over 24 months.
Macular sensitivity is markedly improved.
18 NEW ZEALAND OPTICS November 2015

Figure 6. Right macula of 83 year old female. A-C: baseline colour photo,
drusen volume map, hOCT. D-F: 12 month post treatment. Note OCT post
treatment shows preservation of outer retinal integrity. Remaining drusen
are stable over 12 months.
TREATMENT RISK APPEARS TO BE VERY LOW
By dramatically reducing the laser dose when compared to conventional
laser and by selectively targeting the RPE without damaging the
neuroretina or choroid, treatment risk is expected to be very low.
To date, I haven’t observed any important complications following
treatment of early AMD. The same was found in the pilot study
and, to date, by the other early adopters. Occasionally a very
small haemorrhage occurs with higher powers during threshold
assessment. This was also reported in the pilot study and by other
members of early adopter group. In all cases, the haemorrhage
resolves without any apparent complication.
I inform my patients that no important complications have been
reported in over 2000 treatments for early AMD and, based on this
experience, I consider the risk to be very small.
Could there be that rather than reduced, there is an increased risk
of progression to late AMD, either nAMD or GA? To date, with over
2000 early AMD treatments worldwide, most of which are very high
risk eyes, there are no reports of progression to wet AMD. Possibly
the cases of progression to GA in the pilot study, in retrospect, may
have had what is now termed ‘nascent’ GA at entry 8 . Effectively
these eyes already had GA in that they were already undergoing a
process (nascent) that over a few months will inexorably lead to GA.
A surprisingly large proportion of eyes referred to me as having early
AMD in fact have hOCT evidence of nascent non-central GA. These
eyes do have established GA. This experience would suggest that our
current understanding of the prevalence of early AMD versus late AMD
with GA underestimates the progression to and prevalence of GA.
CONCLUSION
2RT is a promising treatment for dry AMD and should be considered for
patients with early AMD with high risk characteristics for progression
to late disease. It can also be used for eyes with non-central GA.
Your patient needs to be aware that this is a novel treatment.
The pilot study shows good results, my experience to date includes
impressive examples and risks appear to be very low. However, the
evidence of efficacy for early AMD is not yet complete with a phase
III trial still in process. For non-central GA the case for treatment is
supported by pre-clinical evidence and the clinical findings for early
AMD, but has the problem of lacking a method for determining a
short or medium-term treatment effect.
For more information please contact Dr David Worsley, Hamilton
Eye Clinic on 07 834 0006 or referrals@hamiltoneyeclinic.co.nz;
or Dr Jim Borthwick from Southern Eye Specialists in Christchurch
(who joined the early adopter group earlier this year) on 03 355
6397 or info@southerneye.co.nz. ▀
REFERENCES
1. Jobling, A.I., et al., Nanosecond laser therapy reverses pathologic and molecular
changes in age-related macular degeneration without retinal damage. FASEB J,
2015. 29(2): p. 696-710.
2. Advancing Therapeutic Development for Dry Age-Related Macular `Degeneration (AMD):
Workshop in Brief. Institute of Medicine. National Academies Press (US); 2015 Jan.
3. Ferris, F.L., et al., A simplified severity scale for age-related macular degeneration:
AREDS Report No. 18. Arch Ophthalmol, 2005. 123(11): p. 1570-4.
4. Klein, M.L., et al., Risk assessment model for development of advanced agerelated
macular degeneration. Arch Ophthalmol, 2011. 129(12): p. 1543-50.
5. Bindewald, A., et al., Classification of abnormal fundus autofluorescence
patterns in the junctional zone of geographic atrophy in patients with age
related macular degeneration. Br J Ophthalmol, 2005. 89(7): p. 874-8.
6. Mauschitz, M.M., et al., Topography of geographic atrophy in age-related
macular degeneration. Invest Ophthalmol Vis Sci, 2012. 53(8): p. 4932-9.
7. Guymer, R.H., et al., Nanosecond-laser application in intermediate AMD:
12-month results of fundus appearance and macular function. Clin Experiment
Ophthalmol, 2014. 42(5): p. 466-79.
8. Wu, Z., et al., Optical coherence tomography-defined changes preceding
the development of drusen-associated atrophy in age-related macular
degeneration. Ophthalmology, 2014. 121(12): p. 2415-22.
Figure 7. Right macula of 78 year old female. A-C: Baseline
colour photo, drusen volume map and macular microperimetry map. D-F:
9 months post treatment. Note baseline decreased macular sensitivity
corresponds to drusen and post treatment there is a marked improvement.
RESULTS
My Series (n=45
eyes)
Pilot Study (n=50 eyes)
12 months 12 months 24 months
Drusen load reduced 29% 44% 35%
Drusen load stable 64% 78% 75%
Table 2. 12 and 24 month drusen volume changes after 2RT laser for
early AMD. My series of 45 eyes and the the pilot study of 50 eyes 7 .
In the pilot study, three eyes (6%) developed GA at 12 months and 4 (8%)
by 24 months (none developed nAMD). In the natural history group 5%
and 9% respectively developed late AMD, either nAMD or GA. The figures
do not reach significance. In my series, no treated early AMD eyes have
progressed to late AMD at 12 months, either GA or nAMD, nor for that
matter have any of the 269 eyes treated to date. A crucial difference from
my study and the pilot study will be assessment of GA using h-OCT. Major
advances in our understanding of nascent GA mean that I am will almost
certainly classify a higher proportion as having GA prior to treatment
than would have been done in the pilot study. So, it may be that some
or all of the eyes in the pilot study that ‘progeressed’ to GA would, by
current definition, have already had nascent GA at entry. These results
are encouraging when we consider that all the treated eyes are very high
risk. However, follow-up is far too short for this to provide any evidence of
prevention of progression. I would think that my perfect record won’t last
and that with longer follow up I will find a percentage do progress to late
AMD, but hopefully less than what is expected from the natural history.
