Nov 2015

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.


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

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

<strong>Nov</strong>ember <strong>2015</strong>


Far<br />

Intermediate<br />

Near<br />

For more information contact your Bausch & Lomb Territory Manager<br />

or our Customer Services on 0508 375 394<br />

© 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.<br />

Bausch & Lomb (NZ) Ltd c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd. 0508 RADIANT.<br />

2 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Insight Hamilton’s interior<br />

exudes confidence with colour<br />

Dispensing optician Isobel Martinez and<br />

optometrist Wan Syian Yong go way<br />

back, to their days at MySight Vision<br />

Specialists Group.<br />

Yong and Martinez re-established their<br />

professional association last December when<br />

Yong opened her second practice, Insight Eyecare<br />

Hamilton at Te Awa Mall. Yong asked Martinez to<br />

head up the new practice, while she continued<br />

work at Flagstaff Eye Care on River Road.<br />

“When Wan Syian first approached me to see<br />

if I was interested in setting up and managing a<br />

new practice, I said ok, but it has to be different to<br />

anything else we have seen before and seeing as<br />

we are going to be in a mall, we have to appear to<br />

be a bit more retail driven.”<br />

Yong gave Martinez a blank slate, and this trust<br />

led ultimately to recognition in the Resene Total<br />

Colour Awards <strong>2015</strong>. Insight Eyecare and the<br />

architects, Ignite Architects, who realised Martinez’s<br />

vision, took the Colour Commercial Interior Retail<br />

and Public Colour Maestro Award, leading to<br />

coverage in several consumer magazines.<br />

“I was given free rein on design, stock and feel,”<br />

“I was given free rein on design, stock and feel, quite the opportunity,” says Isobel Martinez (seated), who joined<br />

Insight soon after its December 2014 opening<br />

says Martinez. “It was quite the opportunity. I<br />

really felt that the fashion side of optics has been<br />

missing now for some time, and I started to put<br />

together a unique collection strongly representing<br />

our NZ designers.”<br />

Insight’s domestic brands include Karen Walker,<br />

Kate Sylvester, Age and Andrea Moore, which<br />

Martinez says are not otherwise available in its<br />

vicinity. Overseas brands include Paul Taylor, Salt,<br />

Moscot and Pared.<br />

As for as the look and feel of the practice,<br />

Martinez had specific ideas in mind.<br />

“I was very clear with Nicole Hamer-Nel (interior<br />

designer at Ignite) that I really didn’t want<br />

another ‘white practice’. I asked her to look at<br />

Rodd & Gunn in Newmarket. I liked the wood/<br />

industrial feel. I mentioned old chemist and<br />

library looks and that I wanted a dispensing bar<br />

rather than individual tables.”<br />

The architects came through, evidenced by the<br />

recognition of winning Resene’s Australia-New<br />

Zealand-wide competition and the comments<br />

of the judges: “strong colour works well with<br />

the strength of the timber for a clinical yet<br />

comfortable and relaxing feel. The confidence of<br />

the colour and materials palette brings with it a<br />

sense of reassurance and trust, with the dark and<br />

light combination providing a balance….The timber<br />

provides a raw sense of honesty. Solid colour blocks<br />

are used with restraint drawing your eyes into the<br />

product showcases.”<br />

Insight Eyecare’s interior will be featured in<br />

upcoming issues of Urbis magazine and<br />

Fashion Quarterly.<br />

The endorsement, to say nothing of the<br />

forthcoming publicity, highlight a strong first year<br />

for the new practice.<br />

Martinez says the practice provides a mix of<br />

eyewear ranges, but she describes the underlying<br />

style motif as “retro.” Customers also range in kind<br />

and geography, with some clients coming from as<br />

far away as Wellington, she adds. ▀<br />

What’s inside<br />


Is it my imagination or is everyone in vision<br />

health in New Zealand really nice? I know,<br />

people are people, but my first big industry<br />

event, the annual ADONZ conference, allowed<br />

me to meet so many open, friendly and<br />

enthusiastic dispensing opticians, it was almost<br />

overwhelming. You people really know how to<br />

party, at least when it’s a chance to dress up<br />

in 1920s garb. You can read about the ADONZ<br />

annual conference on pages 10-14, with a bit<br />

more to come in the December issue.<br />

While publisher Lesley Springall and I were<br />

busy in Hamilton, our editor-at-large, Maryanne<br />

Dransfield tackled Silmo, and going by her account<br />

on page 8, Paris was burning with innovation.<br />

In this issue, you’ll also read about myopia, a<br />

new textbook on ocular prosthetics, and much<br />

more. I’d also like to mention Eye Institute’s first<br />

ever dispensing opticians and support staff oneday<br />

conference on <strong>Nov</strong>ember 8 in Auckland.<br />

Details inside. ▀<br />

Resene Total Colour Award judges remarked Insight’s<br />

“strong colour works well with the strength of the<br />

timber, for a clinical yet comfortable and relaxing feel.”<br />

An innovative low vision offer for Eye Care Professionals.<br />

More and more people are suffering from low vision as a result of<br />

age-related macular degeneration, diabetic retinopathy, glaucoma,<br />

cataracts and many other conditions.<br />

HumanWare introduce the first one-stop shopping offer to support<br />

Eye Care Professionals wanting to serve this growing segment of the<br />

population. Our offer comprises key aids that will help you address a<br />

vast array of needs including both optical and electronic devices.<br />

More than offering products, our commitment is to offer Eye Care<br />

Professionals the Solutions that will help them grow and develop their<br />

expertise in Low Vision. For more information on how to offer Low<br />

Vision solutions to your patients contact your local HumanWare<br />

Account Manager.<br />


0508 22 55 734<br />

nz.ecp@vahumanware.co.nz<br />


(02) 9686 2600<br />

au.ecp@humanware.com<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Auckland’s Myopia Lab to<br />

shed more light on “epidemic”<br />


A<br />

research paper published in the Journal<br />

of the American Medical Association in<br />

September riwppled through the global<br />

mainstream media.<br />

Headlines shouted the salubrious effect on the<br />

prevalence of myopia among school children who<br />

spent 40 minutes outside each day for three years.<br />

This observational study included 952 children in<br />

an intervention group from six schools, and 951<br />

in a control group from another six schools in<br />

Guangzhou, China.<br />

“There were some studies suggesting the<br />

protective effect of outdoor time in the<br />

development of myopia, but most of this evidence<br />

is from cross-sectional studies (survey) data that<br />

suggest ‘association’ instead of causality,” lead<br />

Myopia rates are soaring around the world, but especially in east Asia<br />

author Dr Mingguang He of Sun Yat-sen University<br />

told Reuters. “Our study, as a randomised trial, is<br />

able to prove causality and also provide a high level<br />

of evidence to inform public policy.”<br />

According to the study the cumulative<br />

incidence rate of myopia was 30.4 per cent in the<br />

intervention group and 39.5 per cent in the control<br />

group. There was also a significant difference in<br />

the three-year change in spherical equivalent<br />

refraction for the intervention group (−1.42D)<br />

compared with the control group (−1.59D), though<br />

the elongation of axial length was not significantly<br />

different between the intervention group (0.95<br />

mm) and the control group (0.98mm).<br />

The story ended there as far as the popular press<br />

was concerned: more time outside equals less<br />

nearsightedness. But it is really only the beginning<br />

for ocular research into a common condition that<br />

has been rapidly getting worse in the last 60 years.<br />

While it has been observed for more than 400<br />

years, the mechanics of myopia still need to be<br />

investigated, to say nothing of the many factors<br />

that seem to play a part in its development: light<br />

exposure, genetic disposition, near-work, and more<br />

recently, electronic displays, and the time of day we<br />

use them, say other researchers.<br />

“I think people were distracted for many years<br />

by the apparent influence of near work and we<br />

tended to not think of light as one of the potential<br />

factors,” says John Phillips, principal investigator at<br />

the University of Auckland’s Myopia Lab. “I think<br />

probably the first occurrences of myopia were in<br />

people who did a lot of reading. The near work<br />

hasn’t been excluded as a cause, it’s just that<br />

myopia is much more multifactorial.”<br />

The rate of myopia appears to have increased<br />

steeply since about the mid-20th Century.<br />

According to an article in Nature last March, 90<br />

per cent of teenagers and young adults in China<br />

are short-sighted, compared to a range of 10 to 20<br />

per cent sixty years ago. Myopia also affects half of<br />

all young adults in Europe and the US, double the<br />

rate in the mid-1960s.<br />

“It’s good to do studies in schools reassigning<br />

light level empirically, but if we are to advance<br />

properly we need to understand why light affects<br />

myopia development and that’s where the<br />

university research comes in,” says Phillips. “Our<br />

overall aim is to understand the mechanisms of<br />

myopia development and ultimately to control it”.<br />

Phillips says an important step in understanding<br />

myopia development is to conduct a meta-analysis<br />

of several studies of light and myopia in schools,<br />

when there are enough well-structured published<br />

studies to analyse, which still isn’t the case at this<br />

point. The Guangzhou study gives researchers a<br />

good starting point.<br />

“There seems to be something about schooling<br />

in its current form which is myopiagenic,” Phillips<br />

says, and we need to understand what it is about<br />

that environment that is causing children to be<br />

myopic. That might extend to children doing<br />

home-work in the evening under electric light or<br />

with a computer.”<br />

Where to look next<br />

The field is still wide open, and the Auckland lab<br />

is investigating different factors that play a part<br />

in myopia development through clinical and labbased<br />

research projects.<br />

“We’re doing a number of other experiments<br />

relating to light which we think are relevant,”<br />

Phillips says. “One investigated the effect of extra<br />

light presented at different times of the day;<br />

another is looking at the effects of light level on<br />

the blood supply to the back of the eye.<br />

“We think this change in choroidal thickness<br />

is a potential early signal of myopia, and we can<br />

experimentally alter the choroid to make it thinner<br />

or thicker using lenses. So, what we’re now doing<br />

is seeing whether the light level itself can alter the<br />

choroid. If bright light makes the choroid thicker,<br />

and dim light makes it thinner, we can measure<br />

this change over time, and we’re developing this<br />

as a technique for assessing how myopiagenic a<br />

particular stimulus is.”<br />

The Myopia Lab is looking at applying this<br />

method for laboratory experiments in both near<br />

work and light level studies.<br />

Another aspect under exploration is the impact of<br />

atropine eye drops on slowing myopia progression.<br />

A PhD student of Phillips’, Samuel Chiang, presented<br />

a paper to the International Myopia Conference<br />

in China in September investigating the effects<br />

of atropine on the choroidal response to impose<br />

hyperopic retinal defocus.<br />

In the study, which has yet to be peer-reviewed,<br />

Chiang took ten East Asian subjects (five males<br />

and five females) with myopia -1.00 to -5.00D,<br />

age 18 to 24 years. The subjects viewed a video<br />

at 6 meters for 60 minutes on two successive<br />

days, while researchers took swept source OCT<br />

images in both eyes every 20 minutes to monitor<br />

subfoveal and parafoveal choroidal thickness.<br />

The control (dominant) eye was optimally<br />

corrected for distance with a contact lens while<br />

the experimental (non-dominant) eye wore a<br />

“The role that screens play is complex. It has<br />

something to do with exposure, and when<br />

screens get used during the day. If they get<br />

used at night, they could be a culprit in<br />

myopia development,” says Phillips.<br />

contact lens imposing 2.00D of hyperopic retinal<br />

defocus. On the second day, the same procedure<br />

was repeated, but the experimental eye had been<br />

treated with one drop of 0.5 per cent atropine 24<br />

hours earlier.<br />

The result was that the normal thinning of the<br />

human choroid in response to imposed hyperopic<br />

defocus was abolished by use of atropine, which<br />

may either act directly on the choroid to inhibit<br />

thinning, inhibit the generation, transmission or<br />

reception of a signal in response to hyperopic retinal<br />

defocus, which normally causes choroidal thinning.<br />

The Myopia Lab is also preparing for an<br />

observational study of light levels in schools. For<br />

now, they plan to measure light levels in different<br />

schools to obtain preliminary data for measuring<br />

a relationship between the distribution of light in<br />

a classroom (ie. children near windows have more<br />

light than those further away) to see whether that<br />

plays a role in myopia development.<br />

Circadian rhythm<br />

Phillips says another angle to explore is the recent<br />

uptake of digital devices, particularly when used<br />

at night. While the huge increase in myopia<br />

began well before the dawn of smartphones,<br />

tablets and PCs, there is already research building<br />

on the connection between screen use and<br />

disruption of the circadian rhythm, which in turn<br />

impacts eye growth.<br />

“The role that screens play is complex. It has<br />

something to do with exposure and when screens<br />

get used during the day. If they get used at night,<br />

they could be a culprit in myopia development.”<br />

Eye growth accelerates and slows according to a<br />

day-night cycle, that is, when electricity isn’t a factor.<br />

“Once you introduce electric light or lightemitting<br />

screens and start using that during the<br />

evening you upset the circadian rhythm of eye<br />

growth. The possibility is you’ll be making the eye<br />

grow for a longer period,” Phillips says, and this can<br />

lead to myopia development.<br />

Another study published in January gave credence<br />

to the role of screens late at night disrupting<br />

circadian cycles. In the study, evening use of<br />

light-emitting eReaders negatively affects sleep,<br />

circadian timing and next-morning alertness. A<br />

team of Harvard researchers led by Anne-Marie<br />

Chang found that “compared with reading a<br />

printed book in reflected light, reading a lightemitting<br />

(LE) eBook in the hours before bedtime<br />

decreased subjective sleepiness, decreased EEG<br />

delta/theta activity and suppressed the late<br />

evening rise of pineal melatonin secretion during<br />

the time that the book was being read.<br />

“We also found that, compared with reading a<br />

printed book, reading an LE-eBook in the hours<br />

before bedtime lengthened sleep latency; delayed<br />

the phase of the endogenous circadian pacemaker<br />

that drives the timing of daily rhythms of melatonin<br />

secretion, sleep propensity and REM sleep<br />

propensity; and impaired morning alertness.”<br />

The study only involved 12 subjects, however, so<br />

more data, and more studies are necessary. ▀<br />

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

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

For editorial and classifieds, please contact Simon Eskow, editor, at 027 288 5401 or editor@nzoptics.co.nz.<br />

For advertising, marketing, the OIG and everything else, please contact Lesley Springall, publisher, at<br />

027 445 3543 or lesley@nzoptics.co.nz.<br />

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

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

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

publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the products and<br />

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

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

4 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>


UK OPTOMS!<br />



Go to<br />

spectrum-blog.com<br />

for all the current<br />

opportunities!<br />

With a significant shortage of optometrists being<br />

experienced across the optometry profession<br />

in metro, regional and rural areas, we’re calling<br />

all UK and Irish optometrists currently in<br />

New Zealand and Australia to talk to us. We have a<br />

wide range of opportunities for you to consider.<br />

Across the two countries this year we will open<br />

15 new stores and expand a further 65 stores<br />

with additional consulting rooms and the latest<br />

automated equipment – and we need to beef up<br />

our professional team to meet demand, as it rises.<br />

About you<br />

You’re an OCANZ qualified optometrist and already<br />

working (or due to work) for the length of your<br />

current working visa – but you would like to stay<br />

on for longer, or even permanently.<br />

We can help<br />

If that sounds like you, we should talk.<br />

Lately, more and more OCANZ qualified UK<br />

and Irish optometrists are asking us about<br />

staying in either New Zealand or Australia<br />

for the longer term and we have the<br />

roles available to make that goal a reality<br />

in both countries.<br />

Let’s get the conversation started<br />

Whatever your goal, both short and longer<br />

term, now’s the time to talk to our professional<br />

recruitment team members about the options for<br />

employed and partnership roles – they’re ready to<br />

talk to you right now.<br />

In the first instance contact Raj Sundarjee on<br />

0800 773 077 or raj.sundarjee@specsavers.com<br />

NZ Franchise<br />

System of<br />

the Year<br />

2014<br />

Retail<br />

Innovator<br />

of the Year<br />

2014<br />

Multichannel<br />

Retailer<br />

of the Year<br />

2014<br />

Roy Morgan<br />

Research<br />

No. 1 for eye tests<br />

2014<br />

FCA International<br />

Franchisor<br />

of the Year<br />

2014<br />

FCA Social<br />

Responsibility<br />

Award<br />

2014<br />

FCA Established<br />

Franchisor<br />

of the Year<br />

2013<br />

FCA Excellence<br />

in Marketing<br />

Award Winner<br />

2013<br />

Australian<br />

Retailer<br />

of the Year<br />

2013<br />

Australian<br />

Retail Employer<br />

of the Year<br />

2013<br />

Asia-Pacific Best<br />

Retail Training<br />

Organisation<br />

2013<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



News<br />

in brief<br />


California-based eyewear company DITA Group has acquired<br />

luxury brand Christian Roth. Co-founders Christian Roth and Eric<br />

Domege will remain as creative directors. Christian Roth’s first<br />

post-acquisition collection will be presented at Silmo 2016. DITA’s<br />

brand portfolio includes the licenses for Thom Browne and Dita<br />

Von Teese eyewear, as well as its house-brand lines. Christian Roth<br />

ended its 12-year licensing deal with Charmant in 2010 and retook<br />

control of its trademarks. In 2011, Christian Roth granted Koreanbased<br />

firm BCD Korea the right to produce and distribute its eyewear<br />

throughout Asia.<br />


Bausch + Lomb is launching a new division, Bausch + Lomb Advanced<br />

Vision Products, following the merger of its Boston office with<br />

Paragon Vision Science, which it acquired early this year. Advanced<br />

Vision Products will be dedicated to addressing severe ocular<br />

conditions including myopia, irregular corneas, ocular surface<br />

diseases and other visual challenges with custom contact lenses and<br />

other approaches. The work will include ortho-k and scleral lenses,<br />

customised soft lens and lens care categories, training in scleral lens<br />

and ortho-k fitting, development of diagnostic fitting and dispensing<br />

systems and lens care products.<br />


A study recently published in Investigative Ophthalmology and<br />

Visual Science shows a significant association between Helicobacter<br />

pylori infection and glaucoma. The meta-analysis of 10 studies<br />

covering 695 glaucoma patients and 1,580 control participants<br />

showed that H. pylori infection was associated with both normal<br />

tension glaucoma and primary open-angle glaucoma, but not<br />

pseudoexfoliation glaucoma.<br />


Dr Carol Greene is returned to Auckland University’s Department of<br />

Ophthalmology as a research fellow to build on her doctoral research<br />

into keratocyte multipotency. Greene hopes to develop tissue<br />

engineering technology, with initial proof of concept studies in a<br />

large animal model, as a treatment for keratoconus.<br />


Flinders University’s year-old Flinders Vision Clinic is expanding<br />

trials of the Flinders Glare test, intended to measure both contrast<br />

sensitivity and glare. In contrast to the usual high-contrast black<br />

letters on a white background method, the Flinders Glare Test uses<br />

“fading” letters—from solid black letters to barely visible gray—and<br />

illumination, to detect early signs of cataract development.<br />


A survey from the Gas Permeable Lens Institute in the US indicates<br />

scleral lenses potentially will grow faster than any other segment of<br />

the contact lens market given the increased prevalence of myopia.<br />

Overall, gas-permeable (GP) lens prescribing in the US was down<br />

from nine per cent to six per cent in 2012, but GP button sales have<br />

increased 13.7 per cent from 2013 to 2014. Clarke Newman from the<br />

Institute said: “We’re moving away from corneal contact lenses to<br />

scleral contacts and lenses designed to reduce myopia,” adding there<br />

was potential to use scleral lenses for toric correction.<br />


The Ministry of Health has begun consultation on a plan outlining<br />

the future of pharmacy services in New Zealand. Health Minister<br />

Jonathan Coleman said the plan helps to “set out how we can<br />

make better use of the knowledge and skills of our pharmacy<br />

workforce” and ensure “pharmacy services are better integrated<br />

with other health professionals in multi-disciplinary teams.” The<br />

Draft Pharmacy Action Plan <strong>2015</strong>-2020 is divided into five themes:<br />

personal and population health; pharmacist clinical services in<br />

integrated teams; acute demand management; dispensing more<br />

effectively; and prescribing. The draft plan can be downloaded from<br />

the MoH’s web site and is available for feedback until <strong>Nov</strong>ember 23.<br />


