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THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY<br />
PO BOX 106 954, AUCKLAND CITY 1143<br />
Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
SEVEN GREAT YEARS<br />
50+ GREAT<br />
NZ STORES<br />
$100+ MILLION<br />
ANNUAL SALES<br />
EVERY STORE ALWAYS<br />
AVAILABLE FOR FRANCHISE<br />
AVERAGE STORE NOW<br />
$2 MILLION SALES PER ANNUM<br />
PARTNERSHIP ROLES<br />
STILL AVAILABLE<br />
NO.1 FOR EYE TESTS AND<br />
PRESCRIPTION EYEWEAR<br />
BETTER PROFITS THAN<br />
EVER BEFORE IN 2014/15!<br />
HUGE GROWTH IN CONTACT LENS PRACTICE<br />
NZ FRANCHISE ASSOCIATION ‘SUPREME AWARD<br />
– BEST FRANCHISE SYSTEM IN NZ 2014/15’<br />
For all the info on Partnership and Employed roles across New Zealand and Australia,<br />
contact Raj Sundarjee on 0800 773 077 or raj.sundarjee@specsavers.com<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 1<br />
9/18/<strong>2015</strong> 6:43:17 AM
6 o C<br />
UV INDEX 2<br />
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2 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 2<br />
30804_NZ Optics Advert_<strong>Oct</strong>_HotAirBalloon.indd 1<br />
9/18/<strong>2015</strong> 6:43:18 AM<br />
4/09/<strong>2015</strong> 12:27 pm
EVF launches<br />
eye screening<br />
initiative at<br />
Kiwi schools<br />
The Essilor Vision Foundation (EVF) has kicked off a new<br />
eye screening programme for low decile Kiwi schools.<br />
More than 120 year-four to year-seven kids were screened<br />
at Flaxmere Primary School in Hastings and nearly 40<br />
per cent were found to be suffering at least some vision problem,<br />
including cases of high myopia and hyperopia.<br />
Kumuda Setty, Essilor New Zealand’s marketing manager, says<br />
she was surprised how high it was despite the figures reflecting<br />
similar statistics overseas.<br />
Setty says part of the reason Flaxmere was chosen as the first<br />
school was because Robyn Isaacson, Flaxmere’s principal, was<br />
a visionary who quickly grasped the power of the screening<br />
programme. “She’s so proud of her school and the children and<br />
as she said ‘it’s all about eliminating the barriers for them not<br />
reaching their full potential’.”<br />
Also supporting the programme were local optometrists Jenny<br />
Stewart, from Grant and Douglas Optometry & Eyewear Hastings<br />
and Havelock North, and Frederick Swain of Frederick Swain<br />
Optometrists in Napier, who both provided their time for free; and<br />
Tim Way from Ophthalmic Instrument Company (OIC), who kindly<br />
donated all the equipment for free. They were helped by locum<br />
optometrists Anita Pistorius and Tracey Jones along with Essilor<br />
staff Vineet Chauhan, Guy Parbury and Gordon Stevenson.<br />
Setty says the programme’s launch in New Zealand has been<br />
on the cards for a while, but it was only at ODMA this year, when<br />
she had a chance to sit down with the head of the foundation and<br />
find out about what worked best overseas, that the ball really got<br />
rolling.<br />
Stewart says the level of eye conditions picked up was<br />
concerning. “In particular we found a large number of cases where<br />
the child’s eyes were not tracking together properly; which means<br />
these students would have difficulty concentrating on written<br />
material after just a few minutes.”<br />
All the Flaxmere children who required further examinations<br />
have opted to go to Stewart as their local optometrist, says Setty.<br />
Essilor has also put together a frame and lens package, including<br />
very tough, kid-friendly frames and Crizal UV-protection lenses,<br />
for those kids who need them. The further eye tests and two<br />
sets of glasses – so they can leave one at school – will be covered<br />
under the community card “Enable” subsidy. If parents don’t have<br />
a community card, Grant and Douglas Optometry have agreed to<br />
cover the cost of any additional eye tests, while EVF will cover the<br />
cost of the glasses.<br />
The programme is already picking up wider interest, with TVNZ’s<br />
Seven Sharp covering the Flaxmere trial, and a few principals of<br />
low decile schools writing to the Foundation to ask if their schools<br />
could be included. Optometrists from different regions are also<br />
excited to be part of this programme and are approaching their<br />
local schools, says Setty.<br />
“There simply isn’t enough awareness within the schools and the<br />
parent community, especially in low decile areas, even if they have<br />
community cards, so we need to drive it through the schools and<br />
the teachers, because they know when their kids are struggling.”<br />
Essilor created the Essilor Vision Foundation in 2008 to “eliminate<br />
poor vision and its lifelong consequences”. A public, non-profit<br />
foundation, based in Dallas, Texas, the programme has now been<br />