Re-treatment is offered if drusen volume continues to enlarge or is
stable at 6-12 months. The eye in figure 4 had re-treatment at
12 months.
I have treated 93 eyes with non-central geographic atrophy, either
nascent or frank GA. The follow up period is so far too short to have
any idea of a treatment effect on progression to centre involvement.
Only a very small number have shown relentless progression
(and these are all eyes with rapid progression documented pretreatment)
while nearly all appear to be either stable or have minor
progression. No eyes have developed nAMD.
2RT HAS REGISTRATION IN EUROPE AND LIMITED
REGISTRATION IN THE USA AND AUSTRALIA
2RT has CE mark (European Union) approval for treatment of Clinically
Significant Diabetic Macular Edema and Early AMD; the Australian
Register of Therapeutic Goods (ARTG) registration for early AMD ‘where
it can produce bilateral improvements in macular appearance and
function’; and FDA 510(k) registration for treatment of DME.
November 2015
NEW ZEALAND OPTICS
19

with
Prof Charles McGhee
& A/Prof Dipika Patel
Series Editors
Paediatric ophthalmic assessment
BY SAMANTHA SIMKIN* AND SHAUN DAI
“A person’s a person, no
matter how small”
—Dr Seuss.
The paediatric ophthalmic examination
is as important as any other ophthalmic
examination because an eye is an eye, no
matter how small. A child’s vision impacts on
all aspects of their and their family’s life. Vision
is necessary for learning, social interaction
and normal development. Ophthalmic
assessment of children is a sub-speciality of the
ophthalmic examination requiring specialist
tests, examination techniques and experience.
Children are developing in many ways including
their comprehension, conceWntration, social
interaction, communication and personality, not
to mention their visual ability. Thus, paediatric
ophthalmic assessment involves a multitude of
skills and each assessment varies depending on
the individual child.
The goals of a paediatric eye examination
include evaluating the child’s visual system
function, assessing ocular health, determining
any diagnoses and the appropriate treatment
plan, as well as to educate parents and children
on eye health. This article will cover the general
layout of a paediatric ophthalmic examination, as
shown in Figure 1. All examination components
are discussed in general terms and the
examination layout and tests used will vary
based on the individual patient’s symptoms and
findings.
Paediatric ophthalmic assessment general layout
1. Patient History
••
Presenting problem
••
Ocular history
••
General health
••
Family ocular history
••
Child development
2. Visual acuity
3. Refraction
••
Retinoscopy
••
Cycloplegic refraction
4. Binocular vision and ocular motility
5. Ocular health
6. Discussion with parents and children
FIGURE 1.
Having an eye examination can be frightening
for many children. In fact, examining a child can
be frightening for many clinicians. It is important
to remember that children, like adults, have
a wide range of personalities and each child
will react differently in the examination room.
Some children are calm and comply well with
instructions, while others are bouncing off the
walls, then there are those who don’t seem to
stop crying. A fearful child is hard to examine
where as a calm child allows for a better and
faster examination. Therefore, as the clinician
it is our role to put them at ease from the
beginning, this is often in the waiting area. A
friendly smile, toys to play with as they wait or
crouching down to eye level all welcome the child
into the new environment and make them feel
relaxed. This first moment of engagement will
flow on into the examination room so consider
it carefully before approaching a child. Once you
have got the child to the room consider where
you would like the family to be situated. For a
small child sitting on a parent or caregiver’s lap
is a safe and comfortable option. Older children
will be happy to sit by themselves, offer the
child the choice if they are unsure. Consider
both the adults and children positioning so
that both can be involved in the examination
without interfering with your examination.
Whilst navigating the labyrinth of the paediatric
ophthalmic examination the focus must
remain clear, to improve any visual reduction
that is currently present and prevent any further
visual loss.
PATIENT HISTORY
Paediatric patient history has similar
components to an adult’s ophthalmic history:
presenting problem, ocular history, general
health and family ocular history. It must also
include pre-natal, peri-natal and post-natal
history as well as the child’s development to
check if regular milestones have been met.
Allowing the childern to answer as many
questions as they keeps them involved, parents
and caregivers tend to jump in when extra
information is needed. Alternatively, further
detailed history can be asked of the parents/
caregivers at the end of this process. Questions
asked must be age appropriate for the children
both in concept and language used. A three
year old will be able to give their name and age
whilst a 12 year old would be able to answer
most of the history. The importance of language
and comprehension level of the child is critical
throughout the assessment.
VISUAL ACUITY
Vision matures rapidly in the first few years of
life as visual pathway development occurs. Visual
acuity is 0.15 logMAR (6/180) at one month of
age and develops to adult equivalent vision of
0.0 logMAR (6/6) by five years. 1,2 Methods for
assessing this varying vision must be age and
developmental stage appropriate. Preferentiallooking
techniques, such as Cardiff or Teller
cards is appropriate for pre-verbal or cognitively
impaired children. 1,3 Lea Symbols is an appropriate
test for pre-school children with a success rate of
76% at 3 years and 95% at 4 years old, as well as
high comparability to the Landolt C. 4 Compliance
with quantitative letter based acuity-testing can
be achieved in the majority of cognitively normal
5 year olds. 3 The ETDRS has high repeatability
measures in school aged children with refractive
errors. 5 Tests should be administered at the
appropriate distance and a matching card used
if necessary, these can be particularly helpful
with shy children. Continually praising children
encourages them to maintain focus and attempt
smaller optotypes during threshold visual
acuity testing.