Analysis of a proposed license plate format in the US suggests<br />

substituting one number in a six-character line improves shorterterm<br />

recollection compared to strictly alphanumeric-only designs.<br />

Researchers from the New England College of Optometry evaluated<br />

the EZ-ID system, which uses graphics of stars, hearts, basic<br />

geometric shapes in place of one alphanumeric character. The<br />

researchers randomly selected 10 six-character Massachusetts<br />

license plates from a sample of cars. Five were modified to replace<br />

one of the two middle characters with a symbol. 53 per cent of those<br />

with symbols were correctly and completely recalled compared to 33<br />

per cent of plates containing only alphanumerics.<br />


William Campbell and Satoshi Omura were jointly named winners<br />

of the <strong>2015</strong> Nobel Prize winner in Physiology or Medicine for work<br />

which led to the development of ivermctin in the treatment of<br />

onchocerciasis, better known as river blindness. They will share the<br />

prize with Youyou Tu for her discoveries concerning a novel therapy<br />

against malaria. River blindness is a parasitic infection that can<br />

cause intense itching, skin discoloration, rashes, and eye disease<br />

that often leads to permanent blindness, and spreads by the<br />

bites of infected black flies that breed in rapidly flowing rivers in<br />

equatorial habitats. ▀<br />

EI attains quality standard<br />

Eye Institute’s new clinic and theatre suites have been accredited<br />

to New Zealand Standards for quality of patient care.<br />

The move to brand new premises at 123 Remuera Road was<br />

the ideal opportunity to formalise Eye Institute’s commitment to<br />

the highest standards throughout the reception, clinic and theatre<br />

environment, said business manager Barbara Hare. So Eye Institute<br />

sought formal assessment by DAA Group and now the high standards<br />

that have been attained throughout the patient care process have<br />

been confirmed, she said.<br />

“The accreditation process has been very worthwhile. It recognises<br />

the terrific efforts by all the staff at Eye Institute who focus on quality<br />

of care every day,” said Barbara.<br />

New Zealand Day-Stay Surgery and Procedures Standard NZS<br />

8164:2005 was developed for organisations providing day-stay and<br />

clinical rooms or office-based surgery or procedures.<br />

Accreditation involves examination of all steps in the patient care<br />

process including aspects as diverse as staff training, infection control,<br />

operating theatre process, data security and assessment of patient<br />

outcomes. Robust protocols are a requisite with confirmation that<br />

these are adhered to through observation, documentation and staff<br />

interviews. Accreditation is an ongoing process with follow-up visits<br />

by the accreditation team performed at regular intervals.<br />

Eye Institute’s facility, which opened at the beginning of this<br />

year, has been designed to optimise the patient’s experience as<br />

well as to create a spacious and pleasant working environment<br />

for staff, combining a relaxing ambience with the latest<br />

technology technology, said Hare. ▀<br />

New conference for DOs and staff<br />

Eye Institute will hold a conference for dispensing opticians and<br />

support staff in parallel with its annual optometry conference<br />

on <strong>Nov</strong>ember 8.<br />

The inaugural Eye Institute Dispensing Optician Conference will be<br />

held at the same venue as the optometry conference, the Waipuna<br />

Hotel and Conference Centre in Auckland, from 8 am to 5 pm.<br />

This is the only conference in <strong>2015</strong> that brings dispensers and<br />

optometrists together under the same roof, says Eye Institute<br />

representatives. “It is an opportunity for practice owners and key<br />

personnel to share in an educational event and to test drive some of<br />

the latest technologies.”<br />

The jam-packed agenda offers DOs tips for frame selection and<br />

spectacle correction for blended vision patients, the meaning behind<br />

floaters, handling emergencies and telephone triage, common post<br />

cataract symptoms—presented by Dr Trevor Gray—and much more<br />

in several snappy 30-minute presentations.<br />

The conference also includes panel discussions and features<br />

three guest speakers: Margaret Lam, from Sydney, Alan Saks and<br />

Grant Watters.<br />

Lam graduated from the University of New South Wales in 2001<br />

and is the founder of Sydney-based theeyecarecompany, a small<br />

group of independent optometry practices. She practices full scope<br />

optometry, with a particular interest in contact lenses and patient<br />

Book drills deep into prosthetics<br />

Vision science has traditionally been silent about ocular<br />

prosthesis for a number of reasons. Before World War II, it was<br />

the purview of glass blowers. Then, with the rise of plastics,<br />

the baton moved to dentists who, after all, were already adept at<br />

creating maxillofacial implants for their patients.<br />

In New Zealand the maxillofacial-optical divide wasn’t really<br />

bridged until Dr Keith Pine decided in 2003 to sell his chain of dental<br />

practices to Lumino, go back to school and earn a Masters and PhD in<br />

optometry, with the specific intent of researching prosthesis from the<br />

perspective of optometry.<br />

“I had provided prosthetic eyes throughout my career, just because<br />

of where I came from,” Pine says. “I went to university and ultimately<br />

suggested we write a book about it.”<br />

The result is Clinical Ocular Prosthetics—arguably the first<br />

comprehensive textbook to provide a comprehensive account of<br />

ocular prosthetics and the evidence underpinning this field of<br />

healthcare. The book is co-authored by Pine’s university supervisors,<br />

Robert Jacobs and Dr Brian Sloan.<br />

According to an announcement, Clinical Ocular Prosthetics<br />

“contains a mix of scientific evidence and clinical experience and<br />

includes inferences based on material from other disciplines that are<br />

applied to the field of ocular prosthetics.”<br />

The book is written primarily for clinicians and caregivers who have<br />

contact with prosthetic eye wearers including ocular, maxillofacial<br />

and anaplastology prosthetists, ophthalmologists, ophthalmic<br />

nurses, optometrists and students of these disciplines.<br />

“The main goal of the book is to bring together everything that<br />

is known about prosthetic eyes into one place,” Pine says. “It’s<br />

comprehensive and evidence-based where it can be. It covers history,<br />

psychology, physiology and socket complications. I would hope that<br />

vision professionals would get an understanding from it, and give<br />

good, sound advice to anophthalmic patients.”<br />

Pine has devoted all of his post-dentistry years to ocular prosthetics.<br />

He founded the New Zealand Artificial Eye Service in 2008, partnering<br />

with optometrists and eye surgeons in Rotorua, South Auckland,<br />

Eye Institute’s Remuera site<br />

The operating theatre<br />

communication, and has extensive experience in specialty contact<br />

lens fitting in corneal ectasia, keratoconus and orthokeratology.<br />

Grant Watters, an educator, researcher and optometrist from<br />

Mortimer Hirst, specialising in paediatric vision and contact lens<br />

fitting, will give a talk on understanding complex contact lens<br />

systems, matching systems to a particular contact lens type and<br />

solving common problems patients experience with contact lenses.<br />

Popular NZ Optics contributor Alan Saks will cover tips for spectacle<br />

correction of blended vision patients. The presentation will include<br />

practical tips for the best matched frame and lens selection and<br />

skills to help patients understand the benefits and drawbacks of<br />

blended vision. Saks is an optometrist and contact lens specialist<br />

with Mortimer Hirst who performs regular clinical trials and premarket<br />

evaluations for a variety of soft-lens and specialty rigid gas<br />

permeable designs for leading manufactures.<br />

Other presentations include a discussion of Meibomian gland<br />

dysfunction with Eye Institute’s Dr Simon Dean; a dispenser’s guide<br />

to glaucoma co-management from Dr Dean Conger; an exploration<br />

of cataract refractive surgery from Dr Nick Mantell; and a look at<br />

periocular skin lesions with Dr Adam Watson.<br />

Registration runs onsite from 8 am to 8:30 am. Light refreshments<br />

will be served and the Eye Institute has applied for CPD for<br />

attending DOs. ▀<br />

Authors Dr Brian Sloan, Keith Pine and Rob Jacobs<br />

Tauranga, Takapuna, Wellington and Whangarei. But, he says, the<br />

patients that need prosthetic eyes or prosthetic contact lenses “is a<br />

small population that is not well promoted or understood.”<br />

“My mission is to wake up vision professionals to this gap in the<br />

services that we provide to patients with disfigured eyeballs. The gap<br />

is the non-treatment and the lack of knowledge of how to go about<br />

dealing with people with missing or disfigured eyes.”<br />

Pine cites research indicating there are about 3,000 people in<br />

New Zealand wearing prosthetic eyes or scleral shell prostheses. He<br />

surmises an even higher number of people could be treated with<br />

prosthetic contact lenses, which, unlike prosthetic eyes, are not<br />

subsidised by the Ministry of Health.<br />

There are a small number of people in New Zealand that specialise<br />

in ocular prosthetics. Pine himself makes regular rounds, lasting a<br />

month to six weeks, of the six clinics working with the Artificial Eye<br />

Service, and may deal with implanting ten prostheses a month.<br />

Clinical Ocular Prosthetics is available as an ebook through the<br />

University of Auckland library system or hardcover from the<br />

publisher, Springer, for $205.18. ▀<br />

6 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Optos and widefield imaging: a profile<br />

Famed for its ultra-widefield (UWF), high-resolution retinal<br />

image equipment, Scottish-born company Optos is not new to<br />

New Zealand.<br />

But given its steady and continued growth, its acquisition by<br />

Japanese firm Nikon (keen to expand beyond photography), and<br />

the RANZCO conference’s return to New Zealand, the time seemed<br />

right to project a higher profile in New Zealand, says Jason Martone,<br />

managing director of Optos Australia.<br />

“Given RANZCO’s in Wellington this year, that gave us the perfect<br />

opportunity to further expand our presence throughout New<br />

Zealand’s ophthalmic community.”<br />

Optos arrived in New Zealand in 2011, just under a year after<br />

opening its Australasian headquarters in Adelaide, South Australia.<br />

The company installed its first UWF device at For Eyes Optometrists<br />

in Kumeu, Auckland, and made a splash checking Prime Minister John<br />

Key’s retinas with thew new-to-New Zealand technology.<br />

Although other companies produce and distribute equipment that<br />

can take widefield images, only Optos’ optomap image captures up<br />

to 82 per cent (or 200 degrees) of the retina in a single capture, the<br />

company says, citing more than 300 studies.<br />

Widefield imaging has certainly captured the attention of the<br />

industry, with one researcher referring to more than 75 papers on<br />

the investigational applications of Optos UWF retinal-imaging at the<br />

2014 Association for Research in Vision and Ophthalmology meeting<br />

in Orlando, Florida.<br />

Writing in a special report in Retina Today, Dr Rishi Singh,<br />

assistant professor of ophthalmology at Case Western Reserve<br />

University in Cleveland, Ohio, says from the research and from his<br />

own experience, “it is evident that UWF technology will take a<br />

more prominent role in the clinical care of patients with<br />

retinal disease.”<br />

Singh’s report reviewed research on the uses of Optos UWF retinal<br />

imaging systems, which employs a scanning laser ophthalmoscope<br />

and a unique ellipsoid mirror to create a virtual focal point inside<br />

the eye to enable a single-shot capture of the central retina and<br />

periphery. Though there is some debate about the clinical relevance<br />

of peripheral findings, all the cited studies showed the advantages<br />

of UWF for detecting, evaluating and monitoring the presence and<br />

severity of retinal pathology, especially for diabetic retinopathy and<br />

macular oedema.<br />

Optos’ latest product, the California—a desktop system equipped<br />

with indocyanine green angiography—has earned more positive<br />

feedback on UWF from ophthalmologists.<br />

“Optomap retinal imaging provides me with an unparalleled ability<br />

to permanently document central and peripheral retinal pathology.<br />

This has important benefits in both patient education and disease<br />

monitoring,” says Dr Simon Chen, a retinal specialist at Vision Eye<br />

Institute, Sydney.<br />

Optos was founded in 1992 by industrial design engineer and<br />

entrepreneur Douglas Anderson after his five-year-old son Leif<br />

went blind in one eye when a retinal detachment was detected<br />

too late. The subsequent eye exams his son underwent were<br />

uncomfortable, making it difficult for the doctor to be thorough,<br />

the company history explains. Anderson was determined to prevent<br />

such suffering among other children and, after several years of<br />

development and regulatory hurdles, Optos debuted its first<br />

product, the P200, in the UK and US in 2000.<br />

Optos Australia's Jason Martone<br />

The company’s UWF, high-resolution imaging devices produce<br />

photographs of the fundus for diagnosing, analysing, documenting<br />

and monitoring ocular pathology that may first present in the<br />

periphery. Optos’ equipment range from devices for screening by<br />

optometrists in primary care settings to more exacting imaging in<br />

secondary care practices. It is currently developing an ultra-widefield<br />

retinal imaging device combined with OCT, and it is still striving to<br />

capture a 100 per cent image of the retina.<br />

Martone says a key strength of Optos compared with some<br />

competitors is that it directly controls and manages its own research<br />

and development, manufacturing and the sales and service aspects<br />

Optos’ California indocyanine green angiography (ICG) image showing AMD,<br />

courtesy of Dr Srinivas Sadda<br />

of all its products. Though this is managed from Australia, the<br />

company has staff dedicated to New Zealand, he says.<br />

Optos continues to grow, says Martone, with sales of more than<br />

8,500 products globally and, in its 2014 financial year, reported<br />

revenue of more than US$170 million and profits of US$8.5 million<br />

up from US$159.5 million and US$6.4 million respectively in 2013.<br />

Nikon’s US$397 million acquisition of Optos in early <strong>2015</strong> is likely<br />

to spur that growth,” says Martone. “The resources and technology<br />

Nikon and Optos have combined, builds for a world leader in the<br />

medical ophthalmic space…to accelerate delivery of our vision to be<br />

‘The Retina Company’.” ▀<br />

Crichton joins<br />

Shamir<br />

ADONZ vice-president and well-known dispensing optician<br />

Donald Crichton<br />

has joined<br />

the Shamir team as<br />

New Zealand sales<br />

representative.<br />

Crichton says he is<br />

excited about returning<br />

to the lens side of the<br />

business.<br />

“I love lens technology<br />

and this has got me right<br />

back into it, allowing<br />

me to re-establish<br />

relationships I had in<br />

the past.”<br />

Crichton has almost three<br />

decades of experience in<br />

the optical industry in both<br />

the UK and New Zealand<br />

working in independent<br />

practice, for Specsavers,<br />

as New Zealand sales<br />

manager for Hoya and, most recently, with final year Optometry students<br />

at Auckland University.<br />

In a statement, Paul Stacey, CEO of Shamir Australia added,<br />

“Don’s wealth of experience and industry knowledge has already<br />

made him a key addition to the Shamir Company family. We view<br />

his appointment as a sign of our commitment to our New Zealand<br />

customers and the optical market.”<br />

Crichton will be based in Auckland. ▀<br />

Long-lasting lubrication for dry eyes<br />

that is preservative-free and completely<br />

sterile, delivered through the unique<br />

COMOD ® multi-dose application system.<br />

The systematic approach to eye lubrication<br />

for<br />

Dry Eyes<br />

*Special Authority criteria applies only to HYLO ® -FRESH – please refer to the New Zealand Pharmaceutical Schedule for details.<br />

For severe or<br />

chronic dry eye<br />

Preservative-free and phosphate-free<br />

Can be used for 6 months after opening<br />

Compatible with all types of contact lenses<br />

At least 300 measured drops per pack,<br />

or 150 treatments (both eyes)<br />


Special authority criteria applies *<br />

For mild to<br />

moderate dry eye<br />

For product enquiries contact:<br />



www.corneal-lens.co.nz<br />

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.<br />

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.<br />

Health Headlines<br />

Hartley Atkinson M.Pharm, PhD<br />

Founder & CEO, AFT Pharmaceuticals<br />

www.aftpharm.com<br />


22855NZO/HL/FP<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Silmo <strong>2015</strong><br />


The weird and the wonderful, the fun and<br />

the funky, the luxurious and the ordinary<br />

are what makes Silmo an exciting show.<br />

Nearly 900 exhibitors participated this year,<br />

with 34,250 professionals attending, up five per<br />

cent on 2014.<br />

International eyewear designers presented<br />

their latest collections, setting the trends with<br />

symphonies of colour, appealing shapes and<br />

superb new materials.<br />

There was an obvious move away from black<br />

frames and a move toward a variety of shapes.<br />

Geometrics are taking hold and the classic cat’s<br />

eye is back, as are round frame styles to take<br />

into account today’s facial proportions. Retro is<br />

in, or out depending on who’s talking.<br />

Fabric-covered frames, multi-layering<br />

techniques, crystal and transparent material,<br />

wood and stone, 3D printing and scanning<br />

fabrication and other impressive technologies<br />

stood out in the crowd. Designers are pushing<br />

the limits of what can done with acetate to<br />

achieve different frame finishes to give frames<br />

that spark of something new and different.<br />

Highlights<br />

Iconic French frame design house Lafont Paris<br />

featured an exhilarating palette, having one<br />

of the most eye-catching stands at the show.<br />

The company has revamped the process it has<br />

used for 20 years, laminating Liberty Art Fabric,<br />

a London-based firm known for its paisley<br />

and floral variations reminiscent of an English<br />

country garden. Lafont’s Raphael Rambeau<br />

says Liberty’s fabric, which is inserted between<br />

sheets of acetate, is ideal for frames, with colour<br />

combinations softening the look of the face, and<br />

with polka-dots and stripes used in the men’s<br />

collection. Lafont debuted its sunglasses line,<br />

with a similar approach.<br />

First-time Silmo exhibitor Falvin hit the<br />

jackpot when its Rock Star model was<br />

nominated for the sunglass category in the<br />

Silmo d’Or awards. The changing light on a<br />

diamond-shaped building in Copenhagen<br />

inspired former jewellery designer Birgitte<br />

Falvin’s Black Crystal collection.<br />

Birgitte Falvin designer of Falvin Eyewear with the<br />

sunglass model, Rock Star, which was nominated in<br />

the sunglass category of the Silmo d’Or awards<br />

“I wanted to design something that really had<br />

a purpose, an accessory people needed so it was<br />

a perfect switch from jewellery to eyewear,”<br />

Falvin says. “I like to make a statement; my<br />

design to have edginess and sophistication.”<br />

Frame house Morel showed off its<br />

collaboration with Ora ïto, applying the<br />

designer’s concept of ‘simplexity’ to spectacles<br />

and sunglasses in the Lightec collection,<br />

launched at Hotel Odyssey (whose interior ïto<br />

designed). ïto has been involved in creating 400<br />

products—from automobiles to shoes—and<br />

loved the challenge frames presented. Lightec<br />

features a patented spring-less/screw-less flexhinge<br />

system.<br />

“I’ve enjoyed working on this collection and<br />

am very committed to eyewear now,” ïto says.<br />

“I wanted to incorporate lightness with comfort<br />

and Lightec was the perfect collection for me.<br />

An ultra-light polyamide known as Lunamide is<br />

used to inject complex, futurist bevelled shapes<br />

around a slim-line, stainless steel core.”<br />

It would not be Silmo without Oliver<br />

Goldsmith, now licensed to Fabris Lane, which<br />

also carries the newly—launched Ben Sherman<br />

brand along with Hook LDN, Accessorize and<br />

American Freshman. Goldsmith and Fabris<br />

Lane debuted their first collaboration, the<br />

Photograph Collection, a line of 14 designs<br />

hand-crafted in Italy. Photograph adjusts or<br />

reduces shapes intentionally reminiscent of<br />

vintage styles, with a modern, fused-acetate<br />

twist. Photograph will eventually expand to 36<br />

models to appeal to all market segments. Two<br />

special numbered Oliver Goldsmith editions<br />

will be launched each year in buffalo horn or<br />

similar material and are destined to become<br />

collector pieces.<br />

Oliver Goldsmith (centre) with his daughter Alex and<br />

grandson Zac. The 1967 portrait on the wall depicts Oliver<br />

and his father Charles Oliver Goldsmith<br />

Blake Kuwahara, an American designer with<br />

an artistic talent and an optometry degree from<br />

the University of California, began designing for<br />

other companies after three years in practice.<br />

He established his brand in 2014, drawing on<br />

his Japanese heritage, and that culture’s “keen<br />

ascetical awareness.”<br />

Claudio Arena and Geraldine Booth from Wellington with<br />

designer Blake Kuwahara<br />

“The osmosis of this has played into how<br />

I design which is efficient so there are no<br />

extraneous elements, it is very pure,” says<br />

Kuwahara.<br />

Kuwahara’s standout “frame within a frame”<br />

concept incorporates a 45-degree angle mitre<br />

(a technique derived from architecture) which<br />

hides the hinge-break away when the temple<br />

is closed. The “inside-” and “outside-” frames<br />

are constructed separately, in different styles<br />

and dimensions, giving the whole a unified,<br />

but different personality at distance, using the<br />

space between the frames as a design element.<br />

The frames are fused in a curing process that<br />

can take up to two months. The Blake Kuwahara<br />

collection is made in Japan, distributed by<br />

Eyemakers in New Zealand. Kuwahara says he<br />

partners with professionals who take the time<br />

to understand his design concepts.<br />

Max Neubauer (centre) from Eyemakers with New<br />

Zealand’s own Alan Saks (left) and Reiner Kuske<br />

“It’s all about communication. In this industry<br />

you can’t be one dimensional. It’s not just<br />

about good quality product, marketing and PR.<br />

We have to have all engines firing on the same<br />

cylinder, that’s why we chose to partner with<br />

Max Neubauer whom I’ve been working with for<br />

20 years,” he said.<br />

Caroline Abram, another vision professional<br />

turned designer, started her career as an<br />

optician in the family practice. Abram was raised<br />

in Dakar, Senegal, and she takes her inspiration<br />

from that and her diverse origins (Caribbean,<br />

Indian, French, and Polish). She incorporates<br />

diverse materials—acetate, metal, wood, stones<br />

and Swarovski crystal—in elegant, innovative<br />

shapes that challenge the imagination without<br />

losing its femininity. Abram’s unique approach<br />

Eric and Linda Bleakley from Image Optics with designer<br />

Caroline Abram, Steph Cawte and Reiner Kuske<br />

was particularly embodied by the Pandora<br />

sunglass range launched earlier this year for the<br />

European summer and now available in New<br />

Zealand, featuring textured acetate and metal<br />

temple detail.<br />

Abram’s Silmo stand showcased the 2016<br />

ranges, which add new palettes to her popular<br />

metal and acetate frames, and include an<br />

optical take on Pandora. Abram also released<br />

a number of new styles of optical acetate<br />

frames, and new children’s frames to add to the<br />

collection that won her an award at Silmo 2014.<br />

A real find at Silmo was TAVAT Eyewear,<br />

a company geared to independent optical<br />

professionals, with its founder, I. Jeremy Baines,<br />

applying a business model he says he wants<br />

independents to embrace.<br />

“There has to be a way to differentiate<br />

between chains and good independents,” says<br />

Baines. “The truth is that the average consumer<br />

believes there is no difference between optical<br />

stores because in this industry the discounters<br />

and chains have monopolised the distribution<br />

channel.”<br />

“Selling nice frames is not enough—you need<br />

to build a brand around excellence of eyecare<br />

and eyewear.”<br />

TAVAT debuted its Soupcan collection at Silmo,<br />

with its round and panto shapes finished in<br />

metal, and a variation with acetate rims. The<br />

company bypassed traditional manufacturing<br />

techniques using frames made from “coined”<br />

Alpacca and assembled and finished by hand.<br />

Their sunglass lenses are infused synthetic<br />

melanin in three bronze, bronze with gold<br />

mirror coating, or bronze with silver mirror<br />

coating. A feature of the optical and sunglass<br />

range is the ex-cam hinge—a highly engineered<br />

concept producing a fluid motion from opening<br />

to closing.<br />

The composition of eyewear in the Soupcan brand<br />

<strong>2015</strong> Silmo d’Or winners<br />

Jono Hennessy Sceats and wife Louise Sceats with his<br />

new Zeffer range<br />

Jonathan (Jono) Hennessy Sceats is<br />

synonymous with Australian eyewear and has<br />

exhibited at Silmo for several years now. This<br />

year he launched his Zeffer, a collection uniting<br />

titanium and High Density Cellulose Acetate<br />

(HDCA), three years in development.<br />

“The technology involved in the construction<br />

of this brand meant it did not fit into our<br />

existing brands,” Sceats says. “The HDCA<br />

material is super strong and super light and<br />

its flexibility meant it could be milled down to<br />

2mm. Also the design is such that no nosepad is<br />

required,” he said.<br />

Mark Collman of Phoenix Eyewear brought the<br />

entire sample set of 19 models in 69 SKUs back<br />

to New Zealand with him.<br />

First-time Silmo exhibitor Michael Crawley<br />

from Valley Eyewear was overwhelmed with<br />

interest in his optical and sunglass collection.<br />

The professional photographer launching into<br />

the industry after working for a major surf label,<br />

when he was asked to critique a sunglasses<br />

range. His employer flew him to France where<br />

he learned the skills needed to design and he’s<br />

never looked back. Opting to go out on his own,<br />

he found a factory to manufacture his sunglass<br />

designs and teamed up with Carl Zeiss for<br />

the lenses.<br />

First time Silmo exhibitor Australian Michael Crawley<br />

with his new brand Valley Eyewear<br />

Crawley hand-draws all his designs and oversees<br />

the production process, visiting China five times a<br />

year, splitting the rest of his life between the Gold<br />

Coast and Los Angeles.<br />

“Sunglass sales over my website from New<br />

Zealand have gone crazy,” Crawley says.<br />

“Working with distributors now, the collection<br />

has gone global. There has been massive<br />

interest in my collection here at Silmo so I<br />

expect even wider distributor now.”<br />

Silmo <strong>2015</strong> coverage will continue in the<br />

December issue, with more about 3D printing,<br />

Danish eyewear, and other exhibitors from<br />

Australia, North America and around<br />

the world. ▀<br />

The annual Silmo d’Or <strong>2015</strong> winners were announced at a ceremony at the Maison de la Radio. The<br />

awards recognise creativity, originality and innovation across all categories. Awards were presented by<br />

Emmanuel Gallina, renowned designer and teacher.<br />

Vision Category:<br />

Essilor Eyezen<br />

Contact lenses:<br />

Johnson & Johnson for 1-Day Acuvue Moist Multifocal<br />

Equipment:<br />

Luneau Technologies for Attitude by Briot<br />

Low Vision Category:<br />

Visiole for Blaze Ez<br />

Children Category:<br />

Minima Junior Hybrid (see ADONZ What’s new story)<br />

Optical Frame: Masunaga for model GMS 106<br />

Sunglasses:<br />

W-Eye for model Aifir<br />

Sports Equipment:<br />

Seiko Optical Group for Seiko X Changer<br />

Frame Technology/Innovation: Blackfin for Shark-Lock<br />

Special Award:<br />

Factory 900 for model FA-087<br />

Japanese company Factory 900 took the Special Silmo<br />

d’Or award for its model FA-087, known as “The Six Eyes”<br />

8 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

HumanWare offers low vision sales option<br />

Kiwi optometrists are being offered a potentially lucrative<br />

opportunity to provide additional resources and care to their<br />

low vision patients.<br />

The Australian head office of HumanWare—one of the world’s leading<br />

providers of high-tech assistive technologies for people who are blind or<br />

have low vision—has joined forces with its majority shareholder Essilor in<br />

New Zealand to offer (in the first instance) Essilor’s 100 Platinum Partners<br />

the opportunity to become resellers for HumanWare.<br />

Jason Abrahams, Australasian general manager for HumanWare,<br />

says current knowledge about the type of tech available to help low<br />

vision sufferers is quite low. “The cut-through is only about five per<br />

cent of the population who know about assistive technology for low<br />

vision. We wanted to be able to provide those with low vision more<br />

opportunity to know what’s out there. So we’re going with a low vision<br />

strategy to eye care professionals in New Zealand.”<br />

Currently most optometrists simply refer low vision patients, where<br />

lenses or surgery are no longer an option, to the Blind Foundation,<br />

says Abrahams, and though the<br />

Foundation does a terrific job,<br />

its resources are limited and<br />

advice can be variable when it<br />

comes to understanding hightech<br />

opportunities for low vision<br />

patients.<br />

HumanWare will be working with<br />

Essilor, which bought a majority<br />

share of the former New Zealand,<br />

now Canadian-based company two<br />

HumanWare’s Jason Abrahams woos<br />

Kiwi ECPs<br />

years ago, because it makes sense<br />

to leverage the strong relationships<br />

Essilor already has with optometrists in New Zealand.<br />

“[Essilor NZ] is very strategic and can see the benefits of HumanWare as<br />

an additional solution for its Platinum Partners,” says Abrahams.<br />

Kumuda Setty, Essilor’s New Zealand marketing manager, says low<br />

vision is a growth area. “The relationship the patient has with their<br />

eye care professional can be extended further since tools like Prodigy<br />

and other HumanWare products can easily be used.”<br />

The decision to extend the reseller offer to Essilor’s Platinum<br />

Partners first is because they are committed to change, says Setty.<br />

“They are willing to go beyond and want to differentiate themselves<br />

in the marketplace.”<br />

One of the first to sign up is Curtis Vision’s Chris Clark in Christchurch.<br />

“We’re excited about the HumanWare products and they’re a natural<br />

fit for our practice as we continue to strengthen our speciality areas.<br />

One of our senior optometrists, Nicola Bolton, has recently become<br />

highly involved with low vision work in the Canterbury area so the new<br />

relationship with HumanWare is an ideal extension to this.”<br />

Abrahams says select optometrists (starting with Essilor’s Platinum<br />

Partners) will be offered the choice of two reseller tiers in key<br />

geographic areas. The first tier focuses on HumanWare’s personal<br />

digital vision assistant Prodigy range. Prodigy resellers will be<br />

offered training, a Prodigy demonstration unit and 15 per cent of<br />

the sale on any Prodigy products they sell. The second tier will offer<br />

HumanWare’s entire low vision catalogue of more than 30 products,<br />

including Prodigy, they will be able to buy a Prodigy system at cost<br />

and make 20 per cent on any HumanWare products sold. Both tiers<br />

will be supported by HumanWare’s New Zealand distributors Vision<br />

Associates, based in Christchurch, which will also be providing<br />

training and ongoing technical support to resellers and their patients.<br />

However any Kiwi eye care professional who’d like to be able to<br />

offer more to their low vision patients can benefit from HumanWare’s<br />

referral programme, says Abrahams. This offers a 10 per cent referral<br />

fee to eye care professionals whose patients purchase HumanWare<br />

products after being referred to Vision Associates. This option is also<br />

available for those resellers who wish to just focus on Prodigy and not<br />

come to grips with the rest of HumanWare’s product range. ▀<br />

HumanWare’s Kiwi ancestry<br />

HumanWare was founded as Pulse Data in Christchurch in 1988 by<br />

electronics engineer Dr Russell Smith. The company grew to become<br />

a multimillion-dollar poster child for Kiwi R&D and export potential,<br />

fawned over by a succession of politicians. It won a series of export<br />

awards and acquired its California-based distributor HumanWare and<br />

Canadian competitor VisuAide in the early 2000s, changing its name to<br />

the more internationally-known HumanWare in the process.<br />

Plans to move the company’s headquarters to North America were in<br />

discussion when Smith and his wife Marian D’Eve died in a light plane<br />

crash off the North Canterbury Coast in August 2005.<br />

The company went through a period of turmoil with a succession of<br />

overseas managers before the majority was sold to Australian privateequity<br />

firm Jolimont Capital in 2007 for $35 million. Former VisuAide<br />

founder and HumanWare director Gilles Pepin stepped into his current role<br />

as CEO of HumanWare in 2008 moving the company’s headquarters, R&D<br />

and centre of operation to Canada in 2009. Today the company has sales in<br />

more than 72 countries, managed from four international hubs in Quebec,<br />

the US, the UK and Australia; it employs more than 150 people; and it has<br />

revenues of more than US$35 million. Vision Associations was founded<br />

by former Christchurch-based HumanWare senior staffers to continue to<br />

supply and look after HumanWare’s customers in New Zealand.<br />

Zeiss NZ comes<br />

together<br />

Lens and ophthalmic equipment manufacturer Zeiss has combined<br />

its New Zealand Medical Technology and Vision Care offices into<br />

one new office in Avondale, Auckland.<br />

Previously its lens business was based in New Lynn and its medical<br />

team in Henderson, but by bringing them under one roof Zeiss New<br />

Zealand can significantly improve cost and customer care efficiencies,<br />

and respond better to crossover requirements within the industry, says<br />

Quinn Bent, Zeiss Vision Care’s Australasian regional sales manager.<br />

“We are signalling that Zeiss has one presence in the market and that<br />

we function as one, so wherever there’s a crossover we can explore the<br />

opportunities and bring these together…and build a true Zeiss culture<br />

here, which is all about supporting each other and our customers.”<br />

Taking pride of place in the new office on the lens side is a MeiEdger<br />

671 edging machine. This and other new equipment, and given the<br />

new space the lens team now enjoy, means there’s plenty of room for<br />

growth in the lens area in New Zealand, says Bent.<br />

GRAND OPENING – 23 SEPT. 2016<br />

Quinn Bent, Auckland branch manager Hermi Hidalgo and Mark Gaunt in Zeiss<br />

new combined office<br />

“With the brand we have, we feel it suits what a lot of the<br />

independent practices are doing as they are increasingly positioning<br />

themselves at the more mid to high-end of the market.<br />

“We pride ourselves on our technology as we put a lot of unique<br />

technology into our lenses. For example, we have a new progressive<br />

range, called the Precision range, which includes patented<br />

technology—digital insight technology, which caters for progressive<br />

lens wearers who use digital devices.”<br />

Bent estimates Zeiss has about seven per cent of the New Zealand<br />

lens market, so it is still small. But it’s growing, he says, with the<br />

company employing two additional staff (one more technician and one<br />

more customer service representative) last year and reporting 30 per<br />

cent year-on-year volume growth.<br />

“Yes, we are still quite small in Australia and New Zealand on the<br />

lens side—not on the equipment side–but we pride ourselves on<br />

being able to provide a very personable service to practitioners,”<br />

Bent says. “All our Zeiss reps are qualified dispensers…we even have<br />

a qualified dispenser working in customer service, and we’ve made<br />

a huge investment in technology. We wouldn’t have moved and<br />

invested in this if we didn’t see the growth.”<br />

Mark Gaunt, Zeiss NZ business development representative, says<br />

given Zeiss manufacturers and sells both diagnostic equipment and<br />

lenses, the combined knowledge and synergy can help optometrists<br />

structure what they need in terms of equipment and, perhaps more<br />

importantly, how they might finance those technology needs.<br />

The financing packages, offsetting technology costs through lens<br />

spend, were introduced almost three years ago and are proving<br />

increasingly popular among independents, adds Bent, making the<br />

recent move make even more sense. ▀<br />


23> 26 SEPT. 2016<br />


Conception : CARLIN<br />


<strong>Nov</strong>ember <strong>2015</strong><br />




ADONZ delivers cpd, networking and fun<br />

If you were in need of a dispensing optician<br />

over the weekend of October 9 to October 11,<br />

statistically speaking, you’d have to be in Hamilton.<br />

That’s because a good number of the country’s<br />

registered DOs attended the ADONZ <strong>2015</strong> National<br />

Conference at the <strong>Nov</strong>otel Hamilton Tainui, where<br />

they were able to earn up to 14 CPD points, meet<br />

more than a dozen Kiwi-centric wholesalers,<br />

suppliers and lens makers and celebrate the 20th<br />

Italia Independent are distributed in New Zealand by Euro Optics who<br />

can be contacted at marketing@optiumumeyewear.co.nz<br />

year of OptiBlocks at a fun-filled costume dinner<br />

party with a roaring ‘20s theme.<br />

“It’s been wonderful. It’s a really nice<br />

atmosphere,” ADONZ President Peggy Savage told<br />

NZ Optics near the end of the weekend. “We’ve<br />

had a bit fun. The standard of education has been<br />

high; the conference in its entirety has been very<br />

well done.”<br />

Savage helped keep the pace through the<br />

three-day event, presiding over<br />

the AGM and paying respect to<br />

key people in the association,<br />

organisers and the top-notch<br />

cadre of presenters, including<br />

ABDO’s Elaine Grisdale, Dr<br />

David Wilson, Steve Daras,<br />

Serah van Haeftan, Dr Richard<br />

Johnson, Mariska Mannes,<br />

Stephen Guest, Andrew<br />

Swensen and amusing MC<br />

Stephen Caunter from ANZ.<br />

The Sunday night gala<br />

evening was a fitting<br />

punctuation for the close-knit<br />

DO community, celebrating<br />

20 years of OptiBlocks, the<br />

ADONZ-owned provider of<br />

practical training blocks for New<br />

Zealand’s dispensing opticians.<br />

Celebrating the 20 year birthday,<br />

the gala dinner at The Verandah,<br />

Hamilton Lake, was awash<br />

with 20s spirt with flappers,<br />

gangsters, sophisticated<br />

socialites, golfers, G-men, and<br />

even an Amelia Earheart.<br />

Wholesalers and frame<br />

vendors were also well<br />

represented in the tight<br />

exhibitor space at the<br />

conference venue with<br />

all New Zealand’s leading<br />

lens manufacturers, frame<br />

distributors and leading<br />

accessory companies<br />

represented (see ADONZ:<br />

What’s new story).<br />


Now Available in Australia!<br />

Glacier Plus UV<br />

Comprehensive UV<br />

protection including<br />

back surface reflection<br />

at no extra cost.<br />

Glacier<br />

Blue-Shield UV<br />

Effective protection<br />

against the harmful<br />

rays of artificial light.<br />

Glacier <br />

Achromatic UV<br />

A crystal clear<br />

coating, keeping eyes<br />

bright with no<br />

reflective bloom.<br />

Glacier Sun UV<br />

Designed for sunwear,<br />

leaves sunglass lens tint<br />

unchanged and protected<br />

from fading.<br />

Glacier Anti-Fog<br />

Rear surface of the lens<br />

repels fogging during<br />

strenuous activity.<br />

No special sprays<br />

or cloths needed.<br />



Glacier Blue-<br />

Shield UV <br />

and Glacier<br />

Plus UV stock<br />

lenses also<br />

available!<br />

Education changes afoot<br />

for Kiwi DOs<br />

A significant development to emerge from the<br />

conference was ADONZ’s decision to actively<br />

explore a domestic education partner for a New<br />

Zealand qualified, diploma-level dispensing<br />

optician programme.<br />

Representing ADONZ, Savage says the<br />

organisation is in the “very early stages” of<br />

working with WinTec (the Waikato Institute of<br />

Technology) to apply for qualification for a DO<br />

programme with the New Zealand Qualifications<br />

Authority (NZQA). Should the programme happen,<br />

and many hope it will, it will replace the general<br />

DO blocks now delivered by Australia-based Open<br />

Training and Education Network (OTEN) and<br />

ensure Kiwi DOs are better qualified than their<br />

Trans-Tasman counterparts, as OTEN consolidates<br />

Australia state standards into a national DO<br />

standard.<br />

The move from OTEN to a domestic qualified<br />

distance learning course stems from the<br />

imminent changes to the standards in Australia,<br />

admits Savage.<br />

“We’ve had a good relationship with them for<br />

a very long time and we will still have a good<br />

relationship with OTEN…but we’ve never had<br />

NZQA qualified recognition, and that’s really what<br />

we’d like to do now. We’ve been in the industry<br />

long enough for us to say, ‘hang on let’s look at<br />

how we can do this better’.”<br />

An NZQA qualification would also provide<br />

a safeguard of independence from private<br />

corporations exercising undue influence on some<br />

teaching facilities, added Savage.<br />

Interest in DO education appears to have<br />

increased over the past four years, with the<br />

number of ADONZ students increasing from 8 in<br />

2011 to 58 this year, which ADONZ leaders see as<br />

another sign of the need for good DO education<br />

in New Zealand.<br />

In a presentation, WinTec representative Sara<br />

Towers explained the process of setting up a new<br />

DO education programme in New Zealand.<br />

“We’re probably looking at a diploma level<br />

qualification, so either a level 5 or level 6 diploma<br />

depending on the level of learning outcomes that<br />

come through in the actual qualification design.”<br />

Towers said they will be looking for input from<br />

ADONZ members and asked for their response<br />

to a simple online survey to demonstrate their<br />

support for the qualification’s development in<br />

New Zealand.<br />

The programme would also have to gain<br />

approval from the Optometrists and Dispensing<br />

Opticians Board to ensure the training continues<br />

to protect public safety.<br />

WinTec intends to finish consultation with<br />

ADONZ members and other education entities<br />

by the end of the year to expedite approval<br />

from NZQA. The goal, Towers said, is to have a<br />

programme in place for the first semester of<br />

2016.<br />

“What this all means is we will end up with a<br />

good academic qualification. We want to make<br />

sure it is the best we can, so we provide the best<br />

service.”<br />

Like OTEN, the New Zealand programme will be<br />

delivered as a distance learning course to service<br />

students throughout the country, and it will<br />

continued to be administered by OptiBlocks.<br />

From the technical<br />

to the ethical<br />

Lecturers from New Zealand, Australia and the<br />

UK covered a range of topics, providing attendees<br />

with 13 CPD points (with an extra CPD point for<br />

attending a workshop) in sessions that sparked<br />

both interest and debate.<br />

Serah van Haeften, legal counsel for Specsavers<br />

Australia, led a presentation on the murky waters<br />

of conflict of interest.<br />

“Under the law you are required to avoid<br />

conflict of interest situations. What that actually<br />

means is putting your patients first,” van Haefetn<br />

said. “You have to have proper skills to make the<br />

right kind of referral and on occasions when there<br />

are things beyond your expertise you have to<br />

make the right kind of referrals. Public health and<br />

safety has to be paramount.”<br />

The simple summary, however, does not tell the<br />

entire story, and van Haeften later admitted that<br />

in any situation, the decision on what is or isn’t<br />

ethical is highly subjective.<br />

“It goes beyond the profit margin,” she said.<br />

“What should you do if you have a conflict?<br />

Transparency, openness and honesty are the keys<br />

to managing conflict. In everyday life we have<br />

this. The idea is not to stop living life or avoiding<br />

things, but to ensure that everyone you work with<br />

is aware of it.”<br />

The presentation led to a lively discussion<br />

exposing the occasional difficulty in determining<br />

what defines a conflict of interest and contrasting<br />

it with customary business practice.<br />

Lens supplier sales incentives, staff discounts<br />

to family, patient-referral incentives and other<br />

scenarios discussed all require finesse to maintain<br />

professional integrity, said van Haeften.<br />

“The questions you should ask yourself are do<br />

my actions feel right? Do they reflect what people<br />

generally think is right and wrong? It’s better<br />

to err on the side of caution so you can sleep at<br />

night and to make sure the values you represent<br />

are in line with the values your serve.”<br />

Joanna Murray, John Ruby and Steph Cawte were<br />

among the first people to go through OptiBlocks when it<br />

launched in 1995<br />

Angela Mitchell as Amelia Earheart<br />

Jennifer Mae Castillo took the First in Class student prize,<br />

sponsored by Essilor<br />

Pene Leadbeater and Jacquie Ellis getting into the spirit<br />

of the ‘20s<br />

Shamir Glacier Coatings Ad - NZ Optics.indd 1<br />

10 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong><br />

13/10/<strong>2015</strong> 10:29:58 AM

Get to the main<br />

cause of dry,<br />

irritated eyes*<br />

4UP TO<br />

HOURS<br />

RELIEF 2<br />


Optrex ActiMist – clinically proven to work<br />

How does Optrex ActiMist work?<br />

ActiMist liposomes<br />

Natural lipids<br />

Optrex ActiMist contains<br />

liposomes (tiny bubbles fi lled with<br />

moisture) that migrate across the<br />

surface of the eyelid and collect<br />

at the edges of the eye.<br />

These liposomes mix with natural<br />

lipids on the eyelid.<br />

ActiMist liposomes<br />

When the eyes are open the new<br />

lipid mixture spreads over the<br />

whole tear fi lm, and helps fi ll the<br />

gaps to restore the damaged<br />

lipid layer.<br />

Hygienic. Can be used<br />

by multiple people<br />

Lasts 6 months<br />

after opening<br />

Won’t smudge<br />

make-up<br />

Convenient and<br />

portable<br />

Suitable for use<br />

with contact lenses<br />

Order stock for your practice today<br />

FREE CALL 0800 393 564 EYELOGIC<br />

www.optrex.co.nz optrex@eyelogic.com.au<br />

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:<br />

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. <strong>Nov</strong>ember Reckitt Benckiser, <strong>2015</strong> NEW Auckland. ZEALAND TAPS DA1541 OPTICS<br />