REFRACTION
Infants are born hyperopic with an average
axial length less than 17mm. The majority of
ocular growth occurs before 24 months and
the emmetropisation process is completed
between 6 and 8 years of age. 6 However,
refractive error continues to change for some
children through out childhood. Objective
determination of children’s refraction through
retinoscopy is an essential component of the
paediatric ophthalmic assessment. Retinoscopy
prior to cycloplegia gives information to the
clinician on the accommodative status of the
child as well as an idea of their refractive error.
However, due to the high accommodative ability
of children, cycloplegic retinoscopy is necessary
for accurate refraction. A combination of
cyclopentolate 1% and tropicamide 1% has been
found to be effective to achieve full cycloplegia
in most children. Parents can help hold smaller
children when drops are administered. Aim to
get both eyes done one after the other before
the child pulls away, this gives them less time
to feel the sting on the first drop and leads to
less protesting. Children don’t like eye drops
so having a lolly or sticker ready to give the
child straight afterwards will get them back
on your side for the rest of the examination.
Accurate retinoscopy is important in children as
subjective refraction can be highly unreliable.
Practicing retinoscopy regularly on adult
patients will improve your accuracy for when it
is necessary to use in children.
Figure 2. A child wearing trial frames for refraction
BINOCULAR VISION AND OCULAR MOTILITY
Full ocular motility and binocular vision should be
assessed on all children when possible. Stereoacuity
tests such as the Lang stereo-test are suitable for
very young children with more detailed stereotests
such as the forced choice circles on the Stereo Fly
test being added to the examination as children
get older. Cover tests, with or without prism
measurement, can be performed on all age groups
as demonstrated in Figure 3. However, in those tricky
to examine the Hircshberg test is a great screening
tool to determine if strabismus is present. Binocular
vision impacts on the prescription given with a full
cyclplegic prescription needed in esotropic children.
Figure 3. Cover test of a young child with an age appropriate fixation target
OCULAR HEALTH ASSESSMENT
Slit lamp examination of the anterior eye can be
achieved with correct positioning of the child.
Babies can be held in the appropriate position by
a parent or caregiver, while older children who
are unable to reach the chin rest can kneel or
stand on the chair to make them comfortable.
Make the most of any time that you get their
head in an examinable position by being focused
on the aspects that need examining based on
the child’s history. This can be achieved in most
children older than 3, or 4 years old. For younger
infants the handheld slit lamp is usually required.
A dilated fundus exam using binocular indirect
ophthalmoscopy allows a fast examination of the
macula, optic nerve and periphery whilst allowing
the child an unrestricted head position. Make this
fun to keep the child engaged, however, if they are
disagreeable to your examination parents can be
asked to hold the child’s arms and head still while
you quickly examine both eyes by holding their lids
open.
Figure 4. Binocular indirect ophthalmoscopy being
performed on a child seated on their parent’s lap
DISCUSSION WITH PARENTS AND CHILDREN
The discussion at the end of the examination
is an important time to communicate results,
the action plan and educate the family. It is
important to clearly and concisely portray
information to children in an age appropriate
manner. Treatment regimens requiring long
term follow up and commitment by the
family, such as patching, should be discussed
at length to ensure the importance of the
treatment has been conveyed. In cases where
follow up of the family proves challenging or
compliance is a continual issue then referral to
a local ophthalmologist is needed. Referral to
a more experienced practitioner or paediatric
ophthalmologist is also appropriate when the
presentation or patient proves challenging,
there is no clear diagnosis or there is any
uncertainty of results.
The paediatric ophthalmic assessment has
many factors that need to be considered including
concentration, comprehension, cognitive and
physical developmental ability and the child’s
emotions. As the clinician you must engage with
both the parent/caregiver and the child to address
the concerns of all parties. With all these factors
it can often be a time consuming, challenging
process. However, it is a rewarding process that can
impact a lifetime. Adapting the examination to the
individual child’s personality and comprehension
will increase your success rate with any child. As,
Dr Seuss wisely wrote “You’ll miss the best things
if you keep your eyes shut”, with a well performed
paediatric ophthalmic assessment we can open
children’s eyes. ▀
REFERENCES:
1. Mayer DL, Beiser AS, Warner AF, Pratt EM, Raye KN,
Lang JM. Monocular acuity norms for the Teller Acuity
Cards between ages one month and four years. Invest
Ophthalmol Vis Sci 1995 Mar;36(3):671-685.
2. Salomao SR, Ventura DF. Large sample population age
norms for visual acuities obtained with Vistech-Teller Acuity
Cards. Invest Ophthalmol Visual Sci 1995;36(3):657-670.
3. Solebo AL, Rahi J. Epidemiology, aetiology and
management of visual impairment in children. Arch Dis
Child 2014 Apr;99(4):375-379.
4. Becker R, Hubsch S, Graf MH, Kaufmann H. Examination
of young children with Lea symbols. Br J Ophthalmol 2002
May;86(5):513-516.
5. Manny RE, Hussein M, Gwiazda J, Marsh-Tootle W,
COMET Study Group. Repeatability of ETDRS visual
acuity in children. Invest Ophthalmol Vis Sci 2003
Aug;44(8):3294-3300.
6. West CE. Refractive Error in Children. Pediatric
Ophthalmology: Springer; 2009. p. 7-20.
ABOUT THE AUTHOR
* Samantha Simkin is a
therapeutically qualified
optometrist from the
University of Auckland.
She is currently pursuing
her PhD in the Department
of Ophthalmology with a
focus of visual impairment
in children. Samantha is
supervised by Professor
Charles McGhee, Dr Shuan
Dai and Dr Stuti Misra.
20 NEW ZEALAND OPTICS November 2015

Aflibercept out-does laser
A
three-year drug trial showed significantly
better outcomes for patients injected with
aflibercept than those undergoing laser
hotocoagulation in the treatment of diabetic
macular edema (DME).
Bayer Healthcare announced the results of
the Phase 3 VIVID trial at the 15th EURETINA
Congress in September in Nice, France. The
company is collaborating with Regeneron
Pharmaceuticals to develop the drug for
treatment of DME under the brand Eylea.
According to a statement from Bayer, patients
in the Vivid-DME trial were randomised to receive
either aflibercept 2 mg every month (n=136),
aflibercept 2 mg every two months after an initial
injection every month for five consecutive doses
(n=135), or the comparator treatment of laser
photocoagulation (n=132). After two years, patients
randomised to laser could receive aflibercept 2 mg
according to protocol specific re-treatment criteria.
After three years, patients receiving aflibercept
every month had a mean gain in BCVA from
baseline of 10.3 letters, patients receiving
aflibercept every two months had a mean gain in
BCVA from baseline of 11.7 letters. Patients in the
laser photocoagulation treatment group had a
mean change in BCVA from baseline of 1.6 letters.
Additionally after three years, 41.2 per cent of
patients in the monthly group and 42.2 per cent
of patients in the bi-monthly group, maintained
significant gains of at least 15 letters, or three
lines, as measured on the Early Treatment Diabetic
Retinopathy Scale (ETDRS) eye chart, compared to
18.9 per cent in the laser treatment group.
Patients treated with aflibercept showed a similar
overall incidence of adverse events to the laser
treatment group. The safety results are in line with the
1 and 2 year data of the VIVID-DME and VISTA-DME
trials as well as the known safety profile of the drug.
Adverse events were typical of those seen in other
studies in patients with diabetes receiving intravitreal
anti-VEGF therapy. The most frequent observed
included conjunctival hemorrhage, cataract and
increased intraocular pressure. The most frequent nonocular
events in these groups included nasopharyngitis
and hypertension. Arterial thromboembolic events—as
defined by the Anti-Platelet Trialists’ Collaboration
(non-fatal stroke, non-fatal myocardial infarction, and
vascular death)—occurred in 14 out of 136 patients
(10.3 per cent) receiving aflibercept every month, six
out of 135 patients (4.4 per cent) in the EYLEA everytwo
months group and seven out of 133 patients (5.3
per cent) in the laser group.
“Allowing people whose eye sight has been
impaired as a result of their diabetes the opportunity
to regain and retain their vision over time is critical,”
said Jean-Francois Korobelnik, principal investigator in
the trial and chief of ophthalmology, CHU Bordeaux.
“Therefore these results are encouraging as the data
show patients who achieved vision gains in the first
year, maintained these gains over three years.”
Eylea is approved for the treatment of
patients with neovascular age-related macular
degeneration (wet AMD), visual impairment due
to diabetic macular edema (DME) and macular
edema secondary to central retinal vein occlusion
(CRVO). Over five million doses of Eylea have been
administered since launch worldwide. ▀
Lively discussion, with tapas
BY SAMANTHA SIMKIN*
The World Society of Paediatric Ophthalmology
and Strabismus (WSPOS) held an interesting
and ambitious programme for this year’s
Barcelona conference. All aspects of paediatrics,
strabismus and the interaction between adult
and paediatric influences were covered from an
international point of view.
Dr Shuan Dai, Dr John Dickson, Dr Stuart Carroll, Samantha
Simkin, Lisa Hamm and Dr Cheefoong Chong at WSPOS
The goal of the congress, which ran in early
September, was to help advance paediatric eye
care around the world through expertise and
knowledge-sharing.
More than 1,200 delegates were warmly
welcomed to the Fira Barcelona Gran Via, near the
heart of this beautiful European city. New Zealand
was represented by six delegates: Dr Stuart Carroll,
Dr Shuan Dai, Dr Cheefoong Chong, Lisa Hamm
and myself, Samantha Simkin (née Watkins) from
Auckland, and Dr John Dickson from Hamilton.
The conference offered a variety of learning
opportunities with free paper sessions, expert-led
panel discussions, symposia, audience-directed
sessions, an electronic poster village and a mock trial.
New Zealand was represented throughout the
conference. Dr Shuan Dai chaired a video symposium
called Signs of Paediatric Ophthalmology &
Strabismus in which he and Dr John Dickson spoke.
Dr Dai also spoke on exotropia, and at a symposium
on retinopathy of prematurity (ROP).
I presented a free paper titled ART-ROP: A Real
World Telemedicine Screening for Retinopathy of
Prematurity, and also represented New Zealand in
the poster village along with my fellow Auckland
University PhD candidate Lisa Hamm.
A wide range of topics were discussed at the
meeting from ophthalmogenetics to myopia
control and early intervention. Lab research,
clinical research and clinical application were all
equally presented and discussed. There were lively
debates on the application of research in different
environments highlighting the vast difference
in practicing conditions between Sweden and
Pakistan, and between Nigeria and New Zealand.