Man versus machine<br />

Steve Daras gave a bird’s eye view on the current<br />

state of Digital Measuring Systems (DMS),<br />

emphasising the need for staff training.<br />

The technology of DMS has generally moved<br />

from tower units to desktops to tablets with<br />

the capability of replacing some or all of the<br />

traditional hand held tools: pupil distance rulers,<br />

marking pens, pupilometers, millimetre rulers,<br />

Fresnel split prisms and vertex callipers.<br />

“These systems have been out a while and<br />

they’re improving,” Daras said. “When they first<br />

came out the images weren’t quite so good, so<br />

they improved the lenses to take better pictures<br />

and better fields of view. The fitting jigs are finer<br />

Steve Stenersen with OptiBlocks providers and<br />

conference presenters David Wilson, Steve Daras and<br />

Mike Firmston, who kept the ball rolling during the<br />

lectures and at the dinner event<br />

and they are improving their targeting systems.”<br />

The original towers also had a problem with<br />

accommodating and converging, because their<br />

design required the patient to stand too close<br />

to the lens, but all in all, the technology has<br />

improved, Daras said.<br />

“These tools make our job a lot easier and make<br />

the patient’s experience a lot better,” he said.<br />

New tablet systems have the advantage of<br />

mobility, freeing up space that would otherwise<br />

be occupied by a dedicated machine.<br />

But, with the technology’s advantages come<br />

drawbacks. Daras emphasised the need to<br />

prepare, to make sure a frame is sitting in the<br />

exact position on a person’s face for accurate<br />

measurement.<br />

“Even with digital technology you still need to<br />

fit that frame correctly and comfortably and in its<br />

final position, so when you put the jig on top, it<br />

doesn’t change anything.”<br />

Aside from taking the PDs, centration<br />

measurement, the pantascopic measurement and<br />

the vertex and face forming measurements in one<br />

process, DMS technology can also now measure<br />

the frame for accurate heights and some have the<br />

ability to take behaviour into consideration, such<br />

as head-eye movement.<br />

Daras says the high-end towers and desktops<br />

are often technically difficult to operate and<br />

require training, preferably on-site from the<br />

manufacturers, with one person in practice<br />

recruited as resident expert and written operation<br />

material for reference.<br />

“Finally, all tools are accurate, including your<br />

ruler, it does nothing wrong,” Daras said. “But<br />

it’s the operator, the human interface that’s the<br />

problem. If the operator doesn’t get it right, that’s<br />

where the error comes from so we have to be on<br />

top of it and practice our skills.”<br />

History lessons<br />

Other presentations gave attendees a look back at<br />

the progress vision science has made.<br />

Dr David Wilson, an OptiBlock teacher from the<br />

University of New South Wales, discussed the<br />

development of eye-charts, in and out of clinical<br />

settings and the rationale behind them.<br />

Most visual acuity tests, he said, are based on<br />

discernment at one minute of arc, tracing its roots<br />

back to 1703 when the English scientist Robert<br />

Hooke determined that the eye could distinguish<br />

between two paired stars at one minute of arc.<br />

Danish ophthalmologist Marius Tscherning in<br />

1898 argued that one minute of arc was not<br />

sufficiently small to measure vision as people<br />

could do better than that, which Wilson said is<br />

borne out by the fact that a 6/6 visual acuity<br />

doesn’t actually translate to “perfect” vision.<br />

Nevertheless, most vision charts are based on<br />

one minute of arc from Herman Snellen’s first eye<br />

charts, to the LogMar chart, which as the name<br />

suggests is a logarithmic, as opposed to a ratio or<br />

decimal measure.<br />

In future, new charts may no longer be based on<br />

the 6 metre distance reading.<br />

“If the aperture is small relative to the distance<br />

of the source, the light passing through the<br />

aperture can be considered to be parallel. For the<br />

human eye, that is generally considered to be a<br />

distance of 6 metres. That’s not necessarily an<br />

accurate assumption,” Wilson said.<br />

In the US, researchers are using a four-metre<br />

chart, with an adjustment of -.25D to account for<br />

distance, the benefit of which is the four metre<br />

chart uses a compensating power standard in<br />

an optometric trial set (which is not the case<br />

for the other alternative five metre set). The<br />

big consideration is having a patient stand four<br />

metres instead of five metres away saves on real<br />

estate.<br />

Another history lesson came with Richard<br />

Johnson’s presentation on contact lens<br />

complications.<br />

“Leonardo da Vinci theor ised if you put your<br />

face in a bowl with curvatures you can negotiate<br />

different powers,” Johnson said. “He made<br />

excellent clinical notes.”<br />

Rene Descartes and Thomas Young centuries<br />

later used tubes of water in contact with a person’s<br />

eye to negate problems, while Sir John Herschel,<br />

more famous for astronomical work, identified the<br />

problem of corneal scarring in keratoconus.<br />

In Germany in the 1880s, various scientists<br />

developed the first scleral contact lenses, which<br />

were made from blown glass and of such a<br />

size that the eye would swell, giving patients<br />

about two hours of clear vision each day. Things<br />

improved in the 1930s with smaller, glass/PMMA<br />

lenses. But it wasn’t until 1949 that techniques<br />

improved to provide oxygen through the glass to<br />

the ocular surface allowing wearers clear vision<br />

for eight hours a day. After another few years soft<br />

contact lenses made from plastic (Hema lenses)<br />

arrived on the scene and finally, in 1985, the first<br />

bio-compatible material was developed, but<br />

the holy grail of contents, said Johnson, was the<br />

advent of silicon-hydrogen daily lens in 2012. ▀<br />

What’s new: ADONZ exhibitors<br />

It may be the quieter year (the year ADONZ<br />

doesn’t combine its annual conference with<br />

the New Zealand Wholesalers Association<br />

conference and exhibition at Visionz) but ADONZ’s<br />

exhibitor space at Hamilton’s <strong>Nov</strong>otel was abuzz<br />

with networking and news.<br />

The social mood was helped by the relatively<br />

tight exhibitor space, which formed a corridor<br />

to and from the main meeting room and food<br />

areas, allowing for plenty of opportunity for<br />

delegates to catch up on what’s new for this<br />

summer and next year.<br />

Leading the charge as you entered ADONZ<br />

<strong>2015</strong> was Fortune Technology Corporation,<br />

a company more at home in New Zealand’s<br />

casinos than Kiwi optical circles, which was<br />

testing the waters for its SuperSelfie Digital<br />

Mirror Kiosk, a distinctively designed touchscreen<br />

display stand allowing patients to see<br />

how they look in various frames.<br />

Brad Boult, Petra Hewitt, Angela Mitchell, and Tom Frowde<br />

12 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong><br />

Ph 0508 FRAMES (372 637)<br />

Debra and Peter O’Sullivan with Karen Walton and<br />

Shelley Endacott<br />

Independent Lens Specialists<br />

(ILS) was sandwiched between<br />

Phoenix Eyewear and Euro<br />

Optics/Elegance in Eyewear,<br />

with Dynamic Eyewear not far<br />

away, which was appropriate<br />

as ILS has partnered with<br />

Phoenix, Elegance in Eyewear<br />

and Dynamic over the past<br />

couple of years to offer a<br />

competitive SunRx programme<br />

to independents, with direct<br />

ordering through the ILS website<br />

www.sunrx.co.nz.<br />

Phoenix Eyewear<br />

SunRx was definitely one of the<br />

main topics of conversation at<br />

ADONZ <strong>2015</strong>, says Phil Wilson,<br />

business development manager<br />

at Phoenix Eyewear.<br />

Phoenix was showcasing some<br />

of its latest frames from Radley,<br />

CAT, Kate Sylvester and O’Neill<br />

as part of its <strong>2015</strong>/2016 SunRx<br />

programme, which it offers in<br />

partnership with ILS and Essilor.<br />

Jono Hennessy’s new releases,<br />

featuring pearlescent colours<br />

and marble colouring in larger<br />

sizes, appealing to the current<br />

fashion for deeper, bigger<br />

Bill Devereaux with Elena Zvyagina<br />

frames for women, was also attracting interest,<br />

while Phoenix’s popular William Morris Black Label<br />

range was completed by the quintessentially-<br />

English frame designer’s new retro-inspired<br />

collection. It harks back to the 50s and 70s with a<br />

lot of antique pewter, metal bridges and double<br />

rivets, says Wilson.<br />

Also attracting interest was Radley’s third<br />

release, which continues to push the mould<br />

in its petite sizing range with bright, vibrate<br />

frames, made from acetate and the increasingly<br />

popular TR90, a thermoplastic material that’s very<br />

lightweight, durable and flexible.<br />

“It’s fantastic because more people are going for<br />

colour, which is about time…though we’re still a<br />

fairly conservative country as a whole,” says Wilson,<br />

hinting there’s even more to come from Phoenix<br />

later this year after a successful foray to Silmo.<br />

“We have a new range coming, which we can’t talk<br />

about it at the moment, but watch this space; it’s<br />

very exciting.”<br />

Euro Optics/Elegance in Eyewear<br />

Carl Doherty, general manager of Euro Optics was<br />

showcasing his new brand Italia Independent.<br />

Donned by the likes of Lady Gaga and Rihanna,<br />

Italia Independent is a great and natural addition<br />

to Euro Optics brands as it will be producing<br />

another Euro Optics’ brand, Adidas Originals—<br />

Adidas’ street-wear range, as opposed to its more<br />

sport-orientated Adidas Performance, made by<br />

Silhoutte, says Doherty.<br />

Rihanna wearing Italia Independent’s brown velvet frames<br />

Gary Edgar, Brian Dover and Carl Doherty<br />

“It works well for us because we wanted to<br />

keep Adidas together and we were also looking<br />

for another brand. Italia Independent is probably<br />

one of the most innovative companies in Italy and<br />

it’s very popular in Europe, so it allows us to offer<br />

something different and doesn’t cannibalise any<br />

of our other brands.”<br />

Created in 2007 in Italy by three<br />

flamboyant founders, Lapo Elkann, Andrea<br />

Tessitore and Giovanni Accongiagioco, Italia<br />

Independent rose to fame as one of the first<br />

sunglasses manufacturers to use carbon fibre<br />

for fashion’s purposes. The company prides<br />

itself on its innovative credentials, using unique<br />

technologies such as thermosensitive fibre and<br />

microfiber linings.<br />

Using a special heat-creating machine, Doherty<br />

was able to demonstrate Italia Independent’s<br />

I-Thermic sunglasses, which are characterised<br />

by a particular enzyme treatment that reacts by<br />

becoming transparent when the sunglasses are<br />

exposed to 30° temperatures thus showing the<br />

colour or pattern underneath.<br />

I-Thermic from Italia Independent and Euro Optics<br />

Though Italia Independent was the focus of<br />

Doherty’s stand, a number of delegates were also<br />

keen to know about the latest additions to his<br />

SunRx programme from Adidas and Silhouette, as<br />

well as the latest from the two popular European<br />

brands. Due out in January, Silhouette’s new range<br />

features innovatively striped-colouring technology<br />

and is made from a very light weight material<br />

called SPX, designed to be both flexible and<br />

maintain its shape for a long time.

Prescription<br />

sun protection<br />

campaign<br />

Instant<br />

prizes<br />

Tropical holiday<br />

for two in<br />

Hawaii<br />

$10,000<br />

worth of cash<br />

vouchers<br />

$6,000<br />

worth of<br />

travel<br />

vouchers<br />

Between 1 st <strong>Nov</strong>ember <strong>2015</strong> to 31 st January 2016, every pair of HOYA Transitions ® Signature VII<br />

and HOYA NuPolar ® purchased will give you and your patients chances to WIN a series of great prizes,<br />

including over $15,000 worth of cash vouchers and a tropical holiday for two in Hawaii! *<br />

How does it work?<br />

Simply register with a HOYA Representative or email us at: hapl_marketing@hoya.com<br />

*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. ©<strong>2015</strong><br />

Transitions Optical, Inc. All rights reserved. Other trademarks or service marks included are property of their respective owners. Photochromic performance is influenced by temperature,<br />

UV exposure, and lens material. NuPolar ® is a trademark of Younger Optics.<br />

<strong>Nov</strong>ember <strong>2015</strong><br />




MSO<br />

Mike Sladen from Mike Sladen Optical was showcasing the<br />

latest looks from Face à Face, which featured a new innovative<br />

colour range and the latest from its popular Bocca range,<br />

characterised by the playful trademark footwear designs,<br />

coloured to match, at the end of the frame arms. “They are<br />

the most beautiful quality acetate frames,” says Sladen, who<br />

represents Eyes Right Optical in New Zealand.<br />

Prodesign’s new range was also doing well, despite only being<br />

available for a week, says MSO’s Rae Long. “They always do<br />

their colour combinations so well.” Prodesign has also released<br />

sunglasses again, the first time in four years, she says.<br />

Another MSO Eyes Right brand not on display though<br />

attracting attention and discussion was Zac Posen, which<br />

rose to fame on the US show Project Runway. The optical and<br />

sunglass collection was launched at ODMA <strong>2015</strong> and apparently<br />

the feedback on the range has been amazing, says Long.<br />

Also attracting attention was MSO’s Jos.Eschenbach range, a<br />

new eyewear brand launched by Eschenbach Optik, Germany’s<br />

leading supplier of eyewear and magnifiers. Priced from $110<br />

to $165 wholesale, 90 per cent of the range is titanium for light<br />

weight, allergy-free comfort, with the rest made from high<br />

quality acetate. Other Eschenbach products on display included<br />

the latest range from Titanflex, that’s a third lighter than<br />

conventional materials and 10 times more flexible and its latest<br />

low vision aids.<br />

Minima’s 10 year-warranted, super-flexible, super-tough<br />

children’s rimless frames were also on display. Very popular<br />

in Europe, they are just gaining attention here, says Sladen.<br />

Minima’s “Junior Hybrid” range, took home the <strong>2015</strong> Silmo d’Or<br />

award in the children’s frames category.<br />

Essilor<br />

Essilor’s stand focused on its Transitions promotion, featuring<br />

Canadian Actress Laurence Leboeuf wearing Transitions<br />

Graphite Green lenses, an alternative to the more common<br />

brown and grey options.<br />

Chris Aldous, Essilor’s business development manager, was<br />

also on hand to explain Essilor’s “Power of 3” promotion for kids,<br />

though it’s attracting attention from adults too. Crizal Prevencia<br />

Kids is designed to protect kids’ eyes from blue-violet light<br />

emitted from digital devices and UV, including the reflection of<br />

UV from the back of the lenses. The lenses themselves are also<br />

made from Airwear, a shatter-proof polycarbonate material,<br />

which is scratch resistant, durable and lightweight.<br />

Though it’s relatively new here, Crizal Prevencia is proving<br />

popular in Asia with more parents purchasing coated plano<br />

lenses to protect their children’s eyes, says Aldous. “Traditionally<br />

it’s been about helping people see, but now it’s about having<br />

healthy eyes as well. For the first time the child who is the<br />

spectacle wearer has an advantage over non-spectacle wearers.”<br />

ILS/Younger Optics<br />

Causing a significant stir at ADONZ was the pre-release of<br />

Camber, the latest lens innovation from Younger Optics which<br />

offers a new front surface innovation known as a variable base<br />

curve to increase acuity across all viewing zones. Once all the<br />

qualifying steps have been taken, the lens will only be available<br />

from Independent Lens Specialists (ILS) in New Zealand.<br />

Though details were limited at this time, Younger Optics’<br />

Australasian sales and marketing manager Trevor Inglis was on<br />

hand to support ILS introduce Camber and promote Younger’s<br />

NuPolar Gradient lens, now available in polycarb for both single<br />

visions and progressive lens wearers. Another Younger patented<br />

technology, NuPolar is the first polarised lens available in a<br />

gradient tint. “As it’s built into the lens film it’s not going to<br />

fade,” explains Glenn Bolton, ILS director.<br />

Inglis was also on hand to introduce his replacement Sam<br />

Crooke who will be replacing him at the end of this year (see<br />

story p22).<br />

Hoya<br />

Hoya continued the rollout of its new line of vocational lenses,<br />

Workstyle V+, designed to give presbyopic patients a better<br />

option if they frequently switch focus from screen to desk to<br />

general office.<br />

Looking ahead to 2016<br />

New Zealand’s answer to ODMA, Visionz, will run alongside<br />

the ADONZ annual conference once again in 2016.<br />

The fourth bi-annual Visionz will run at the Ellerslie<br />

Events Centre from October 14 to October 16, with the ADONZ<br />

annual conference, and for the first time in New Zealand, the<br />

International Opticians<br />

Association meeting.<br />

The New Zealand<br />

Wholesalers Association<br />

(NZOWA) syncopates<br />

its biannual show with<br />

ODMA’s Australia-based<br />

biannual expos. NZOWA<br />

President Gary Edgar says<br />

he was disappointed that<br />

despite several months<br />

of discussions the New<br />

Zealand Association of<br />

Optometrists (NZAO),<br />

that organisation decided<br />

Gary Edgar<br />

to hold its annual 86th<br />

Any new product takes about three months to roll out, says<br />

Hoya’s country manager Stuart Whelan. “ADONZ is a great event<br />

to reach those DOs who weren’t able to come to the Auckland or<br />

Wellington launch events.”<br />

As well as explaining Workstyle V+, Whelan was also taking<br />

registrations for Hoya’s just-launched, new prescription sun<br />

protection campaign, offering practices and consumers the<br />

opportunity to win prizes worth more than $20,000, including<br />

a five-day trip to Hawaii for two. The campaign runs from 1st<br />

<strong>Nov</strong>ember to 31st January 2016 (see Hoya’s ad this issue for<br />

more information).<br />

Others exhibiting at ADONZ included General Optical which<br />

was focusing on the varied assistance programmes it runs for<br />

customers, its SunRx programme, which it handles through its<br />

own labs in Australia and its Nike Performance and Rewards<br />

programmes. With more than 40 brands in its portfolio and a<br />

host of new initiatives for customers, there was a lot to talk<br />

about at ADONZ says Genop’s New Zealand general manager<br />

Brent Rushworth and customer service manager Richard Tooby.<br />

Tools galore at Eyeline Optical<br />

Dynamic Eyewear’s Paul Beswick attracted some positive<br />

attention by handing out hangover packs featuring, among<br />

other goodies, a can of Red Bull, designed to make you feel a<br />

better and promote Red Bull’s new super light Racing eyewear<br />

range, which is new to Dynamic and new to New Zealand. Other<br />

brands featured included Australian-designed Charlie Brown<br />

and Nicola Finetti.<br />

Eyeline Optical exhibited a host of fascinating gadgets and<br />

optical accessories, several of which featured as must have<br />

pieces of equipment for dispensing opticians, such as a facial<br />

gauge, in key note speaker Elaine Grinsdale’s talks.<br />

While others exhibiting included Misty Optics, which shared<br />

a stand with CMI Optical; Optique Line; Little Peach, which<br />

was showcasing some intricate lace-inspired clips-ons from<br />

Face&Cie; Allied Health Aotearoa and the ODOB; and Optica<br />

Life Accessories, which was showcasing its Peeps eyewear and<br />

sunglass cleaner as well as other accessories which can be<br />

branded with customers’ own logos. ▀<br />

Taking care of<br />

business<br />

The Association of Dispensing Opticians NZ made<br />

several appointments at the AGM part of its<br />

October conference in Hamilton: Vineet Chouhan<br />

was reappointed to a two-year term as treasurer; Lynette<br />

Hunter was reappointed to the executive council; Lucie<br />

Single was elected to an open seat; Steph Caute and<br />

Sarah Bycroft were re-elected to the continuing education<br />

committee; and Emmaleen Sherriff was elected as a<br />

new member.<br />

Annual Conference over the same dates in New Plymouth.<br />

Edgar says NZAO had wanted NZOWA to underwrite the costs<br />

of NZAO’s part of the conference, which its members weren’t<br />

prepared to do, and was concerned about the overlap between<br />

ADONZ and the NZAO parts of the conference, meaning<br />

practices could have both their optometrist and DO away on the<br />

same day.<br />

Callum Milburn, the new NZAO president says he thinks Visionz<br />

is a great endeavour. “We gave serious consideration to the<br />

option of holding our 2016 conference at Ellerslie to coincide with<br />

Visionz, but our association was already well down the path of<br />

setting our 2016 conference in New Plymouth. As a significant<br />

proportion of our members are employed practitioners, with little<br />

or no influence on the purchase of product, their motivation,<br />

interest for trade displays is not great. We had to consider if<br />

the lure of Ellerslie (lovely suburb that it is) would be enough<br />

to fill the auditorium for educational sessions and enable our<br />

conference to pay its way? In the end it will be a Visionz-ADONZ<br />

event and I am delighted for ADONZ that they are hosting the<br />

International Opticians Association. This is a tremendous honour<br />

and they should be very proud.” ▀<br />

Focus<br />

on Business<br />



To operate a business you<br />

have to make certain<br />

commitments, many of<br />

which involve signing documents<br />

that bind you to a course of action–<br />

and if circumstances change and<br />

the goal posts shift there can be<br />

significant consequences.<br />

We’ve seen numerous instances<br />

of this occurring in the optometry<br />

sector over recent years, stories<br />

that illustrate why it’s critical<br />

to fully understand the current<br />

and ongoing implications of the<br />

commitments you are making–and<br />

why taking appropriate legal and<br />

business advice is essential.<br />

A number of years ago, several<br />

aggregators of optometry practices<br />

were active paying good money for<br />

successful businesses.<br />

In many cases, the aggregator<br />

retains the previous owner (who<br />

is paid a market salary) to provide<br />

continuity and patient retention.<br />

With the completion of the<br />

contract, the new owner is entitled<br />

to operate the business as they see<br />

fit: the previous owner may or may<br />

not be consulted. In some cases,<br />

a joint ownership arrangement is<br />

implemented with the associated<br />

parties have an ongoing working<br />

protocol put in place.<br />

Some of the aggregators, though,<br />

have subsequently decided to<br />

sell-up and exit the market, leaving<br />

the original owner to deal with a<br />

new organisation, and different<br />

philosophies. Compatibility issues may<br />

arise particularly if there is a different<br />

business focus. The only avenue<br />

available is to accommodate the<br />

changes, or to exit the organisation,<br />

discontinuing the association with<br />

what has been their “life’s work”, and<br />

seeking opportunities elsewhere.<br />

Ultimately, good money was paid and<br />

ownership changed.<br />

The lessons<br />

Read the fine print. Where<br />

a practice has entered into a<br />

franchise arrangement, a full<br />

understanding of the implications<br />

of the legal documents is essential,<br />

particularly the fine print. You need<br />

to comprehend the requirements<br />

around the supply chain, reporting<br />

(financial and other), branding<br />

and marketing, training and<br />

operational matters.<br />

Sale/exit provisions. Of special<br />

interest will be the provisions<br />

concerning who you might be<br />

able to sell your practice or share<br />

of the practice to. Constraints<br />

may result in a disappointment in<br />

the price achieved. Alternatively,<br />

the franchisor may assist in a<br />

significantly improved price in terms<br />

of perceived value by the purchaser.<br />

This may be a good result but the<br />

overriding issue will be the ability to<br />

sell to the most suitable party.<br />

This is of interest where<br />

a practice owner might be<br />

withdrawing from a partnership<br />

arrangement for good reasons.<br />

The ongoing partner(s) may wish<br />

to take the business in a different<br />

direction, possibly outside the<br />

franchise arrangements. The legal<br />

documents signed will dictate the<br />

steps the must be taken to achieve<br />

the separation sort.<br />

Compliance with the prescribed<br />

course of actions in most cases will<br />


be mandatory particularly if the<br />

franchisor perceives a disadvantage.<br />

Invariably, the level of detail involved<br />

can become extreme ranging from<br />

major items to minor and even<br />

trivial matters. This process can<br />

become very frustrating requiring<br />

patience and negotiation to achieve<br />

the desired outcome. Significant<br />

costs may be incurred as well if legal<br />

advice and activity is required.<br />

With the passage of time, the<br />

persons previously leading the<br />

organisation may no longer<br />

be doing so. This may result in<br />

different interpretations and<br />

expectations being applied or<br />

different approaches being used.<br />

The ability to achieve a seamless<br />

transition may be hindered thereby<br />

slowing the process down.<br />

Arm yourself with the facts. In<br />

these situations, being prepared<br />

and arming yourself with a good<br />

understanding of the facts will pay<br />

dividends in achieving your goals.<br />

Also, allowing a reasonable period<br />

of time is important to avoid the<br />

possibility of delays and potential<br />

cross over periods with ensuing<br />

additional costs.<br />

Loan and guarantee documents.<br />

In previous articles, we have<br />

covered the need to understand<br />

loan agreements and guarantee<br />

documents that may have been<br />

signed. An understanding of those<br />

commitments should be reviewed<br />

annually. Increasingly suppliers<br />

are asking for personal guarantees<br />

before supplying products and<br />

services. A register of guarantees<br />

granted should be maintained to<br />

ensure full visibility of the extent of<br />

the commitments made.<br />

Talk to your bank. Similarly,<br />

banks and lending institutions<br />

are requiring more security to<br />

support their lending. As loans<br />

are repaid, borrowers should<br />

review the securities given for<br />

appropriateness of quantum.<br />

Wherever possible, a discussion<br />

with your lending manager should<br />

occur annually to signal that<br />

you are serious about achieving<br />

reduction, particularly where<br />

security might be over property. If<br />

a personal guarantee is involved,<br />

ensure you can limit the extent.<br />

Assess all documents Other legal<br />

documents which may have been<br />

signed and therefore requiring<br />

analysis will be property lease,<br />

optical and other equipment leases<br />

and contract for services, including<br />

employment contracts.<br />

Hindsight is a luxury unavailable<br />

at the time commitments are<br />

entered into. Thinking carefully<br />

about the arrangements you are<br />

entering into contractually is crucial<br />

to your success and wellbeing. Time<br />

needs to be taken to evaluate the<br />

opportunities and risks involved<br />

in the fullness of time. Being in<br />

business involves risk; it is a question<br />

of how that risk is managed. ▀<br />

* David Pearson is<br />

managing partner with<br />

BDO Napier and has a<br />

specialty interest in<br />

advisory services to<br />

the optometry sector.<br />

For more information<br />

contact David at david.<br />

pearson@bdo.co.nz or<br />

visit www.BDO.co.nz.<br />

14 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>




The SYSTANE ® portfolio Protects, Preserves and<br />

Promotes a Healthy Ocular Surface 1–5 . See eye care<br />

through a different lens with our innovative portfolio.<br />

Surface protection and more<br />


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<br />

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<br />

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<br />

with a new lubricant eye drop formulation. J Ocul Pharmacol Ther. 2010;26(4):347-353. 4. Aguilar A. Efficacy of a <strong>Nov</strong>el Lubricant Eye Drops in Reducing Squamous Metaplasia in Dry Eye<br />