Yet, a passion for patient care across the world
was clearly evident, as was the desire to improve
paediatric eye health internationally.
The mock trial was on the sensitive subject of a nonaccidental
injury, featuring US-based Dr Alex Levin
of Wills Eye Hospital and Dr Gil Binenbaum of The
Children’s Hospital of Philadelphia. They presented as
“Dr Defence” and “Dr Prosecutor”. Witness deposition,
harsh cross-examination and extended lively
discussions culminated in an audience vote for guilty
or not guilty (it was just over half for guilty) of the
fictitious case. Close to 1000 delegates attended this
session alone with Dr Levin closing with some top tips
on being an expert witness in such cases.
The inaugural Kanski Medal Lecture was given by
paediatric ophthalmologist Dr Helen Mintz-Hittner
of Houston, Texas, who is internationally known for
her pioneering research in ROP. Dr Mintz-Hittner
discussed the use of bevacizumab as a treatment
for ROP, and the BEAT-ROP trial. Her first-hand
experience of using the anti-VEGF injection of
bevacizumab compared to the standard treatment
of laser photocoagulation is challenging the way
ROP is being treated around the world.
This is of high importance with the rising
number of ROP worldwide, especially given,
what is considered to be, a third epidemic of ROP
occurring in middle-income countries.
The latest outcomes for BEAT-ROP show more
favourable long-term outcomes than current laser
treatment including reduced refractive errors and
increased visual fields. The BEAT-ROP treatment
regimen shows a slightly higher recurrence rate of
ROP thus would impact on follow-up management
of those infants receiving the treatment. Dr Mintz-
Hittner’s ground-breaking work has the potential
to save the sight of infants across the world, the
epitome of WSPOS’s goals.
Having a conference in Spain, means dinner
shouldn’t be expected until at least nine pm. So
to wind down from a day of learning, tapas and
sangria were a must. The New Zealand team along
with other congress delegates from across the
world gathered for lively discussion of new research
ideas, current projects and clinical application.
On the final night, we were joined by Dr Ken
Nischal, one of the WSPOS’ presidents, as well as
delegates from Singapore, Hong Kong and Australia.
The conference was a wonderful success for
the WSPOS. It was a privilege for New Zealand
to be strongly represented and to contribute on
international discussions, and in some cases,
lead the field. International discussions and
relationships built over there will impact on
research and clinical practice in the years to come.
The delegates from the 3rd World Congress of
Paediatric Ophthalmology and Strabismus will
all be looking forward to meeting again in Jaipur,
India in 2017. ▀
* Samantha Simkin received her Bachelor of Optometry with
first class honours from the Department of Optometry and is
now a PhD candidate in the Department of Ophthalmology at
the University of Auckland.”
Tel: 027 273 8126
InterMed Medical Limited Free Phone: or 0800 333 333 444 www.intermed.co.nz 444
71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740
InterMed Medical Limited Free Phone: 0800 333 444 www.intermed.co.nz
71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740
*Venter JA, Barclay D, Pelourskova M, Bull CE. Inital
experience with a new refractive rotationally asymmetric
multifocal intraocular lens. J Refract Surg 2014: 30(11):770-6.
PKB50 REV1
November 2015
NEW ZEALAND OPTICS
21

Progress for retinal
prosthesis system
New views
From time to time I feature guest columnists. My dear wife Karen has written a few well received
pieces for me. They’ve featured contact lens and makeup tips, experiences with multifocal
contact lenses, lens care and solutions. I thus recently suggested she do another. Here follows her
latest contribution.
A tribute to my mother
Alan recently sent me an email. It read: “u must write more columns for me!”
His September column paid tribute to Brien Holden and Trevor Duncan, who both passed
away in July. I knew them both. Their sad passing added to a winter of losses; a few other
people we knew recently passed on, as did a favourite dog called Max. We miss them all.
I always proof read Alan’s writing, (which is why it’s so good ). The final version of the September In
Contact column was submitted on the 17th of August, which happens to be my mother’s birthday.
The thought came to me that sometimes we should pay tribute before it’s too late, to let people
know how much we value them. We should say thank you for the richness they bring to our and
other’s lives, while they are still able to hear or read our words.
Like Alan, my mom Rita is also a writer. Early on she wrote a few novels, particularly in the early stages
of my father’s publishing career. One or two books might have been written because they had to have
something for the monthly Mills & Boon-like, subscription books my dad published. My dad also wrote a
book, for the same reason, over a weekend at the kitchen table: talk about doing what you have to.
My mom’s writing was good, always inspirational. The books she really enjoyed working on though
were the interior decorating books that followed later. Creating a visual delight on each page brought
her immense joy.
By that stage I’d joined the family publishing company that was founded by my grandfather. We had
a huge amount of fun together, working on these publications. The interior decorating books were
really a summary of my mother’s philosophy. She often said things like “beauty before practicality”, or
actually, “practicality be damned, this is a jewel”, which is an odd thing for an interior decorator to say,
but totally in character. My mother sees the world through rose-tinted glasses, her glass is always half
full, the horoscope always has a positive message, good things lie ahead, life is amazing!
My mother hears the birds, she sees the first hint of spring in the garden. She has champagne in her
veins, despite being a lifelong teetotaller. She is high on life, when times are good, and even when they’re
not so good. Dark days mean that a turning point is near, that the next dawn will be the brightest ever!
As Jim Morrison once said, “the future is uncertain and the end is always near”. All we really have
with some degree of certainty is NOW. Live life while you have it, do the things that you want to do,
stick your neck out, take risks.