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<br />

Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction. IOVS. 2011;52(4):2050-2064. Alcon Laboratories (Australia)<br />

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.<br />

POPH.15104. TAPS.PP6717. NP4.A21507352604.<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Focus on<br />

Eye Research<br />

Cornea Review<br />




Sandvik GF, et al. Cornea.<br />

<strong>2015</strong>;34(9):991-5.<br />

Review<br />

Crosslinking is the creation of bonds that<br />

connect one polymer chain to another.<br />

This review evaluates the effect of collagen<br />

crosslinking (CXL) treatment on long term<br />

keratoplasty rates in keratoconic patients.<br />

Corneal collagen crosslinking is a technique<br />

used to strengthen corneal tissue utilising<br />

riboflavin (vitamin B 2<br />

) as a photosensitiser<br />

and Ultraviolet-A (UVA) to increase the<br />

formation of intra and inter-fibrillar carbonylbased<br />

covalent bonds through the process of<br />

photopolymerisation. The authors report the<br />

frequency rate of keratoplasty in keratoconic<br />

patients in a 12-month window before and<br />

after the introduction of CXL treatment in a<br />

single center.<br />

The total number of keratoplasties performed<br />

for keratoconus during period 1 (before the<br />

introduction of CXL) was 55. The corresponding<br />

numbers in period 2 (after the introduction of<br />

CXL) was 26. The difference in the number of<br />

keratoplasties for keratoconus in both periods<br />

was statistically significant. There were no<br />

significant differences in the distributions of age<br />

and gender between both periods.<br />

Comment<br />

CXL treatment was heralded as having the<br />

potential to reduce the need for corneal<br />

transplantation in keratoectatic patients by as<br />

much as 50% shortly after it was first reported<br />

on in 2003. More than a decade after being<br />

introduced this minimally invasive treatment<br />

modality is now fulfilling the promise of treating<br />

keratoectasia at an earlier stage, preventing the<br />

morbidity associated with disease progression,<br />

and precluding the need for the more invasive<br />

keratoplasty procedure.<br />





Uddaraju M, et al. Am J Ophthalmol.<br />

<strong>2015</strong>;160(1):131-4.<br />

Review<br />

Fungal keratitis is an important cause of ocular<br />

morbidity, especially in developing countries.<br />

Fungal corneal infections often carry a worse<br />

prognosis compared to bacterial keratitis<br />

cases. A recent study found that 16% of eyes<br />

perforated or required therapeutic keratoplasty.<br />

Uddaraju and associates investigate the effects<br />

of CXL treatment on recalcitrant deep stromal<br />

fungal keratitis. The authors used the Dresden<br />

protocol settings (riboflavin 0.1%, ultraviolet A<br />

[UV-A] 370 nm at 3 mW/cm2 during 30 minutes)<br />

as an adjunct to antifungal treatment on culture<br />

positive fungal keratitis patients not responding<br />

to appropriate medical therapy for a period of 2<br />

weeks. The pre-specified primary outcome was<br />

treatment failure at 6 weeks after enrollment,<br />

defined as perforation and/or increase in ulcer<br />

size by ≥2 mm.<br />

The trial was prematurely stopped before full<br />

enrollment because of a marked difference in<br />

the rate of perforation between the 2 groups.<br />

Of the 13 cases enrolled in the study, 6 were<br />

randomised to the CXL group and 7 to the non-<br />

CXL group. Five eyes in the CXL group and 3 eyes<br />

in the non-CXL group experienced treatment<br />

failure by 6 weeks. In a secondary analysis, the<br />

CXL group experienced more perforations than<br />

the non-CXL group (4 vs 0, respectively). The<br />

authors conclude that CXL used as adjuvant<br />


therapy for recalcitrant deep stromal fungal<br />

keratitis does not improve outcomes.<br />

Comment<br />

This randomised controlled trial has several<br />

deficiencies including a small heterogeneous<br />

patient population and the use of a Dresden<br />

treatment protocol (developed for treating<br />

keratoectasia cases) rather than newer protocols<br />

such as PACK–CXL (photoactivated chromophore<br />

for infectious keratitis). This paper does however<br />

highlight the fact that conventional Dresden<br />

CXL protocol is not designed to target microbial<br />

keratitis and that new and more effective<br />

antimicrobial CXL protocols are required to treat<br />

difficult cases of deep corneal keratitis.<br />





Kim KH, Kim WS. Am J Ophthalmol.<br />

<strong>2015</strong>;160(3):463-469.<br />

Review<br />

Intraocular lens (IOL) dislocation is a known<br />

complication of cataract surgery, with an<br />

incidence ranging from 0.2% to 3%. Given<br />

the ageing population and the increasing<br />

number of cataract surgeries performed<br />

worldwide there may well be an increasing<br />

trend in IOL dislocation in the coming years. The<br />

authors evaluated he surgical outcomes of 78<br />

consecutive patients who underwent surgical<br />

repositioning of dislocated intraocular lenses<br />

using suturing to the sclera or iris. Forty-four<br />

eyes of 44 patients underwent scleral fixation<br />

and Thirty-five eyes of 34 patients underwent<br />

iris fixation of dislocated intraocular lenses.<br />

Corrected distance visual acuity (CDVA)<br />

improved significantly1 month postoperatively<br />

in both groups and remained stable for 12<br />

months. The authors found that Iris fixation and<br />

scleral fixation techniques had similar efficacy<br />

in the repositioning of dislocated intraocular<br />

lenses. Although operation time was shorter<br />

for iris fixation, it had several disadvantages,<br />

including induced astigmatism, immediate<br />

postoperative inflammation, earlier recurrence,<br />

and less stable refraction. The recurrence rate<br />

of dislocation in this study was similar in both<br />

groups (~15% at the one-year time point) but<br />

the recurrences occurred significantly earlier<br />

in the iris fixation group, with all recurrences<br />

observed within 3 months after surgery.<br />

Comment<br />

The ophthalmic surgeon has limited options<br />

at their disposal when dealing with a case of<br />

late IOL dislocation. This article highlights the<br />

shortcoming of current surgical techniques<br />

currently available to secure unstable IOL’s.<br />

<strong>Nov</strong>el surgical techniques such as intrascleral<br />

haptic fixation and new suture material such<br />

as GORE-TEX (a microporous, nonabsorbable<br />

monofilament suture) may well improve long<br />

term outcomes of patients with IOL dislocation<br />

after cataract surgery.<br />


* Dr Mohammed Ziaei<br />

is a cornea & anterior<br />

segment fellow at<br />

Greenlane Clinical Centre<br />

and the University of<br />

Auckland who completed<br />

his ophthalmology<br />

training in the UK.<br />

BDV: Step-by-Step<br />


John Veale, an optometrist and friend in<br />

Christchurch, casually approached me in April<br />

about providing “some oculoplastic teaching”<br />

at a charitable clinic in Cambodia. I knew John<br />

had shared his expertise there before and, as it<br />

happened, I’d found myself with spare annual<br />

leave I’d hoped to spend away from the frosty<br />

Christchurch winter.<br />

I had never been to Cambodia and the idea of<br />

teaching in an unfamiliar, perhaps challenging<br />

clinic appealed to me, especially with the<br />

possibility of adding on a tour of Angkor Wat<br />

afterwards.<br />

I agreed to help for a week in July, with little<br />

idea of what specific things the clinic director<br />

wanted from me. I learned the clinic was<br />

supported by Rose Charities New Zealand,<br />

was dedicated to helping the poorest folk<br />

with visual disorders and was located on the<br />

outskirts of the capital Phnom Penh.<br />

From a historical viewpoint, I knew of Pol Pot<br />

and the Khmer Rouge’s genocide activities of<br />

1975 to 1979 and how two million people were<br />

slaughtered in the “killing fields”. I would learn<br />

later that Vra, the ophthalmologist I worked<br />

with, had two older brothers killed by the<br />

regime when he was a child.<br />

Weekend Working<br />

I landed in the capital on a Saturday morning.<br />

I was met by Mike Webber, an experienced<br />

optometrist from Wanganui (who has been<br />

involved with Rose Charities for many<br />

years), and Dr Hang Vra, the clinic’s main<br />

ophthalmologist. They escorted me to a small<br />

hotel in the city. In the afternoon, Mike and<br />

I went on a brief sight-seeing tour, but the<br />

32ºC heat and full-on humidity was draining,<br />

explaining why July is Cambodia’s low season<br />

for tourism.<br />

Vra, 50, undertook his medical training in<br />

Moscow, where he met and married Natalia, a<br />

fellow medical student from Donetz, Ukraine.<br />

She is now a third-year ophthalmology resident<br />

in a teaching programme in Phnom Penh. The<br />

couple have spent the last 20 years in Vra’s<br />

native Cambodia, raising their three sons,<br />

working at the clinic, and running their own<br />

“new” private practice on weekends. My focus<br />

for the week was to help upskill Natalia, and<br />

another male third-year resident, in oculoplastic<br />

surgery.<br />

By Sunday morning, we were hard at work<br />

at Vra’s’ new clinic, seeing private patients.<br />

I instructed the ophthalmic assistants on the<br />

use of the Goldmann applanation tonometer,<br />

rather than using the Schiotz tonometry. They<br />

managed it, but longevity? In the afternoon<br />

Natalia did two cataracts using Alcon AcrySof<br />

IOLs, and several pterygia excisions with<br />

conjunctival autografts (but without using<br />

MMC). The private practice charges for cataract<br />

surgery are about half the price of rival city<br />

practitioners.<br />

On Monday morning we went to work at<br />

the old charitable clinic in the northeast area<br />

of the city. In addition to the Saturday and<br />

Sunday weekend work at the new private<br />

practice clinic, Vra, Natalia and the ophthalmic<br />

technicians work Monday to Friday at the<br />

charitable clinic. Natalia also attends clinics at<br />

the teaching hospital in the city. I commented<br />

to them about burn-out, but it never appeared<br />

to have crossed their minds that spending seven<br />

days a week working was odd.<br />

Morning at the old clinic<br />

The charitable programme runs with minimal<br />

administration out of an old school building<br />

that Vra converted to an ophthalmology clinic<br />

in 2003. The building is rent-free (governmentowned)<br />

but water and electricity are paid for<br />

by Vra. Rose Charities Canada underwrites<br />

Vra’s salary, along with the 20 staffers working<br />

there. Rose Charities New Zealand initially paid<br />

for clinical gear and continues to donate about<br />

$23,000 a year to fund the three residents in<br />

training from the Preah Ang Duong Hospital<br />

(PADH) training programme—including Natalia.<br />

Two senior ophthalmologists also perform<br />

cataract surgery at the clinic. I observed one<br />

doing an ECCE +IOL and he was very slick. The<br />

procedure was 10 minutes long from start<br />

to finish.<br />

The clinic sees up to 120 people on any given<br />

Monday and by 8:30am on my first morning<br />

there, 50 or so people were already awaiting<br />

their turn in a covered, outdoor reception area.<br />

Dr Weatherhead at work<br />

Dr Weatherhead at work<br />

The recovery area<br />

In the operating theatre<br />

Inside, residents were busy at the slit-lamps in<br />

the open-plan examination area, cooled by two<br />

ceiling fans.<br />

A very brief history, Natalia’s imperfect English<br />

translations, and only a momentary slit-lamp<br />

view, made it difficult for me to make an<br />

accurate diagnosis for each patient. The most<br />

common presentations, however, were visual<br />

loss from bilateral cataracts, refractive errors,<br />

pterygia and uveitis.<br />

Together, Natalia and I started with two cases<br />

of dysthyroid orbitopathy (one active case<br />

with corneal ulceration), childhood allergic eye<br />

disease (vernal), and then three cases of severe<br />

conjunctivitis in one family from suspected<br />

pollutant-induced chemical conjunctivitis.<br />

This was followed by a case of severe dry eye<br />

with filamentary keratopathy from probable<br />

Sjogren’s syndrome, an exposed evisceration<br />

implant, another patient with conjunctival<br />

symblephara formation from probable OCP, a<br />

unilateral traumatic cataract with asymmetric<br />

palpebral apertures, a 25-year-old girl with<br />

a unilateral ptosis following an evisceration<br />

for trauma, visual loss from Herpes simplex<br />

keratitis scarring, a corneal FB, and a 15-yearold<br />

lad with a corneal ulcer and hypopyon from<br />

a superficial scissor injury two weeks earlier.<br />

A 19-year-old lad with uveitis with secondary<br />

glaucoma OU came to us later that morning.<br />

A year before, he was HM HM. but the status<br />

was now NPL 6/24, as he had no money for<br />

medications. He had a negative CXR, tuberculin<br />

test and ACE test.<br />

Blurred vision from myopia, an epidermal<br />

cyst under the lateral eyebrow (not a childhood<br />

dermoid cyst), a vertical diplopia one month<br />

after blunt trauma to the eyebrow – probably<br />

a right fourth nerve palsy, a maculopathy<br />

following cataract surgery, and a woman with<br />

new-onset decreased vision. The latter case had<br />

bilateral trabeculectomies a year earlier. She had<br />

developed cataracts. The prognosis for visual<br />

improvement with cataract surgery is variable in<br />

such a case.<br />

We finished the clinic at about 1:40pm, having<br />

seen 126 patients.<br />

16 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Operating Conditions<br />

We spent that afternoon in surgery on the cases<br />

diagnosed before lunch (no waiting lists here):<br />

11 cataracts, two trabeculectomies, six ptergia,<br />

one levator aponeurosis repair, one evisceration<br />

implant exposure repair, one lateral tarsorrhaphy,<br />

one bilateral lower eyelid entropion repair, one<br />

brow cyst, one lower eyelid Z-plasty vs FTSG, and<br />

two lower punctual closures (with a flame-heated<br />

metal probe for cautery).<br />

The main source of funding for the ophthalmic<br />

surgery at the clinic is from ABC Tissue Vision,<br />

who pay US$40.00 for each completed surgery.<br />

The man behind the surgical funding is a<br />

Chinese Cambodian businessman who resides in<br />

Australia (think of Quilton toilet paper products).<br />

Our first case was a young girl with a four-tofive<br />

mm upper eyelid anophthalmic ptosis. Socket<br />

sutures needed to be removed, and her prosthesis<br />

was not custom-made. The antibacterial prepping<br />

immediately wiped off my pre-op skin crease<br />

marks (a Sharpie from the local market was the<br />

standard pen available). The unipolar cautery<br />

didn’t work. The bipolar version, when trialled<br />

at the end of the case, did work. Ultimately,<br />

we didn’t need to use the cautery on the case.<br />

Natalia had placed a 20mm implant during the<br />

evisceration two months earlier (the minimal size<br />

needed to avoid post-op volume under-correction)<br />

and there was good volume correction. A totally<br />

disinserted levator aponeurosis was found at<br />

exploration and was re-attached.<br />

We then closed a lacrimal fistula, did two cases<br />

of bilateral lower punctual cauteries, a lateral<br />

tarsorrhaphy and repaired a bilateral senile<br />

lower eyelid entropion (LLR surgery and LTS).<br />

Then back to the hotel in the tuk tuk with<br />

Mike, for a much needed Angkor beer at the end<br />

of the day.<br />

A week of it<br />

Though we spent much of the week at the<br />

clinic, I made time to give a lecture on common<br />

orbital conditions at the training hospital, the<br />

presentation geared toward the third and fourth<br />

year registrars. My impression afterwards was<br />

that this subspecialty presentation was a little<br />

over the heads of the 12 residents who attended.<br />

At least it introduced them to disorders they<br />

will encounter clinically, even if they do not<br />

manage them at present. Ophthalmic teaching in<br />

Cambodia, therefore, needs to be for educating<br />

and upskilling in general ophthalmology.<br />

The development of subspecialties will<br />

probably not occur until there are at least<br />

300 ophthalmologists working in the country<br />

(currently 74).<br />

On a practical level, I felt I was able to teach<br />

Natalia and the other residents a few things<br />

during the surgical sessions—nasociliary<br />

blocks, the lateral tarsal strip procedure,<br />

lower eyelid retractor identification and<br />

advancement, a better external DCR technique,<br />

an external levator aponeurosis approach, a<br />

direct browplasty technique and upper eyelid<br />

blepharoplasty.<br />

And the title of this article? “BDV” stands<br />

for blurred distance vision, the most common<br />

presenting symptom and patient note entry.<br />

And “Step-by-Step”? It appears that there is no<br />

equivalent Cambodian or Ukrainian translation<br />

of the word “gradual”, so everything was “stepby-step”.<br />

▀<br />

Full-on in Fiji for ophthalmic volunteers<br />

A group from Volunteer<br />

Ophthalmic Services<br />

Overseas (VOSO) provided<br />

surgery, exams and scrips<br />

at the Labasa Hospital<br />

from June 27 to July 11.<br />


REPORTS.<br />

Flying over the sugar cane fields of Vanua Levu,<br />

the team came in to land at Labasa Airport<br />

where we were greeted by 26°C heat and a<br />

very warm welcome from the Labasa Lions Club.<br />

Our team included ophthalmologists Rebecca<br />

Stack, Genevieve Oliver, ophthalmic nurse Marie<br />

Taylor, optometrists Michael Brown, Ravi Dass,<br />

Marika Fiolitakis, Karen Moulton and myself,<br />

as well as Neil Pugh and Jennie Vowles, both<br />

members of the New Zealand Lions, a crucial<br />

VOSO supporter.<br />

We went straight to Labasa Hospital from the<br />

airport to deliver supplies and prepare for the<br />

work ahead. The optometrists set up testing<br />

stations and a glasses dispensary, while the<br />

surgical squad familiarised themselves with the<br />

operating theatres.<br />

The next morning, we broke into action.<br />

Michael, Marika and Karen worked the refraction<br />

and screening stations, while Jennie gave out<br />

prescriptions at the dispensary table. In the<br />

theatres, the team adapted to performing<br />

small incision cataract surgery in an unfamiliar<br />

environment. They dealt with white cataracts, a<br />

black cataract and an Argentinian Flag all on that<br />

first day.<br />

Meanwhile, Ravi, Neil and I brought our services<br />

to the small, remote village of Coqeloa, seeing<br />

those who couldn’t travel to Labasa. And every day<br />

we worked a pair from our team would bring the<br />

same services to a different village.<br />

The Labasa Lions extended their hospitality to us<br />

The team: optometrist Michael Brown, Dr Rebecca Stack, ophthalmic nurse Marie Taylor, Dr Genevieve Oliver, Lions member<br />

Jenny Vowles, optometrists Karen Moulton, Marika Fiolitakis, Ravi Dass, and Reuben Gordon, and Lions member Neil Pugh.<br />

throughout the week with after-work dinners, cohosted<br />

by the Labasa Rotary Club and the hospital<br />

board. Michael also arranged interesting tours<br />

through a sugar cane field and a plywood factory<br />

and by the end of that busy week we enjoyed a<br />

getaway to Savusavu. We spent the weekend in the<br />

markets, looking around the town, exploring the<br />

resorts, snorkelling and taking in the epic Super15<br />

final. A well-needed weekend to recover before<br />

getting back into it.<br />

The last week went way too quickly. I was<br />

staggered to hear that we had performed 2,370<br />

eye screenings and distributed more than 2,000<br />

pairs of glasses. The surgical team performed 77<br />

procedures, including 73 cataract removals and a<br />

penetrating eye injury.<br />

Labasa Hospital has improved immensely from<br />

what I had been told to expect, testament to the<br />

hard work of the local team led by ophthalmologist<br />

Dr Uyanga Enebish.<br />

It was an amazing experience and the VOSO team<br />

were humbled by the hospitality of the Labasa<br />

Lions. We all worked hard throughout the trip, had<br />

interesting interdisciplinary chats and had a great<br />

time socially. I am keen to return in the future and<br />

Getting down to cases<br />

would recommend it to all.<br />

Anyone keen to volunteer should email<br />

visionzsecretary@gmail.com. ▀<br />

* Reuben Gordon is an optometrist at the Greenlane Eye Clinic<br />

in Auckland and works for Shanu Subbiah at Eye Institute<br />

Maui Jim training an amusing spectacle<br />

He called himself “Chad from Texas” and<br />

though he said he was tired, he came off as<br />

the indefatigable life of the party.<br />

At least that’s how Maui Jim’s travelling trainer<br />

Chad Smith presented himself at a recent education<br />

session for New Zealand’s dispensing opticians.<br />

Smith intermingled personal anecdotes with<br />

sales tips, technical information and company<br />

history, in a Lone Star State drawl that made<br />

earning CPDs a breezy night out.<br />

“I got into this business by accident,” Smith said.<br />

“I was going to university, and after six weeks my<br />

dad called me on the phone and said, ‘I got your<br />

credit card bill’.” Smith said his father gave him an<br />

ultimatum: get a job, or lose his car, a virtual death<br />

sentence for a college student at the time. The<br />

following Monday Smith landed an assistant role<br />

with a practice through a friend of a friend and the<br />

rest is history.<br />

More than 30 dispensing opticians and others<br />

attended the September evening session at the<br />

Sofitel Hotel in Auckland. Attending DOs qualified<br />

for CPD points for the hour-long session, which<br />

was the first the company has made available in<br />

three years, according to Maui Jim’s New Zealand<br />

sales executive Mark Buist.<br />

Maui Jim is one of the last privately-held<br />

sun glasses manufacturers to avoid a merger,<br />

according to Smith, who joined the company<br />

14 years ago from Luxottica, a perennial name<br />

circulating the rumour mill as a potential buyer.<br />

The company launched in 1988 in Hawaii, where<br />

it still maintains offices. It has a lab in Texas and<br />

a distribution centre in Illinois. The brand is sold<br />

through 15 optical practices in New Zealand.<br />

But virtually no consumers know the brand,<br />

said Smith, quoting research revealing only seven<br />

per cent of the American public knew what<br />

Maui Jim was and three per cent of Australians.<br />

Nevertheless, by some measure, the company has<br />

made inroads, he continued.<br />

“In 2007 we became the number-three brand<br />

in America (after Ray Ban and Oakley) and we’re<br />

the number one premium polarised brand. Not<br />

because we advertise, but because of you guys:<br />

people come into your practice and you give them<br />

Maui Jim. That’s what made all those conversions<br />

because you know if you sell to one, you’ll sell to all<br />

their family members.”<br />

Maui Jim sells a limited range of sunglasses—150,<br />

crafted and refitted exclusively in its Texas labs—<br />

with or without prescription, using polarised lenses<br />

in a selection of tints the company says combine to<br />

relax the eyes and make colours come alive to the<br />

wearer.<br />

Maui Jim’s approach has earned it a seal approval<br />

from the American Cancer Society for protecting<br />

the area of the face people forget to apply<br />

sunscreen.<br />

This December, Maui Jim will roll out its first<br />

blue mirror lens, called Blue Hawaii, making its<br />

world debut in time for the southern hemisphere<br />

summer. The company has also introduced a<br />

new display unit. It lambasts the idea of<br />

spinning displays.<br />

“Spinning is for strippers,” said Smith. “Not for<br />

glasses.”<br />

Attendees found Smith’s presentation<br />

entertaining and informative, Buist says.<br />

Most of Maui Jim’s products in New Zealand are<br />

sold through optometrists, but 10 per cent are sold<br />

through sunglass stores and pharmacies. ▀<br />

* Rob Weatherhead attended medical school in Dunedin.<br />

After graduation, he worked as an RMO in Brisbane and<br />

then travelled to Britain to start vocational training in<br />

ophthalmology. Two years were spent at Kings College<br />

Hospital in London followed by an appointment on the<br />

training scheme at Moorfields Eye Hospital. At the time,<br />

this was the main route for New Zealanders to learn<br />

ophthalmology. After completing the FRCS (Ophthalmology)<br />

and a Higher Surgical Training Certificate, he attempted<br />

to return to New Zealand, but had his arm twisted to work<br />

in Saudi Arabia at the King Khalid Eye Specialist Hospital.<br />

After 11 years as Chief of the Oculoplastic Division, he<br />

finally made it home. He has been working in Christchurch<br />

(private and public) for the last 15 years, including ten<br />

years as an examiner for the RANZCO RACE exam. He has<br />

three sons who are all on lower golf handicaps than he is,<br />

an indication that he is working too hard.<br />

Alley Bissett, Pene Fox and Christine Rae of Orewa Optics,<br />

with Maui Jim’s Mark Buist<br />

Zoe Ross, Susan Cathersides and Naomi Bicheno<br />

Alex Bicheno of Mortimer Hirst with Graham Jenkins and<br />

Tania Forde from Howick Village Optometrists<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Nanosecond laser therapy for dry AMD—Part 2<br />


In the first part of this article in the July edition of<br />

NZ Optics I introduced you to the 2RT laser (Ellex<br />

Medical Lasers) which delivers a low-energy<br />

nanosecond laser pulse that specifically targets the<br />

retinal pigment epithelium (RPE) without damage<br />

to the overlying neuroretina. We saw how studies in<br />

AMD rodent models demonstrate regeneration of<br />

RPE cells, re-activation of retinal microglial cells and<br />

thinning of Bruch’s membrane with normalisation<br />

of transmembrane transport—reversal of three key<br />

pathological features of early AMD 1 . Furthermore,<br />

histological examination of human early AMD<br />

macula treated with 2RT demonstrated translation<br />

of the animal model findings 1 .<br />

At Hamilton Eye Clinic I have a 2RT laser as part<br />

of an international ‘early adopter’ group tasked<br />

with developing clinical protocols, providing real<br />

world data and undertaking further research.<br />

I now have two years experience with 2RT and<br />

have treated over 360 eyes with dry AMD. I plan to<br />

commence an interventional study later this year<br />

using protocols based on this experience.<br />

In this article I will discuss how to select patients<br />

suitable for referral, the referral process, laser<br />

treatment, results and risks.<br />

The principle aim of 2RT treatment is to reduce<br />

vision loss from early AMD by reducing disease<br />

progression to late AMD<br />

Drusen, and more specifically drusen volume, is<br />

recogn ised as the most important risk factor for<br />

progression to late AMD, either geographic atrophy<br />

(GA) or neovascular AMD (nAMD). New vessels<br />

and GA usually arise at the site of a soft drusen.<br />

As GA forms there is a concomitant resolution<br />

of the underlying drusen. In contrast, with this<br />

process, 2RT laser leads to drusen resolution<br />

with the crucial difference of resolution without<br />

concomitant development of GA. The pilot clinical<br />

study of patients with early AMD resulted in an<br />

approximate 40% reduction in drusen volume<br />

and an 80% stabilisation of drusen volume at 24<br />

months 1 . The phase III LEAD study (NCT01790802)<br />

is a multi-centre random ised trial of 2RT<br />

treatment of early AMD that is fully recruited and<br />

expected to report in 2018.<br />

Early AMD is a slowly progressive disease.<br />

Therefore a clinical program to assess the efficacy<br />

of 2RT using reducing progression to late AMD as<br />

the outcome measure will require up to 18 years<br />

duration 2 .<br />

The optometrist is the primary point of contact for<br />

the vast majority of people with early AMD. Therefore<br />

it is important for optometrists to be skilled in the<br />

identification of the specific features of early AMD<br />

that confer high risk of progression to late disease.<br />

This will then provide the earliest opportunity to<br />

commence AREDS supplements , provide dietary<br />

advice and consider referral for 2RT laser.<br />

There are several easily identifiable macular<br />

factors assessable with a slit lamp and<br />

fundus lens:<br />

••<br />

Drusen size. The AREDS study showed a<br />

higher risk with any soft drusen that are<br />

larger than 125μm (approximately the<br />

diameter of a temporal retinal vein as it<br />

crosses the optic disc margin)3 (Figure 1A).<br />

These are termed large drusen. A drusen<br />

>250 μm is termed a very large drusen<br />

and is associated with a much higher risk.<br />

(Figure 1B). The larger the total drusen area<br />

and height (drusen volume) the greater the<br />

risk. Fundus photography and/or OCT make<br />

this assessment relatively easy.<br />

••<br />

Drusen proximity to the macula centre. The<br />

closer, the higher the risk.<br />

••<br />

Pigment changes.<br />

••<br />

Late AMD (nAMD or GA) in the other eye.<br />

Additional non-ocular factors:<br />

••<br />

Age<br />

••<br />

Family history of late AMD<br />

••<br />

Smoking<br />

So, for many patients the risks mount up. But<br />

how can you put all these factors meaningfully<br />

together to get an idea of the risk facing your<br />

patient? I recommend you use the online Casey<br />

AMD risk calculator for risk of progression of<br />

early to late AMD 4 . This can be open as a tab on<br />

your web browser in the clinic room. There is an<br />

instruction guide. The data listed in the bullet<br />

points above is all that is required to calculate<br />

risk. The section on genetics isn’t a requirement.<br />

It is important to note that the calculator doesn’t<br />

give a personalised risk of progression, but rather<br />

provides an estimate of the proportion of patients<br />

sharing the same characteristics who are likely to<br />

develop late AMD in the specified time interval.<br />

Figure 1A. A Large (125um diametre) drusen<br />

(AREDS image). This is the threshold of<br />

high risk. 1B. Large, Very Large (>250um),<br />

confluent drusen and pigmentary change<br />

indicate this eye is very high risk.<br />

It is a logical extension of the rationale for<br />

treatment of early AMD that 2RT may be beneficial<br />

for late AMD with non-central GA. The fundamental<br />

2RT-induced changes in the RPE, retinal microglia<br />

and Bruch’s membrane in early AMD may also be<br />

beneficial for GA. These eyes retain good central<br />

vision but are at very high risk of GA progression to<br />

the macular centre—progression to the centre is<br />

considered to be inevitable should longevity permit.<br />

2RT, by delaying or preventing central progression<br />

may thereby preserve central vision.<br />

A clinical study of 2RT for non-central GA would<br />

be problematic. A clinical trial to provide an answer<br />

to the whether 2RT reduces progression to centre<br />

involvement would need to be many years long and<br />

potentially need large numbers. This isn’t peculiar<br />

to 2RT. Assessing treatments for GA is recogn ised<br />

as facing many hurdles due to its slow progression<br />

and our limited understanding of disease<br />

progression 5,6 . At this point of time, we have only a<br />

rudimentary understanding of how to predict the<br />

rate of GA progression. Progression to the macular<br />

centre is considered to be inevitable, longevity<br />

permitting, but progression is very variable and for<br />

an individual patient realistically all we can say is<br />

that it is ‘high’. There is some recent, albeit early,<br />

progress toward a useful clinical classification of<br />

GA into subtypes with differing risks of progression<br />

to central visual loss, but these are in need of<br />

further definition before being of use 2 . There are no<br />

known near-term markers that would allow us to<br />

determine that progression of GA has been altered<br />

by a treatment. The key near-term marker for 2RT<br />

early AMD treatment, drusen reduction without<br />

developing GA, can’t be used as a measure of<br />

treatment effect for GA, as explained earlier.<br />

The rationale for 2RT treatment of early AMD<br />

can logically be applied to non-central GA. The<br />

aim of treatment is to slow progression to central<br />

involvement. 2RT’s simplicity, low cost and low risk<br />

makes it an attractive consideration for an otherwise<br />

untreatable condition with a very high risk of central<br />

vision loss. On this basis I am comfortable providing<br />

treatment for non-central GA.<br />

Early to moderat cataract doesn’t prevent 2RT<br />

treatment<br />

Coexistent cataract is common in older patients.<br />

Early or moderate cataract is usually not a<br />

problem, the only modification required is a higher<br />

laser power.<br />


For treatment of early AMD I use a protocol based<br />

on that used in the pilot study and the LEAD study.<br />

2RT is delivered by a slit-lamp system and<br />

contact fundus lens. It is painless. The first step is<br />

to determine the laser threshold. Beginning with<br />

a moderate power setting, single applications at<br />

progressively increasing powers are made outside<br />

the temporal vascular arcades until a subtle<br />

graying of the RPE is observed (threshold). The<br />

treatment is approximately 30-40 applications<br />

with an outer arc using 80% of threshold power<br />

and an inner circle just outside the macula using<br />

50% of threshold power (figure 2). The treatment<br />

applications must cause no visible reaction; if they<br />

do the power is further reduced.<br />

Threshold can be very subtle and difficult to<br />

observe and therefore, for safety, I never treat<br />

above 0.30 mJ for the first treatment. If the result<br />

is inadequate, treatment can be repeated at a<br />

higher power.<br />

Immediately after treatment there will be no<br />

visible retinal lesion, nor will there be anything<br />

detectable on OCT or fundus autofluorescence.<br />

Figure 2. My current protocol. Approximately 30-40<br />

laser applications. Green: outer arc at 80% threshold<br />

power. Grey: inner circle, just outside the macula, at 50%<br />

threshold power.<br />

Figure 3. Autofluorescent imaging of the RPE. A. pretreatment.<br />

B. Two months post-treatment Optimal RPE<br />

‘footprints’ indicate that RPE repopulation and the other<br />

treatment effects have occurred.<br />

My experience treating GA is that a far lower power<br />

is required and threshold is very difficult to determine<br />

by looking for a graying of the RPE. There is a risk of<br />

over-treatment which could lead to complete loss<br />

of RPE at the treatment spot and potentially lead<br />

to a new focus of GA. I have developed a treatment<br />

protocol for GA eyes that avoids this trap. Briefly,<br />

treatment is divided into two sessions. At the first<br />

session, three laser spots at each of five progressively<br />

increasing powers are placed well away from the<br />

macula. Should RPE graying (threshold) be observed<br />

then no more spots are applied. Six to eight<br />

weeks later, fundus autofluorescence imaging will<br />

determine the power setting that leads to an optimal<br />

RPE footprint. Treatment is then completed at this<br />

power. Laser spots are only placed outside of the<br />

macula, near to the arcades and avoiding all potential<br />

areas of RPE stress - margins of existing GA and areas<br />

of very abnormal autofluorescence. By this protocol<br />

over-treatment of stressed RPE, which might risk RPE<br />

loss and GA at the treatment spot, is avoided.<br />

A<br />

B<br />

Figure 4. A: Fundus aurofluorescent image showing noncentral<br />

geographic atrophy and B: Yellow outlines geographic<br />

atrophy (demarcated non-fluorescence) and red outlines the<br />

area of surrounding stressed RPE (patchy hyperfluorescence).<br />

My protocol is to keep 2RT applications outside of the blue<br />

line to avoid treatment within areas of ‘stressed’ RPE.<br />


It takes approximately 6 to 8 weeks for the<br />

adequacy of the laser applications to be<br />

detectable by autofluorescent imaging. At the<br />

first follow-up visit a top-up treatment is given if<br />

the RPE ‘footprints’ are inadequate.<br />

It is my experience that when treating early<br />

AMD that drusen volume stabilisation or<br />

reduction take at least 6 to 12 months to be<br />

evident. In fact, drusen may continue to enlarge<br />

in the first few months post treatment before<br />

beginning to stabil ise. Macular sensitivity<br />

improvements follow a similar time course.<br />



As discussed, it will take perhaps many years to<br />

know how successfully 2RT treatment lowers the<br />

risk of early AMD progression to late AMD or slow<br />

down progression of non-central GA. In the interim,<br />

the current benchmarks for treatment of early AMD<br />

is the 12 and 24 month results of the pilot study;<br />

75% stabilisation and 35% reduction in drusen load<br />

and no incidence of nAMD at 24 months 1,6 .<br />

At the time of writing I only have one early AMD eye<br />

with 24 months follow-up. The pre-treatment and 24<br />

month follow-up is illustrated in figure 5. This patient<br />

demonstrates a remarkable and dramatic response to<br />

treatment, however this should not be considered to<br />

be the typical outcome. Interestingly, as this eye had<br />

stable drusen volume at 12 months a re-treatment<br />

was given and drusen reduction occurred after that.<br />

Forty-five eyes have completed the 12 month followup.<br />

Figure 6 is a patient treated in August 2014 with,<br />

again, a remarkable improvement seen at 12 months.<br />

I have not yet completed the full analysis of my 12<br />

month results; however Table 2 summar ises the<br />

primarily brief analysis of the drusen volume changes.<br />

Figure 5. Left macula of 55 year old male. A-D: baseline<br />

colour photo, drusen volume map, macular microperimetry<br />

and hOCT. E-H: 24 month post-treatment. Note OCT post<br />

treatment shows preservation of outer retinal integrity.<br />

The remaining drusen are nearly all stable over 24 months.<br />

Macular sensitivity is markedly improved.<br />

18 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Figure 6. Right macula of 83 year old female. A-C: baseline colour photo,<br />

drusen volume map, hOCT. D-F: 12 month post treatment. Note OCT post<br />

treatment shows preservation of outer retinal integrity. Remaining drusen<br />

are stable over 12 months.<br />


By dramatically reducing the laser dose when compared to conventional<br />

laser and by selectively targeting the RPE without damaging the<br />

neuroretina or choroid, treatment risk is expected to be very low.<br />

To date, I haven’t observed any important complications following<br />

treatment of early AMD. The same was found in the pilot study<br />

and, to date, by the other early adopters. Occasionally a very<br />

small haemorrhage occurs with higher powers during threshold<br />

assessment. This was also reported in the pilot study and by other<br />

members of early adopter group. In all cases, the haemorrhage<br />

resolves without any apparent complication.<br />

I inform my patients that no important complications have been<br />

reported in over 2000 treatments for early AMD and, based on this<br />

experience, I consider the risk to be very small.<br />

Could there be that rather than reduced, there is an increased risk<br />

of progression to late AMD, either nAMD or GA? To date, with over<br />

2000 early AMD treatments worldwide, most of which are very high<br />

risk eyes, there are no reports of progression to wet AMD. Possibly<br />

the cases of progression to GA in the pilot study, in retrospect, may<br />

have had what is now termed ‘nascent’ GA at entry 8 . Effectively<br />

these eyes already had GA in that they were already undergoing a<br />

process (nascent) that over a few months will inexorably lead to GA.<br />

A surprisingly large proportion of eyes referred to me as having early<br />

AMD in fact have hOCT evidence of nascent non-central GA. These<br />

eyes do have established GA. This experience would suggest that our<br />

current understanding of the prevalence of early AMD versus late AMD<br />

with GA underestimates the progression to and prevalence of GA.<br />


2RT is a promising treatment for dry AMD and should be considered for<br />

patients with early AMD with high risk characteristics for progression<br />

to late disease. It can also be used for eyes with non-central GA.<br />

Your patient needs to be aware that this is a novel treatment.<br />

The pilot study shows good results, my experience to date includes<br />

impressive examples and risks appear to be very low. However, the<br />

evidence of efficacy for early AMD is not yet complete with a phase<br />

III trial still in process. For non-central GA the case for treatment is<br />

supported by pre-clinical evidence and the clinical findings for early<br />

AMD, but has the problem of lacking a method for determining a<br />

short or medium-term treatment effect.<br />

For more information please contact Dr David Worsley, Hamilton<br />

Eye Clinic on 07 834 0006 or referrals@hamiltoneyeclinic.co.nz;<br />

or Dr Jim Borthwick from Southern Eye Specialists in Christchurch<br />

(who joined the early adopter group earlier this year) on 03 355<br />

6397 or info@southerneye.co.nz. ▀<br />


1. Jobling, A.I., et al., Nanosecond laser therapy reverses pathologic and molecular<br />

changes in age-related macular degeneration without retinal damage. FASEB J,<br />

<strong>2015</strong>. 29(2): p. 696-710.<br />

2. Advancing Therapeutic Development for Dry Age-Related Macular `Degeneration (AMD):<br />

Workshop in Brief. Institute of Medicine. National Academies Press (US); <strong>2015</strong> Jan.<br />

3. Ferris, F.L., et al., A simplified severity scale for age-related macular degeneration:<br />

AREDS Report No. 18. Arch Ophthalmol, 2005. 123(11): p. 1570-4.<br />

4. Klein, M.L., et al., Risk assessment model for development of advanced agerelated<br />

macular degeneration. Arch Ophthalmol, 2011. 129(12): p. 1543-50.<br />

5. Bindewald, A., et al., Classification of abnormal fundus autofluorescence<br />

patterns in the junctional zone of geographic atrophy in patients with age<br />

related macular degeneration. Br J Ophthalmol, 2005. 89(7): p. 874-8.<br />

6. Mauschitz, M.M., et al., Topography of geographic atrophy in age-related<br />

macular degeneration. Invest Ophthalmol Vis Sci, 2012. 53(8): p. 4932-9.<br />

7. Guymer, R.H., et al., Nanosecond-laser application in intermediate AMD:<br />

12-month results of fundus appearance and macular function. Clin Experiment<br />