Optometrists, or optimists as our daughter used to say when she was young, give the gift of
improved vision. A new pair of stylish frames can work miracles, or no frames and improved vision with
contact lenses can be life changing. A new image, a new phase in life…
Let there be sight, and see the beauty around you!
A rosy outlook
I’m finishing this column off after a whirlwind trip to Silmo in Paris; a fantastic exposition of frames,
sunglasses, lenses, instruments and low vision aids. Read all about it in this edition in Maryanne’s
report. It’s taken me over thirty years to finally visit Silmo. I’ve always had a more senior partner
ahead of me in the queue to attend overseas trade fairs. Thanks to Maryanne for showing me the
ropes. I was amazed to see how many people knew Maryanne and were so happy to see her. We hung
out with a few Danes, French, Kiwis, Aussies, POHMS and the odd South African, German and Austrian.
We had entertaining meals, including a memorable dinner with the legendary Oliver Goldsmith, a
real character and stalwart of the optical world. He’s always good for a story.
Any independent optometrist looking
for a competitive edge, or simply seeking
maximum exposure to the widest range of
frames possible, would be well-served by
attending Silmo. France in the Autumn is also
rather pleasant. I enjoyed some great walks
wandering the suburbs of Paris and exploring
the canals, cemetries, museums, parks and
shops, before the ever hectic trade fair
kicked off.
Having being relatively uninvolved in frame
buying since selling our practices around seven One of the many colourful, attractive stands. A giant
years ago, it was a great opprtunity to get up to model of a printed frame.
speed on the latest trends, fashion and technology.
I was impressed with some new innovations and with the quality and technological development.
Maryanne will elaborate in her report.
Proper people
What Silmo also reinforced for me was the importance of working with a great team of people
and the importance of the suitability, quality and functionaility of the dispensed eyewear.
Every person in the supply chain plays a role.
Spectacles are commonly the physical manifestation and summation of all that we do. They largely
determine the success of the outcome and overall satisfaction of the patient.
Dispensing can be rather challenging at times.
I’ve been very lucky in my career to work with great teams of people and skilled professionals, who
are focussed on excellent outomes for our patients.
That is after all what it’s all about.
Let there be light.
Let there be sight, and see the beauty around you.
After two interesting days back at the office, writing three columns, washing clothes, some gardening
and repacking my bags, it’s off to New Orleans, a city high on my bucket list. The American Academy
of Optometry conference, arguably the number one optometric conference in the world, beckons. Not
that our local CPD managers recognise that. I have to do a heap of paperwork and pay to have the CPD
recognised in NZ, so I usually don’t bother. If I ever lacked points for an annual registration, I’d probably
bother more. The upside is I can skip a few lectures and enjoy more of New Orleans.
Yeeehah.
I’ll report back on my return.
Cheers from the departure lounge!
Larry Hester, the seventh person in the U.S. to have an Argus II Retinal Prosthesis Device implanted allowing him to see
for the first time in 33 years
Popular press trumpeted the first implant of
a “bionic eye” for patients with dry agerelated
macular degeneration when doctors
performed the first implant and activation of the
Argus II Retinal Prosthesis system earlier this year.
The bionic eye part is debatable, but the
operation—performed at the Manchester Royal
Eye Hospital in June by Dr Paulo Stanga—was a
step forward for the Argus II system, which was
originally tested, and approved for restoring some
vision in patients with retinitis pigmentosa (RP) in
the US in 2013 and Europe in 2011.
The Argus II System has now been implanted
in 150 patients in the US, Canada, France, Italy,
Germany, the Netherlands, Saudi Arabia, Spain,
Switzerland and the UK. The Manchester implant
was part of a feasibility trial for evaluating Argus II
for treating late-stage Dry AMD.
While Second Sight Inc.—the California, based
company behind the Argus II system—has not
been the only company in the last 15 years to
pursue retinal implant systems, it appears to have
gone the furthest, at least as far as feasibility and
clinical trials, and regulatory approval.
Argus II is comprised of a small electronic device
implanted in and around the eye, a small video
camera attached to a pair of glasses, and a video
processing unit worn or carried by the patient. The
video processing unit receives images captured by
the camera, and turns them into signals transmitted
to the implant wirelessly. The implant transmits
the signals to the retina in electrical pulses, which
are intended to bypass damaged photoreceptors by
stimulating the retina’s remaining cells. The system
creates the perception of patterns of light which
patients can learn to interpret as visual patterns.
According to an announcement released by
Change of guard at
Younger Optics
Younger Optics Australasian sales and
marketing manager Trevor Inglis is retiring
after 10 years. To work on his golf handicap,
he says jokingly.
Speaking to NZ Optics at ADONZ 2015, Inglis says
he’s been planning the move for some time, but
wanted to make sure he had the right successor
in place and he was on hand to ensure a smooth
handover before moving on.
That successor is Samantha “Sam” Crooke, an
Australian optometrist by training, who has held
a variety of positions in the optical field including
practice manager, professional education manager
and even Queensland territory manager for
Younger Optics. The two have known each other
since 2008 and Inglis was visibly delighted to be
Samantha Crooke
Second Sight, the Argus II Manchester implant was
the first of a larger study to expand the application
of the system. Eligibility for this study includes
patients 25 to 85 years of age with advanced dry
AMD, some residual light perception and a previous
history of useful form vision. Study subjects will
be followed for three years to evaluate safety and
utility of the system on visual function.