Ophthalmol, 2014. 42(5): p. 466-79.<br />

8. Wu, Z., et al., Optical coherence tomography-defined changes preceding<br />

the development of drusen-associated atrophy in age-related macular<br />

degeneration. Ophthalmology, 2014. 121(12): p. 2415-22.<br />

Figure 7. Right macula of 78 year old female. A-C: Baseline<br />

colour photo, drusen volume map and macular microperimetry map. D-F:<br />

9 months post treatment. Note baseline decreased macular sensitivity<br />

corresponds to drusen and post treatment there is a marked improvement.<br />


My Series (n=45<br />

eyes)<br />

Pilot Study (n=50 eyes)<br />

12 months 12 months 24 months<br />

Drusen load reduced 29% 44% 35%<br />

Drusen load stable 64% 78% 75%<br />

Table 2. 12 and 24 month drusen volume changes after 2RT laser for<br />

early AMD. My series of 45 eyes and the the pilot study of 50 eyes 7 .<br />

In the pilot study, three eyes (6%) developed GA at 12 months and 4 (8%)<br />

by 24 months (none developed nAMD). In the natural history group 5%<br />

and 9% respectively developed late AMD, either nAMD or GA. The figures<br />

do not reach significance. In my series, no treated early AMD eyes have<br />

progressed to late AMD at 12 months, either GA or nAMD, nor for that<br />

matter have any of the 269 eyes treated to date. A crucial difference from<br />

my study and the pilot study will be assessment of GA using h-OCT. Major<br />

advances in our understanding of nascent GA mean that I am will almost<br />

certainly classify a higher proportion as having GA prior to treatment<br />

than would have been done in the pilot study. So, it may be that some<br />

or all of the eyes in the pilot study that ‘progeressed’ to GA would, by<br />

current definition, have already had nascent GA at entry. These results<br />

are encouraging when we consider that all the treated eyes are very high<br />

risk. However, follow-up is far too short for this to provide any evidence of<br />

prevention of progression. I would think that my perfect record won’t last<br />

and that with longer follow up I will find a percentage do progress to late<br />

AMD, but hopefully less than what is expected from the natural history.<br />

Re-treatment is offered if drusen volume continues to enlarge or is<br />

stable at 6-12 months. The eye in figure 4 had re-treatment at<br />

12 months.<br />

I have treated 93 eyes with non-central geographic atrophy, either<br />

nascent or frank GA. The follow up period is so far too short to have<br />

any idea of a treatment effect on progression to centre involvement.<br />

Only a very small number have shown relentless progression<br />

(and these are all eyes with rapid progression documented pretreatment)<br />

while nearly all appear to be either stable or have minor<br />

progression. No eyes have developed nAMD.<br />



2RT has CE mark (European Union) approval for treatment of Clinically<br />

Significant Diabetic Macular Edema and Early AMD; the Australian<br />

Register of Therapeutic Goods (ARTG) registration for early AMD ‘where<br />

it can produce bilateral improvements in macular appearance and<br />

function’; and FDA 510(k) registration for treatment of DME.<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



with<br />

Prof Charles McGhee<br />

& A/Prof Dipika Patel<br />

Series Editors<br />

Paediatric ophthalmic assessment<br />


“A person’s a person, no<br />

matter how small”<br />

—Dr Seuss.<br />

The paediatric ophthalmic examination<br />

is as important as any other ophthalmic<br />

examination because an eye is an eye, no<br />

matter how small. A child’s vision impacts on<br />

all aspects of their and their family’s life. Vision<br />

is necessary for learning, social interaction<br />

and normal development. Ophthalmic<br />

assessment of children is a sub-speciality of the<br />

ophthalmic examination requiring specialist<br />

tests, examination techniques and experience.<br />

Children are developing in many ways including<br />

their comprehension, conceWntration, social<br />

interaction, communication and personality, not<br />

to mention their visual ability. Thus, paediatric<br />

ophthalmic assessment involves a multitude of<br />

skills and each assessment varies depending on<br />

the individual child.<br />

The goals of a paediatric eye examination<br />

include evaluating the child’s visual system<br />

function, assessing ocular health, determining<br />

any diagnoses and the appropriate treatment<br />

plan, as well as to educate parents and children<br />

on eye health. This article will cover the general<br />

layout of a paediatric ophthalmic examination, as<br />

shown in Figure 1. All examination components<br />

are discussed in general terms and the<br />

examination layout and tests used will vary<br />

based on the individual patient’s symptoms and<br />

findings.<br />

Paediatric ophthalmic assessment general layout<br />

1. Patient History<br />

••<br />

Presenting problem<br />

••<br />

Ocular history<br />

••<br />

General health<br />

••<br />

Family ocular history<br />

••<br />

Child development<br />

2. Visual acuity<br />

3. Refraction<br />

••<br />

Retinoscopy<br />

••<br />

Cycloplegic refraction<br />

4. Binocular vision and ocular motility<br />

5. Ocular health<br />

6. Discussion with parents and children<br />

FIGURE 1.<br />

Having an eye examination can be frightening<br />

for many children. In fact, examining a child can<br />

be frightening for many clinicians. It is important<br />

to remember that children, like adults, have<br />

a wide range of personalities and each child<br />

will react differently in the examination room.<br />

Some children are calm and comply well with<br />

instructions, while others are bouncing off the<br />

walls, then there are those who don’t seem to<br />

stop crying. A fearful child is hard to examine<br />

where as a calm child allows for a better and<br />

faster examination. Therefore, as the clinician<br />

it is our role to put them at ease from the<br />

beginning, this is often in the waiting area. A<br />

friendly smile, toys to play with as they wait or<br />

crouching down to eye level all welcome the child<br />

into the new environment and make them feel<br />

relaxed. This first moment of engagement will<br />

flow on into the examination room so consider<br />

it carefully before approaching a child. Once you<br />

have got the child to the room consider where<br />

you would like the family to be situated. For a<br />

small child sitting on a parent or caregiver’s lap<br />

is a safe and comfortable option. Older children<br />

will be happy to sit by themselves, offer the<br />

child the choice if they are unsure. Consider<br />

both the adults and children positioning so<br />

that both can be involved in the examination<br />

without interfering with your examination.<br />

Whilst navigating the labyrinth of the paediatric<br />

ophthalmic examination the focus must<br />

remain clear, to improve any visual reduction<br />

that is currently present and prevent any further<br />

visual loss.<br />


Paediatric patient history has similar<br />

components to an adult’s ophthalmic history:<br />

presenting problem, ocular history, general<br />

health and family ocular history. It must also<br />

include pre-natal, peri-natal and post-natal<br />

history as well as the child’s development to<br />

check if regular milestones have been met.<br />

Allowing the childern to answer as many<br />

questions as they keeps them involved, parents<br />

and caregivers tend to jump in when extra<br />

information is needed. Alternatively, further<br />

detailed history can be asked of the parents/<br />

caregivers at the end of this process. Questions<br />

asked must be age appropriate for the children<br />

both in concept and language used. A three<br />

year old will be able to give their name and age<br />

whilst a 12 year old would be able to answer<br />

most of the history. The importance of language<br />

and comprehension level of the child is critical<br />

throughout the assessment.<br />


Vision matures rapidly in the first few years of<br />

life as visual pathway development occurs. Visual<br />

acuity is 0.15 logMAR (6/180) at one month of<br />

age and develops to adult equivalent vision of<br />

0.0 logMAR (6/6) by five years. 1,2 Methods for<br />

assessing this varying vision must be age and<br />

developmental stage appropriate. Preferentiallooking<br />

techniques, such as Cardiff or Teller<br />

cards is appropriate for pre-verbal or cognitively<br />

impaired children. 1,3 Lea Symbols is an appropriate<br />

test for pre-school children with a success rate of<br />

76% at 3 years and 95% at 4 years old, as well as<br />

high comparability to the Landolt C. 4 Compliance<br />

with quantitative letter based acuity-testing can<br />

be achieved in the majority of cognitively normal<br />

5 year olds. 3 The ETDRS has high repeatability<br />

measures in school aged children with refractive<br />

errors. 5 Tests should be administered at the<br />

appropriate distance and a matching card used<br />

if necessary, these can be particularly helpful<br />

with shy children. Continually praising children<br />

encourages them to maintain focus and attempt<br />

smaller optotypes during threshold visual<br />

acuity testing.<br />


Infants are born hyperopic with an average<br />

axial length less than 17mm. The majority of<br />

ocular growth occurs before 24 months and<br />

the emmetropisation process is completed<br />

between 6 and 8 years of age. 6 However,<br />

refractive error continues to change for some<br />

children through out childhood. Objective<br />

determination of children’s refraction through<br />

retinoscopy is an essential component of the<br />

paediatric ophthalmic assessment. Retinoscopy<br />

prior to cycloplegia gives information to the<br />

clinician on the accommodative status of the<br />

child as well as an idea of their refractive error.<br />

However, due to the high accommodative ability<br />

of children, cycloplegic retinoscopy is necessary<br />

for accurate refraction. A combination of<br />

cyclopentolate 1% and tropicamide 1% has been<br />

found to be effective to achieve full cycloplegia<br />

in most children. Parents can help hold smaller<br />

children when drops are administered. Aim to<br />

get both eyes done one after the other before<br />

the child pulls away, this gives them less time<br />

to feel the sting on the first drop and leads to<br />

less protesting. Children don’t like eye drops<br />

so having a lolly or sticker ready to give the<br />

child straight afterwards will get them back<br />

on your side for the rest of the examination.<br />

Accurate retinoscopy is important in children as<br />

subjective refraction can be highly unreliable.<br />

Practicing retinoscopy regularly on adult<br />

patients will improve your accuracy for when it<br />

is necessary to use in children.<br />

Figure 2. A child wearing trial frames for refraction<br />


Full ocular motility and binocular vision should be<br />

assessed on all children when possible. Stereoacuity<br />

tests such as the Lang stereo-test are suitable for<br />

very young children with more detailed stereotests<br />

such as the forced choice circles on the Stereo Fly<br />

test being added to the examination as children<br />

get older. Cover tests, with or without prism<br />

measurement, can be performed on all age groups<br />

as demonstrated in Figure 3. However, in those tricky<br />

to examine the Hircshberg test is a great screening<br />

tool to determine if strabismus is present. Binocular<br />

vision impacts on the prescription given with a full<br />

cyclplegic prescription needed in esotropic children.<br />

Figure 3. Cover test of a young child with an age appropriate fixation target<br />


Slit lamp examination of the anterior eye can be<br />

achieved with correct positioning of the child.<br />

Babies can be held in the appropriate position by<br />

a parent or caregiver, while older children who<br />

are unable to reach the chin rest can kneel or<br />

stand on the chair to make them comfortable.<br />

Make the most of any time that you get their<br />

head in an examinable position by being focused<br />

on the aspects that need examining based on<br />

the child’s history. This can be achieved in most<br />

children older than 3, or 4 years old. For younger<br />

infants the handheld slit lamp is usually required.<br />

A dilated fundus exam using binocular indirect<br />

ophthalmoscopy allows a fast examination of the<br />

macula, optic nerve and periphery whilst allowing<br />

the child an unrestricted head position. Make this<br />

fun to keep the child engaged, however, if they are<br />

disagreeable to your examination parents can be<br />

asked to hold the child’s arms and head still while<br />

you quickly examine both eyes by holding their lids<br />

open.<br />

Figure 4. Binocular indirect ophthalmoscopy being<br />

performed on a child seated on their parent’s lap<br />


The discussion at the end of the examination<br />

is an important time to communicate results,<br />

the action plan and educate the family. It is<br />

important to clearly and concisely portray<br />

information to children in an age appropriate<br />

manner. Treatment regimens requiring long<br />

term follow up and commitment by the<br />

family, such as patching, should be discussed<br />

at length to ensure the importance of the<br />

treatment has been conveyed. In cases where<br />

follow up of the family proves challenging or<br />

compliance is a continual issue then referral to<br />

a local ophthalmologist is needed. Referral to<br />

a more experienced practitioner or paediatric<br />

ophthalmologist is also appropriate when the<br />

presentation or patient proves challenging,<br />

there is no clear diagnosis or there is any<br />

uncertainty of results.<br />

The paediatric ophthalmic assessment has<br />

many factors that need to be considered including<br />

concentration, comprehension, cognitive and<br />

physical developmental ability and the child’s<br />

emotions. As the clinician you must engage with<br />

both the parent/caregiver and the child to address<br />

the concerns of all parties. With all these factors<br />

it can often be a time consuming, challenging<br />

process. However, it is a rewarding process that can<br />

impact a lifetime. Adapting the examination to the<br />

individual child’s personality and comprehension<br />

will increase your success rate with any child. As,<br />

Dr Seuss wisely wrote “You’ll miss the best things<br />

if you keep your eyes shut”, with a well performed<br />

paediatric ophthalmic assessment we can open<br />

children’s eyes. ▀<br />


1. Mayer DL, Beiser AS, Warner AF, Pratt EM, Raye KN,<br />

Lang JM. Monocular acuity norms for the Teller Acuity<br />

Cards between ages one month and four years. Invest<br />

Ophthalmol Vis Sci 1995 Mar;36(3):671-685.<br />

2. Salomao SR, Ventura DF. Large sample population age<br />

norms for visual acuities obtained with Vistech-Teller Acuity<br />

Cards. Invest Ophthalmol Visual Sci 1995;36(3):657-670.<br />

3. Solebo AL, Rahi J. Epidemiology, aetiology and<br />

management of visual impairment in children. Arch Dis<br />

Child 2014 Apr;99(4):375-379.<br />

4. Becker R, Hubsch S, Graf MH, Kaufmann H. Examination<br />

of young children with Lea symbols. Br J Ophthalmol 2002<br />

May;86(5):513-516.<br />

5. Manny RE, Hussein M, Gwiazda J, Marsh-Tootle W,<br />

COMET Study Group. Repeatability of ETDRS visual<br />

acuity in children. Invest Ophthalmol Vis Sci 2003<br />

Aug;44(8):3294-3300.<br />

6. West CE. Refractive Error in Children. Pediatric<br />

Ophthalmology: Springer; 2009. p. 7-20.<br />


* Samantha Simkin is a<br />

therapeutically qualified<br />

optometrist from the<br />

University of Auckland.<br />

She is currently pursuing<br />

her PhD in the Department<br />

of Ophthalmology with a<br />

focus of visual impairment<br />

in children. Samantha is<br />

supervised by Professor<br />

Charles McGhee, Dr Shuan<br />

Dai and Dr Stuti Misra.<br />

20 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Aflibercept out-does laser<br />

A<br />

three-year drug trial showed significantly<br />

better outcomes for patients injected with<br />

aflibercept than those undergoing laser<br />

hotocoagulation in the treatment of diabetic<br />

macular edema (DME).<br />

Bayer Healthcare announced the results of<br />

the Phase 3 VIVID trial at the 15th EURETINA<br />

Congress in September in Nice, France. The<br />

company is collaborating with Regeneron<br />

Pharmaceuticals to develop the drug for<br />

treatment of DME under the brand Eylea.<br />

According to a statement from Bayer, patients<br />

in the Vivid-DME trial were randomised to receive<br />

either aflibercept 2 mg every month (n=136),<br />

aflibercept 2 mg every two months after an initial<br />

injection every month for five consecutive doses<br />

(n=135), or the comparator treatment of laser<br />

photocoagulation (n=132). After two years, patients<br />

randomised to laser could receive aflibercept 2 mg<br />

according to protocol specific re-treatment criteria.<br />

After three years, patients receiving aflibercept<br />

every month had a mean gain in BCVA from<br />

baseline of 10.3 letters, patients receiving<br />

aflibercept every two months had a mean gain in<br />

BCVA from baseline of 11.7 letters. Patients in the<br />

laser photocoagulation treatment group had a<br />

mean change in BCVA from baseline of 1.6 letters.<br />

Additionally after three years, 41.2 per cent of<br />

patients in the monthly group and 42.2 per cent<br />

of patients in the bi-monthly group, maintained<br />

significant gains of at least 15 letters, or three<br />

lines, as measured on the Early Treatment Diabetic<br />

Retinopathy Scale (ETDRS) eye chart, compared to<br />

18.9 per cent in the laser treatment group.<br />

Patients treated with aflibercept showed a similar<br />

overall incidence of adverse events to the laser<br />

treatment group. The safety results are in line with the<br />

1 and 2 year data of the VIVID-DME and VISTA-DME<br />

trials as well as the known safety profile of the drug.<br />

Adverse events were typical of those seen in other<br />

studies in patients with diabetes receiving intravitreal<br />

anti-VEGF therapy. The most frequent observed<br />

included conjunctival hemorrhage, cataract and<br />

increased intraocular pressure. The most frequent nonocular<br />

events in these groups included nasopharyngitis<br />

and hypertension. Arterial thromboembolic events—as<br />

defined by the Anti-Platelet Trialists’ Collaboration<br />

(non-fatal stroke, non-fatal myocardial infarction, and<br />

vascular death)—occurred in 14 out of 136 patients<br />

(10.3 per cent) receiving aflibercept every month, six<br />

out of 135 patients (4.4 per cent) in the EYLEA everytwo<br />

months group and seven out of 133 patients (5.3<br />

per cent) in the laser group.<br />

“Allowing people whose eye sight has been<br />

impaired as a result of their diabetes the opportunity<br />

to regain and retain their vision over time is critical,”<br />

said Jean-Francois Korobelnik, principal investigator in<br />

the trial and chief of ophthalmology, CHU Bordeaux.<br />

“Therefore these results are encouraging as the data<br />

show patients who achieved vision gains in the first<br />

year, maintained these gains over three years.”<br />

Eylea is approved for the treatment of<br />

patients with neovascular age-related macular<br />

degeneration (wet AMD), visual impairment due<br />

to diabetic macular edema (DME) and macular<br />

edema secondary to central retinal vein occlusion<br />

(CRVO). Over five million doses of Eylea have been<br />

administered since launch worldwide. ▀<br />

Lively discussion, with tapas<br />


The World Society of Paediatric Ophthalmology<br />

and Strabismus (WSPOS) held an interesting<br />

and ambitious programme for this year’s<br />

Barcelona conference. All aspects of paediatrics,<br />

strabismus and the interaction between adult<br />

and paediatric influences were covered from an<br />

international point of view.<br />

Dr Shuan Dai, Dr John Dickson, Dr Stuart Carroll, Samantha<br />

Simkin, Lisa Hamm and Dr Cheefoong Chong at WSPOS<br />

The goal of the congress, which ran in early<br />

September, was to help advance paediatric eye<br />

care around the world through expertise and<br />

knowledge-sharing.<br />

More than 1,200 delegates were warmly<br />

welcomed to the Fira Barcelona Gran Via, near the<br />

heart of this beautiful European city. New Zealand<br />

was represented by six delegates: Dr Stuart Carroll,<br />

Dr Shuan Dai, Dr Cheefoong Chong, Lisa Hamm<br />

and myself, Samantha Simkin (née Watkins) from<br />

Auckland, and Dr John Dickson from Hamilton.<br />

The conference offered a variety of learning<br />

opportunities with free paper sessions, expert-led<br />

panel discussions, symposia, audience-directed<br />

sessions, an electronic poster village and a mock trial.<br />

New Zealand was represented throughout the<br />

conference. Dr Shuan Dai chaired a video symposium<br />

called Signs of Paediatric Ophthalmology &<br />

Strabismus in which he and Dr John Dickson spoke.<br />

Dr Dai also spoke on exotropia, and at a symposium<br />

on retinopathy of prematurity (ROP).<br />

I presented a free paper titled ART-ROP: A Real<br />

World Telemedicine Screening for Retinopathy of<br />

Prematurity, and also represented New Zealand in<br />

the poster village along with my fellow Auckland<br />

University PhD candidate Lisa Hamm.<br />

A wide range of topics were discussed at the<br />

meeting from ophthalmogenetics to myopia<br />

control and early intervention. Lab research,<br />

clinical research and clinical application were all<br />

equally presented and discussed. There were lively<br />

debates on the application of research in different<br />

environments highlighting the vast difference<br />

in practicing conditions between Sweden and<br />

Pakistan, and between Nigeria and New Zealand.<br />

Yet, a passion for patient care across the world<br />

was clearly evident, as was the desire to improve<br />

paediatric eye health internationally.<br />

The mock trial was on the sensitive subject of a nonaccidental<br />

injury, featuring US-based Dr Alex Levin<br />

of Wills Eye Hospital and Dr Gil Binenbaum of The<br />

Children’s Hospital of Philadelphia. They presented as<br />

“Dr Defence” and “Dr Prosecutor”. Witness deposition,<br />

harsh cross-examination and extended lively<br />

discussions culminated in an audience vote for guilty<br />

or not guilty (it was just over half for guilty) of the<br />

fictitious case. Close to 1000 delegates attended this<br />

session alone with Dr Levin closing with some top tips<br />

on being an expert witness in such cases.<br />

The inaugural Kanski Medal Lecture was given by<br />

paediatric ophthalmologist Dr Helen Mintz-Hittner<br />

of Houston, Texas, who is internationally known for<br />

her pioneering research in ROP. Dr Mintz-Hittner<br />

discussed the use of bevacizumab as a treatment<br />

for ROP, and the BEAT-ROP trial. Her first-hand<br />

experience of using the anti-VEGF injection of<br />

bevacizumab compared to the standard treatment<br />

of laser photocoagulation is challenging the way<br />

ROP is being treated around the world.<br />

This is of high importance with the rising<br />

number of ROP worldwide, especially given,<br />

what is considered to be, a third epidemic of ROP<br />

occurring in middle-income countries.<br />

The latest outcomes for BEAT-ROP show more<br />

favourable long-term outcomes than current laser<br />

treatment including reduced refractive errors and<br />

increased visual fields. The BEAT-ROP treatment<br />

regimen shows a slightly higher recurrence rate of<br />

ROP thus would impact on follow-up management<br />

of those infants receiving the treatment. Dr Mintz-<br />

Hittner’s ground-breaking work has the potential<br />

to save the sight of infants across the world, the<br />

epitome of WSPOS’s goals.<br />

Having a conference in Spain, means dinner<br />

shouldn’t be expected until at least nine pm. So<br />

to wind down from a day of learning, tapas and<br />

sangria were a must. The New Zealand team along<br />

with other congress delegates from across the<br />

world gathered for lively discussion of new research<br />

ideas, current projects and clinical application.<br />

On the final night, we were joined by Dr Ken<br />

Nischal, one of the WSPOS’ presidents, as well as<br />

delegates from Singapore, Hong Kong and Australia.<br />

The conference was a wonderful success for<br />

the WSPOS. It was a privilege for New Zealand<br />

to be strongly represented and to contribute on<br />

international discussions, and in some cases,<br />

lead the field. International discussions and<br />

relationships built over there will impact on<br />

research and clinical practice in the years to come.<br />

The delegates from the 3rd World Congress of<br />

Paediatric Ophthalmology and Strabismus will<br />

all be looking forward to meeting again in Jaipur,<br />

India in 2017. ▀<br />

* Samantha Simkin received her Bachelor of Optometry with<br />

first class honours from the Department of Optometry and is<br />

now a PhD candidate in the Department of Ophthalmology at<br />

the University of Auckland.”<br />

Tel: 027 273 8126<br />

InterMed Medical Limited Free Phone: or 0800 333 333 444 www.intermed.co.nz 444<br />