The first recipient of the Argus II in the study
was Ray Flynn, 80, of Manchester who had lost his
central vision to AMD, but had some peripheral
vision. According to reports, Flynn was able to
detect the pattern of horizontal, vertical and
diagonal lines on a computer screen using the
implant in a test just two weeks after surgery.
In its approval of the device for use in up to 4,000
procedures per year, the FDA in 2013 stated it had
reviewed data that included a clinical study of 30
participants with RP who received the Argus II
Retinal Prosthesis System. Investigators monitored
participants for adverse events related to the
device or to the implant surgery and regularly
assessed their vision for at least two years after
receiving the implant.
Results from the clinical study show that most
participants were able to perform basic activities
better with the Argus II than without it including
locating and touching a square on a white field,
detecting motion direction and recognising large
letters, words, or sentences, among other tests.
Following the implant surgery, 19 of the 30 study
patients experienced no adverse events related
to the device or the surgery. However, 11 study
subjects experienced a total of 23 serious adverse
events, including erosion of the conjunctiva,
dehiscence, retinal detachment, inflammation, and
low intraocular pressure. ▀
able to introduce Sam at ADONZ to many existing
and would-be New Zealand customers.
With several new products in the pipeline,
including the as yet to be launched Camber it’s an
exciting time to be taking over, says Crooke.
“In an ever-consolidating and competitive
market, Trevor has contributed to Younger Optics’
growth, and more importantly our customers’
growth by understanding their needs, providing
exceptional customer service and support,” said
Mark Rupert, Younger Optics general manager, Asia
Pacific, in a statement. “Both Younger Optics and
our customers will miss him, and we wish him
the best.”
Inglis will leave Younger at the end of the year,
ending a 35-year career in the optical industry. ▀
Trevor Inglis
22 NEW ZEALAND OPTICS November 2015

Kiwi cameos feature in
Australian optometry
history
The Australian College of Optometry
(ACO) has published a history book to
commemorate its Diamond Jubilee.
A History of Australian Optometry by Professor
Emeritus Barry Cole was debuted at the ACO
National Conference on October 24.
“The college has been an important player in
the history of optometry over the last 75 years
and whilst it has its own chapter, the book tells
the story of more than 200 years and features
optometric institutions and optometrists
Australia wide,” Cole said in a statement released
prior to the debut.
A History of Australian Optometry begins with
the spectacle sellers and sight-testing opticians
who became the early adapters of refraction
techniques in the second half of the 19th century,
and proceeds to the associations, regulations and
new technologies of the 20th century.
But given our close association, the book soon
demonstrates that a history of optometry in
Australia cannot be written without New Zealand
making more than a few appearances.
According to ACO’s Arwen Bardsley, the history
book reports the first person to graduate with
an optometry degree from the University of
Melbourne was New Zealander Gavin Bridgman.
“He studied optometry in the ACO expecting to
qualify with a diploma of Licentiate of Optometric
Science (LOSc). He was in his final year in 1961
when the course became a degree course of
the university and he was admitted to the new
degree course in that year with full credit for his
prior studies in the college,” says Bardsley. “He
obtained both the LOSc diploma from the college
and a Bachelor of Applied Science (Optometry)
from the university. He was in fact the only final
year student in that year, so he has the single
honour of being the first to obtain a degree in
optometry in the University of Melbourne.”
While that wasn’t the first degree in optometry
awarded in Australia, it reinforces the intertwined
history of the profession in Australian and New
Zealand. A number of New Zealanders studied
optometry in Australia through the 1950s,
including Roger Sargent, John Fairmaid and
Lex Grocott.
A chapter focused on Registration Acts shows
New Zealand also played a more active role in the
Trans-Tasman Mutual Recognition Act than some
Australian states. Australia, in turn, contributed
Professor Emeritus Barry Cole, author of ACO’s new
history book
New approaches to
presbyopia
Pharmaceutical company Novartis has
teamed up with Google to integrate the
search engine giant’s technology within
contact lenses.
According to Reuters, Novartis is already
planning initial human tests on the first product
to emerge from the collaboration—contact
lenses that can accommodate vision correction
in presbyopes.
New approaches to presbyopia are
accelerating. Several companies are testing
or already marketing presbyopia solutions
from different angles. Presbyopes, it appears,
will have a wider selection of options beyond
multi-focal CLs, progressives and LASIK, with
Google-Novartis’ auto focusing CLs, inlays and
eye drops.
In October, Texas-based Encore Vision
announced the US Food and Drug
Administration (FDA) had granted it permission
to begin clinical trials on a topical treatment for
presbyopia. Encore’s EV06 is an investigational
proprietary lipoic acid choline ester compound
aimed at reversing changes in the crystalline
lens that result in diminished lens elasticity.
The company says it will be the first clinical
evaluation of a new chemical entity to address
the underlying physiological processes causing
presbyopia.
“To have a pharmaceutical therapy that could
effectively reduce dependence on bifocals
or reading glasses is truly a groundbreaking
approach in the treatment of presbyopia,”
to the development
of optometry
education in New
Zealand, with
Australian Leon
Garner becoming
the foundation
professor of
optometry at
the University of
Auckland.
Author Professor
Cole has seen a good deal of the history of
Australian optometry up close. He qualified in
optometry at the ACO in 1954 and was appointed
its first full-time lecturer in 1958. He was made the
head of the Department of Optometry and Vision
Sciences at the University of Melbourne when it
was established in 1973 and he was appointed
the foundation professor of optometry in the
University in 1978. He is now Professor Emeritus in
the University of Melbourne.
A History of Australian Optometry (320 pages,
illustrated) is available in softback (A$75) or deluxe
hardback format ($160) from
www.optometry.org.au/shoponline.aspx or
www.aco.org.au/history-book. ▀
says Dr Richard Lindstrom, adjunct professor
emeritus of ophthalmology at the University
of Minnesota. “If EV06 proves successful in the
clinic, this will be a major shift in how we treat
the massive presbyopic population.”
The first EV06 study will compare the safety
and efficacy of EV06 to placebo in at least 72
subjects, 45 to 55 years of age with presbyopia,
and evaluate mean change in distance corrected
near visual acuity (DCNVA) and best corrected
distance visual acuity (BCDVA), along with
additional secondary outcomes.
Corneal inlays have also begun to take off
with AcuFocus’ Kamra inlay receiving regulatory
approval this year for marketing in the US and
Europe. The Kamra device is 3.8 mm in diameter
and 6 microns thick with a tiny 1.6 mm central
opening that creates a pinhole camera effect.
The Kamra inlay procedure takes less than 15
minutes and does not require stitches.
Revision Optics of California is waiting in the
wings to bring its Raindrop Inlay to market as
soon as the FDA gives its final sign off, likely by
mid-2016.
The Raindrop is a microscopic hydrogel that
is 80 per cent water, and as with existing inlay
processes, is implanted in the non-dominant
eye, in an in-office laser procedure.
The company says the inlay changes the
anterior curvature of the cornea, allowing for a
“natural restoration of near vision” and because
it is mostly water, the inlay does not restrict the
amount of light reaching the retina. ▀
A collector’s
rare frames hunt
Tom Chapman has been a collector of all
things vintage for years, from t-shirts to
music to footwear. The young Australian
school teacher, however, ventured into classic eye
frames back in 2008, and has since built a small,
but prized collection around original
Cazal designs.
“The inspiration came from a now defunct
vintage store that I found in Bangkok, Thailand
while I was teaching overseas,” Chapman says.
“I still remember the revered Cazal 858 frames
sitting in the window of the store, the price tag
was about two weeks wages for me at the time
and for many weeks I walked by without trying
them on, and then one day I took the plunge, tried
them on and immediately made the purchase.”
Chapman now owns among the highest valued
Cazals sought by collectors, such as the large
The grey 616 (bottom) is the rarest Cazal in Chapman’s
collection
NEW
Built on the ACUVUE ® MOIST Platform
the #1 best-selling daily disposable brand around the globe 1
Her Vision Will Change.
Her Experience Won’t.
Now you can continue excellent care as her vision evolves into presbyopia
with 1-DAY ACUVUE ® MOIST Brand MULTIFOCAL Contact Lenses
of patients were successfully fit
with 2 pairs of lenses or less
94 % when using the Fitting Tips.*
*Up to 4 lenses total. 1 JJVC Data on File 2015 (Internal Analysis, based on independent third-party data)
mottle grey 616—one of the rarest—the red 951,
the large amber brown 642, and a custom 951.
He says his is small compared to other vintage
frame collectors who can own hundreds or
thousands of items.
“I have collected, sold and traded perhaps only
about 50 or so frames,” Chapman says. “Any more,
and I think my wife would have something to say.”
His collection now also includes Cartier, Dior, and
Porcshe Carrera frames, but some of his Cazals are
counted by collectors as the Holy Grail of the niche.
“Its distinctive style, created and designed
by Cari Zalloni, was made famous long before I
was around,” Chapman says. “The hip hop stars
and celebrities of the 80s and 90s and now
even today have favoured many of the creator’s
frames. The legendary style can be still seen in
many of today’s movies, music video clips and
even on the catwalks.”
The majority of the original frames were made
in West Germany. Chapman collects from various
auction and classified websites. The odd collector
may come across frames in practices, Chapman
says, sitting long-forgotten in a store room,
covered in dust and cobwebs, but he has never
had such luck.
“My collection is on display and cared for in
my home, but unlike some other collectors,
mine are worn on a daily basis. I’m a teacher
and the kids at school always get a buzz out of
the frames I wear,” he says.
The brand happened to enjoy a renaissance after
Chapman started collecting and Cazal now sells
some of its iconic lines alongside new designs.
Collectors seek certain numbers (or “series”),
most notably the 600 and 900 series, and
some frames from the 100, 700 and 800 series.
The popular frames from the extensive Cazal
collection each have a unique style, making them
more desirable to collectors.
So if anyone out there has some old Cazal
frames lying around in the practice, contact Tom
Chapman at tomchapman00@gmail.com. ▀
Learn more about the
predictable and positive
fitting experience.
ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience
mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or
other eye problems. Consult the patient information guide for more information.
Johnson & Johnson Vision Care, a division of Johnson & Johnson Pacific Pty Ltd., 45 Jones Street, Ultimo NSW 2007 Australia. Phone 1-800-125-024. www.acuvue.com.au.
Johnson & Johnson Vision Care, a division of Johnson & Johnson (New Zealand) Ltd., 507 Mt. Wellington Highway, Mt. Wellington, Auckland 1060, New Zealand.
Phone: 0800-449-535. www.acuvue.co.nz ®TM Registered Trademark. CCP 8785/15
ACUVUE® and 1-DAY ACUVUE® MOIST are trademarks of Johnson & Johnson Vision Care Companies. © Johnson & Johnson Vision Care Companies 2015 10314426-A April 2015
November 2015
NEW ZEALAND OPTICS
23