71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740<br />

InterMed Medical Limited Free Phone: 0800 333 444 www.intermed.co.nz<br />

71 Apollo Drive, Albany, Auckland 0632 PO Box 33268, Takapuna, Auckland 0740<br />

*Venter JA, Barclay D, Pelourskova M, Bull CE. Inital<br />

experience with a new refractive rotationally asymmetric<br />

multifocal intraocular lens. J Refract Surg 2014: 30(11):770-6.<br />

PKB50 REV1<br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Progress for retinal<br />

prosthesis system<br />

New views<br />

From time to time I feature guest columnists. My dear wife Karen has written a few well received<br />

pieces for me. They’ve featured contact lens and makeup tips, experiences with multifocal<br />

contact lenses, lens care and solutions. I thus recently suggested she do another. Here follows her<br />

latest contribution.<br />

A tribute to my mother<br />

Alan recently sent me an email. It read: “u must write more columns for me!”<br />

His September column paid tribute to Brien Holden and Trevor Duncan, who both passed<br />

away in July. I knew them both. Their sad passing added to a winter of losses; a few other<br />

people we knew recently passed on, as did a favourite dog called Max. We miss them all.<br />

I always proof read Alan’s writing, (which is why it’s so good ). The final version of the September In<br />

Contact column was submitted on the 17th of August, which happens to be my mother’s birthday.<br />

The thought came to me that sometimes we should pay tribute before it’s too late, to let people<br />

know how much we value them. We should say thank you for the richness they bring to our and<br />

other’s lives, while they are still able to hear or read our words.<br />

Like Alan, my mom Rita is also a writer. Early on she wrote a few novels, particularly in the early stages<br />

of my father’s publishing career. One or two books might have been written because they had to have<br />

something for the monthly Mills & Boon-like, subscription books my dad published. My dad also wrote a<br />

book, for the same reason, over a weekend at the kitchen table: talk about doing what you have to.<br />

My mom’s writing was good, always inspirational. The books she really enjoyed working on though<br />

were the interior decorating books that followed later. Creating a visual delight on each page brought<br />

her immense joy.<br />

By that stage I’d joined the family publishing company that was founded by my grandfather. We had<br />

a huge amount of fun together, working on these publications. The interior decorating books were<br />

really a summary of my mother’s philosophy. She often said things like “beauty before practicality”, or<br />

actually, “practicality be damned, this is a jewel”, which is an odd thing for an interior decorator to say,<br />

but totally in character. My mother sees the world through rose-tinted glasses, her glass is always half<br />

full, the horoscope always has a positive message, good things lie ahead, life is amazing!<br />

My mother hears the birds, she sees the first hint of spring in the garden. She has champagne in her<br />

veins, despite being a lifelong teetotaller. She is high on life, when times are good, and even when they’re<br />

not so good. Dark days mean that a turning point is near, that the next dawn will be the brightest ever!<br />

As Jim Morrison once said, “the future is uncertain and the end is always near”. All we really have<br />

with some degree of certainty is NOW. Live life while you have it, do the things that you want to do,<br />

stick your neck out, take risks.<br />

Optometrists, or optimists as our daughter used to say when she was young, give the gift of<br />

improved vision. A new pair of stylish frames can work miracles, or no frames and improved vision with<br />

contact lenses can be life changing. A new image, a new phase in life…<br />

Let there be sight, and see the beauty around you!<br />

A rosy outlook<br />

I’m finishing this column off after a whirlwind trip to Silmo in Paris; a fantastic exposition of frames,<br />

sunglasses, lenses, instruments and low vision aids. Read all about it in this edition in Maryanne’s<br />

report. It’s taken me over thirty years to finally visit Silmo. I’ve always had a more senior partner<br />

ahead of me in the queue to attend overseas trade fairs. Thanks to Maryanne for showing me the<br />

ropes. I was amazed to see how many people knew Maryanne and were so happy to see her. We hung<br />

out with a few Danes, French, Kiwis, Aussies, POHMS and the odd South African, German and Austrian.<br />

We had entertaining meals, including a memorable dinner with the legendary Oliver Goldsmith, a<br />

real character and stalwart of the optical world. He’s always good for a story.<br />

Any independent optometrist looking<br />

for a competitive edge, or simply seeking<br />

maximum exposure to the widest range of<br />

frames possible, would be well-served by<br />

attending Silmo. France in the Autumn is also<br />

rather pleasant. I enjoyed some great walks<br />

wandering the suburbs of Paris and exploring<br />

the canals, cemetries, museums, parks and<br />

shops, before the ever hectic trade fair<br />

kicked off.<br />

Having being relatively uninvolved in frame<br />

buying since selling our practices around seven One of the many colourful, attractive stands. A giant<br />

years ago, it was a great opprtunity to get up to model of a printed frame.<br />

speed on the latest trends, fashion and technology.<br />

I was impressed with some new innovations and with the quality and technological development.<br />

Maryanne will elaborate in her report.<br />

Proper people<br />

What Silmo also reinforced for me was the importance of working with a great team of people<br />

and the importance of the suitability, quality and functionaility of the dispensed eyewear.<br />

Every person in the supply chain plays a role.<br />

Spectacles are commonly the physical manifestation and summation of all that we do. They largely<br />

determine the success of the outcome and overall satisfaction of the patient.<br />

Dispensing can be rather challenging at times.<br />

I’ve been very lucky in my career to work with great teams of people and skilled professionals, who<br />

are focussed on excellent outomes for our patients.<br />

That is after all what it’s all about.<br />

Let there be light.<br />

Let there be sight, and see the beauty around you.<br />

After two interesting days back at the office, writing three columns, washing clothes, some gardening<br />

and repacking my bags, it’s off to New Orleans, a city high on my bucket list. The American Academy<br />

of Optometry conference, arguably the number one optometric conference in the world, beckons. Not<br />

that our local CPD managers recognise that. I have to do a heap of paperwork and pay to have the CPD<br />

recognised in NZ, so I usually don’t bother. If I ever lacked points for an annual registration, I’d probably<br />

bother more. The upside is I can skip a few lectures and enjoy more of New Orleans.<br />

Yeeehah.<br />

I’ll report back on my return.<br />

Cheers from the departure lounge!<br />

Larry Hester, the seventh person in the U.S. to have an Argus II Retinal Prosthesis Device implanted allowing him to see<br />

for the first time in 33 years<br />

Popular press trumpeted the first implant of<br />

a “bionic eye” for patients with dry agerelated<br />

macular degeneration when doctors<br />

performed the first implant and activation of the<br />

Argus II Retinal Prosthesis system earlier this year.<br />

The bionic eye part is debatable, but the<br />

operation—performed at the Manchester Royal<br />

Eye Hospital in June by Dr Paulo Stanga—was a<br />

step forward for the Argus II system, which was<br />

originally tested, and approved for restoring some<br />

vision in patients with retinitis pigmentosa (RP) in<br />

the US in 2013 and Europe in 2011.<br />

The Argus II System has now been implanted<br />

in 150 patients in the US, Canada, France, Italy,<br />

Germany, the Netherlands, Saudi Arabia, Spain,<br />

Switzerland and the UK. The Manchester implant<br />

was part of a feasibility trial for evaluating Argus II<br />

for treating late-stage Dry AMD.<br />

While Second Sight Inc.—the California, based<br />

company behind the Argus II system—has not<br />

been the only company in the last 15 years to<br />

pursue retinal implant systems, it appears to have<br />

gone the furthest, at least as far as feasibility and<br />

clinical trials, and regulatory approval.<br />

Argus II is comprised of a small electronic device<br />

implanted in and around the eye, a small video<br />

camera attached to a pair of glasses, and a video<br />

processing unit worn or carried by the patient. The<br />

video processing unit receives images captured by<br />

the camera, and turns them into signals transmitted<br />

to the implant wirelessly. The implant transmits<br />

the signals to the retina in electrical pulses, which<br />

are intended to bypass damaged photoreceptors by<br />

stimulating the retina’s remaining cells. The system<br />

creates the perception of patterns of light which<br />

patients can learn to interpret as visual patterns.<br />

According to an announcement released by<br />

Change of guard at<br />

Younger Optics<br />

Younger Optics Australasian sales and<br />

marketing manager Trevor Inglis is retiring<br />

after 10 years. To work on his golf handicap,<br />

he says jokingly.<br />

Speaking to NZ Optics at ADONZ <strong>2015</strong>, Inglis says<br />

he’s been planning the move for some time, but<br />

wanted to make sure he had the right successor<br />

in place and he was on hand to ensure a smooth<br />

handover before moving on.<br />

That successor is Samantha “Sam” Crooke, an<br />

Australian optometrist by training, who has held<br />

a variety of positions in the optical field including<br />

practice manager, professional education manager<br />

and even Queensland territory manager for<br />

Younger Optics. The two have known each other<br />

since 2008 and Inglis was visibly delighted to be<br />

Samantha Crooke<br />

Second Sight, the Argus II Manchester implant was<br />

the first of a larger study to expand the application<br />

of the system. Eligibility for this study includes<br />

patients 25 to 85 years of age with advanced dry<br />

AMD, some residual light perception and a previous<br />

history of useful form vision. Study subjects will<br />

be followed for three years to evaluate safety and<br />

utility of the system on visual function.<br />

The first recipient of the Argus II in the study<br />

was Ray Flynn, 80, of Manchester who had lost his<br />

central vision to AMD, but had some peripheral<br />

vision. According to reports, Flynn was able to<br />

detect the pattern of horizontal, vertical and<br />

diagonal lines on a computer screen using the<br />

implant in a test just two weeks after surgery.<br />

In its approval of the device for use in up to 4,000<br />

procedures per year, the FDA in 2013 stated it had<br />

reviewed data that included a clinical study of 30<br />

participants with RP who received the Argus II<br />

Retinal Prosthesis System. Investigators monitored<br />

participants for adverse events related to the<br />

device or to the implant surgery and regularly<br />

assessed their vision for at least two years after<br />

receiving the implant.<br />

Results from the clinical study show that most<br />

participants were able to perform basic activities<br />

better with the Argus II than without it including<br />

locating and touching a square on a white field,<br />

detecting motion direction and recognising large<br />

letters, words, or sentences, among other tests.<br />

Following the implant surgery, 19 of the 30 study<br />

patients experienced no adverse events related<br />

to the device or the surgery. However, 11 study<br />

subjects experienced a total of 23 serious adverse<br />

events, including erosion of the conjunctiva,<br />

dehiscence, retinal detachment, inflammation, and<br />

low intraocular pressure. ▀<br />

able to introduce Sam at ADONZ to many existing<br />

and would-be New Zealand customers.<br />

With several new products in the pipeline,<br />

including the as yet to be launched Camber it’s an<br />

exciting time to be taking over, says Crooke.<br />

“In an ever-consolidating and competitive<br />

market, Trevor has contributed to Younger Optics’<br />

growth, and more importantly our customers’<br />

growth by understanding their needs, providing<br />

exceptional customer service and support,” said<br />

Mark Rupert, Younger Optics general manager, Asia<br />

Pacific, in a statement. “Both Younger Optics and<br />

our customers will miss him, and we wish him<br />

the best.”<br />

Inglis will leave Younger at the end of the year,<br />

ending a 35-year career in the optical industry. ▀<br />

Trevor Inglis<br />

22 NEW ZEALAND OPTICS <strong>Nov</strong>ember <strong>2015</strong>

Kiwi cameos feature in<br />

Australian optometry<br />

history<br />

The Australian College of Optometry<br />

(ACO) has published a history book to<br />

commemorate its Diamond Jubilee.<br />

A History of Australian Optometry by Professor<br />

Emeritus Barry Cole was debuted at the ACO<br />

National Conference on October 24.<br />

“The college has been an important player in<br />

the history of optometry over the last 75 years<br />

and whilst it has its own chapter, the book tells<br />

the story of more than 200 years and features<br />

optometric institutions and optometrists<br />

Australia wide,” Cole said in a statement released<br />

prior to the debut.<br />

A History of Australian Optometry begins with<br />

the spectacle sellers and sight-testing opticians<br />

who became the early adapters of refraction<br />

techniques in the second half of the 19th century,<br />

and proceeds to the associations, regulations and<br />

new technologies of the 20th century.<br />

But given our close association, the book soon<br />

demonstrates that a history of optometry in<br />

Australia cannot be written without New Zealand<br />

making more than a few appearances.<br />

According to ACO’s Arwen Bardsley, the history<br />

book reports the first person to graduate with<br />

an optometry degree from the University of<br />

Melbourne was New Zealander Gavin Bridgman.<br />

“He studied optometry in the ACO expecting to<br />

qualify with a diploma of Licentiate of Optometric<br />

Science (LOSc). He was in his final year in 1961<br />

when the course became a degree course of<br />

the university and he was admitted to the new<br />

degree course in that year with full credit for his<br />

prior studies in the college,” says Bardsley. “He<br />

obtained both the LOSc diploma from the college<br />

and a Bachelor of Applied Science (Optometry)<br />

from the university. He was in fact the only final<br />

year student in that year, so he has the single<br />

honour of being the first to obtain a degree in<br />

optometry in the University of Melbourne.”<br />

While that wasn’t the first degree in optometry<br />

awarded in Australia, it reinforces the intertwined<br />

history of the profession in Australian and New<br />

Zealand. A number of New Zealanders studied<br />

optometry in Australia through the 1950s,<br />

including Roger Sargent, John Fairmaid and<br />

Lex Grocott.<br />

A chapter focused on Registration Acts shows<br />

New Zealand also played a more active role in the<br />

Trans-Tasman Mutual Recognition Act than some<br />

Australian states. Australia, in turn, contributed<br />

Professor Emeritus Barry Cole, author of ACO’s new<br />

history book<br />

New approaches to<br />

presbyopia<br />

Pharmaceutical company <strong>Nov</strong>artis has<br />

teamed up with Google to integrate the<br />

search engine giant’s technology within<br />

contact lenses.<br />

According to Reuters, <strong>Nov</strong>artis is already<br />

planning initial human tests on the first product<br />

to emerge from the collaboration—contact<br />

lenses that can accommodate vision correction<br />

in presbyopes.<br />

New approaches to presbyopia are<br />

accelerating. Several companies are testing<br />

or already marketing presbyopia solutions<br />

from different angles. Presbyopes, it appears,<br />

will have a wider selection of options beyond<br />

multi-focal CLs, progressives and LASIK, with<br />

Google-<strong>Nov</strong>artis’ auto focusing CLs, inlays and<br />

eye drops.<br />

In October, Texas-based Encore Vision<br />

announced the US Food and Drug<br />

Administration (FDA) had granted it permission<br />

to begin clinical trials on a topical treatment for<br />

presbyopia. Encore’s EV06 is an investigational<br />

proprietary lipoic acid choline ester compound<br />

aimed at reversing changes in the crystalline<br />

lens that result in diminished lens elasticity.<br />

The company says it will be the first clinical<br />

evaluation of a new chemical entity to address<br />

the underlying physiological processes causing<br />

presbyopia.<br />

“To have a pharmaceutical therapy that could<br />

effectively reduce dependence on bifocals<br />

or reading glasses is truly a groundbreaking<br />

approach in the treatment of presbyopia,”<br />

to the development<br />

of optometry<br />

education in New<br />

Zealand, with<br />

Australian Leon<br />

Garner becoming<br />

the foundation<br />

professor of<br />

optometry at<br />

the University of<br />

Auckland.<br />

Author Professor<br />

Cole has seen a good deal of the history of<br />

Australian optometry up close. He qualified in<br />

optometry at the ACO in 1954 and was appointed<br />

its first full-time lecturer in 1958. He was made the<br />

head of the Department of Optometry and Vision<br />

Sciences at the University of Melbourne when it<br />

was established in 1973 and he was appointed<br />

the foundation professor of optometry in the<br />

University in 1978. He is now Professor Emeritus in<br />

the University of Melbourne.<br />

A History of Australian Optometry (320 pages,<br />

illustrated) is available in softback (A$75) or deluxe<br />

hardback format ($160) from<br />

www.optometry.org.au/shoponline.aspx or<br />

www.aco.org.au/history-book. ▀<br />

says Dr Richard Lindstrom, adjunct professor<br />

emeritus of ophthalmology at the University<br />

of Minnesota. “If EV06 proves successful in the<br />

clinic, this will be a major shift in how we treat<br />

the massive presbyopic population.”<br />

The first EV06 study will compare the safety<br />

and efficacy of EV06 to placebo in at least 72<br />

subjects, 45 to 55 years of age with presbyopia,<br />

and evaluate mean change in distance corrected<br />

near visual acuity (DCNVA) and best corrected<br />

distance visual acuity (BCDVA), along with<br />

additional secondary outcomes.<br />

Corneal inlays have also begun to take off<br />

with AcuFocus’ Kamra inlay receiving regulatory<br />

approval this year for marketing in the US and<br />

Europe. The Kamra device is 3.8 mm in diameter<br />

and 6 microns thick with a tiny 1.6 mm central<br />

opening that creates a pinhole camera effect.<br />

The Kamra inlay procedure takes less than 15<br />

minutes and does not require stitches.<br />

Revision Optics of California is waiting in the<br />

wings to bring its Raindrop Inlay to market as<br />

soon as the FDA gives its final sign off, likely by<br />

mid-2016.<br />

The Raindrop is a microscopic hydrogel that<br />

is 80 per cent water, and as with existing inlay<br />

processes, is implanted in the non-dominant<br />

eye, in an in-office laser procedure.<br />

The company says the inlay changes the<br />

anterior curvature of the cornea, allowing for a<br />

“natural restoration of near vision” and because<br />

it is mostly water, the inlay does not restrict the<br />

amount of light reaching the retina. ▀<br />

A collector’s<br />

rare frames hunt<br />

Tom Chapman has been a collector of all<br />

things vintage for years, from t-shirts to<br />

music to footwear. The young Australian<br />

school teacher, however, ventured into classic eye<br />

frames back in 2008, and has since built a small,<br />

but prized collection around original<br />

Cazal designs.<br />

“The inspiration came from a now defunct<br />

vintage store that I found in Bangkok, Thailand<br />

while I was teaching overseas,” Chapman says.<br />

“I still remember the revered Cazal 858 frames<br />

sitting in the window of the store, the price tag<br />

was about two weeks wages for me at the time<br />

and for many weeks I walked by without trying<br />

them on, and then one day I took the plunge, tried<br />

them on and immediately made the purchase.”<br />

Chapman now owns among the highest valued<br />

Cazals sought by collectors, such as the large<br />

The grey 616 (bottom) is the rarest Cazal in Chapman’s<br />

collection<br />

NEW<br />

Built on the ACUVUE ® MOIST Platform<br />

the #1 best-selling daily disposable brand around the globe 1<br />

Her Vision Will Change.<br />

Her Experience Won’t.<br />

Now you can continue excellent care as her vision evolves into presbyopia<br />

with 1-DAY ACUVUE ® MOIST Brand MULTIFOCAL Contact Lenses<br />

of patients were successfully fit<br />

with 2 pairs of lenses or less<br />

94 % when using the Fitting Tips.*<br />

*Up to 4 lenses total. 1 JJVC Data on File <strong>2015</strong> (Internal Analysis, based on independent third-party data)<br />

mottle grey 616—one of the rarest—the red 951,<br />

the large amber brown 642, and a custom 951.<br />

He says his is small compared to other vintage<br />

frame collectors who can own hundreds or<br />

thousands of items.<br />

“I have collected, sold and traded perhaps only<br />

about 50 or so frames,” Chapman says. “Any more,<br />

and I think my wife would have something to say.”<br />

His collection now also includes Cartier, Dior, and<br />

Porcshe Carrera frames, but some of his Cazals are<br />

counted by collectors as the Holy Grail of the niche.<br />

“Its distinctive style, created and designed<br />

by Cari Zalloni, was made famous long before I<br />

was around,” Chapman says. “The hip hop stars<br />

and celebrities of the 80s and 90s and now<br />

even today have favoured many of the creator’s<br />

frames. The legendary style can be still seen in<br />

many of today’s movies, music video clips and<br />

even on the catwalks.”<br />

The majority of the original frames were made<br />

in West Germany. Chapman collects from various<br />

auction and classified websites. The odd collector<br />

may come across frames in practices, Chapman<br />

says, sitting long-forgotten in a store room,<br />

covered in dust and cobwebs, but he has never<br />

had such luck.<br />

“My collection is on display and cared for in<br />

my home, but unlike some other collectors,<br />

mine are worn on a daily basis. I’m a teacher<br />

and the kids at school always get a buzz out of<br />

the frames I wear,” he says.<br />

The brand happened to enjoy a renaissance after<br />

Chapman started collecting and Cazal now sells<br />

some of its iconic lines alongside new designs.<br />

Collectors seek certain numbers (or “series”),<br />

most notably the 600 and 900 series, and<br />

some frames from the 100, 700 and 800 series.<br />

The popular frames from the extensive Cazal<br />

collection each have a unique style, making them<br />

more desirable to collectors.<br />

So if anyone out there has some old Cazal<br />

frames lying around in the practice, contact Tom<br />

Chapman at tomchapman00@gmail.com. ▀<br />

Learn more about the<br />

predictable and positive<br />

fitting experience.<br />

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<br />

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<br />

other eye problems. Consult the patient information guide for more information.<br />

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.<br />

Johnson & Johnson Vision Care, a division of Johnson & Johnson (New Zealand) Ltd., 507 Mt. Wellington Highway, Mt. Wellington, Auckland 1060, New Zealand.<br />

Phone: 0800-449-535. www.acuvue.co.nz ®TM Registered Trademark. CCP 8785/15<br />

ACUVUE® and 1-DAY ACUVUE® MOIST are trademarks of Johnson & Johnson Vision Care Companies. © Johnson & Johnson Vision Care Companies <strong>2015</strong> 10314426-A April <strong>2015</strong><br />

<strong>Nov</strong>ember <strong>2015</strong><br />



Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!