rolled out in Canada, China, Singapore, India and parts of Europe,<br />
Latin America and Asia Pacific.<br />
Essilor: a most innovative company<br />
For the fifth year in a row, Essilor has been ranked as one of Forbes<br />
magazine’s top 100 most innovative companies.<br />
A pioneer in ophthalmic optics for more than 165 years, Essilor<br />
is credited with breakthroughs such as progressive, organic and<br />
photochromic organic lenses.<br />
“Innovation is part of our DNA and a key driver in our business<br />
of providing solutions to a fundamental human need: good<br />
vision,” said Jean Carrier, Essilor International’s chief operating<br />
officer.<br />
Essilor has five research and development centres, including<br />
three centres of innovation and technology in France, the US,<br />
Singapore. The Group also operates a photochromic technology<br />
centre (Transitions) in Pinnelas Park, US, and a joint research<br />
centre with Nikon (NEIJRC) in Japan. The company has more than<br />
100 research agreements with universities, public and private<br />
sector laboratories and industrial companies. Last year it invested<br />
180 million Euros in research and innovation. It holds 7200<br />
patents, and 40 per cent of its revenue is generated by products<br />
less than four years old. ▀<br />
(L to R) Vineet Chauhan, Gordon Stevenson, Kumuda Setty, Jenny Stewart, Anita<br />
Pistorius, Tracey Jones and vGuy Parbury at Flaxmere Primary<br />
Optometrist Jenny Stewart tests a young patient’s eyes<br />
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PROUDLY NEW ZEALAND OWNED<br />
What a month<br />
and RANZCO to come<br />
EDITORIAL BY LESLEY SPRINGALL<br />
What a month. From the Eye Institute’s Night of<br />
Mystery and Intrigue to Specsavers fourth clinical<br />
conference in Brisbane, and two new product<br />
launches, the month was packed with new <br />
developments and a host of educational opportunities.<br />
The Eye Institute introduced a far more interactive and fun<br />
approach to its evening and delivered a packed series of tutorials,<br />
while Specsavers added an interesting afternoon to its conference,<br />
both covered in detail in this month’s NZ Optics, while Hoya’s<br />
launch of its newly improved Workstyle V+ and Johnson &<br />
Johnson Vision Care’s new 1-Day Acuvue Moist multifocal provided<br />
some exciting new choices for optometrists.<br />
Then there was OphthalmicDocs (oDocs), a Kiwi-based social<br />
enterprise determined to bring better eye care to developing<br />
nations, which hosted an Auckland dinner to spread the word,<br />
attracted Google and was nominated for an innovation award. And<br />
Maryanne and Simon were at them all, armed with their cameras.<br />
If that wasn’t enough, we’ve also got a special feature<br />
on RANZCO covering what’s on at the conference for<br />
ophthalmologists, orthoptists and practice managers, who’s<br />
exhibiting, what’s new and what to do in Wellington.<br />
Enjoy and don’t forget to let us know what you think.<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
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<strong>Oct</strong>ober <strong>2015</strong>.indd 3<br />
9/18/<strong>2015</strong> 6:43:21 AM<br />
12:27 pm
Scientists identify gene<br />
mutation in Acrginatopsia<br />
A<br />
rare<br />
eye disorder marked by colour<br />
blindness, light sensitivity, and other<br />
vision problems can result from a<br />
newly discovered gene mutation<br />
identified by an international research team. The<br />
team published their findings in Nature Genetics,<br />
which may lead to treatments for this form of<br />
colour blindness.<br />
According to the research, mutations to the<br />
ATF6 gene, a key regulator of the unfolded<br />
protein response, can lead to achromatopsia, a<br />
hereditary visual disorder characterised by colour<br />
blindness, decreased vision, light sensitivity and<br />
uncontrolled eye movement in children.<br />
The unfolded protein response is a mechanism<br />
cells use to prevent the dangerous accumulation<br />
of unfolded or mis-folded proteins. Based on<br />
mouse studies, the researchers suspect that the<br />
cone cells of people with achromatopsia are not<br />
permanently damaged and could be revived<br />
by enhancing the pathway that regulates the<br />
unfolded protein response.<br />
“Several drugs that activate this pathway have<br />
already been approved by the FDA for other<br />
conditions and could potentially benefit patients<br />
with achromatopsia,” said one of the study<br />
leaders, Associate Professor Stephen Tsang.<br />
“Five genes had previously been linked to<br />
achromatopsia, however they accounted for only<br />
about half of all cases. Using next-generation<br />
gene sequencing on a small group of patients,<br />
we found that mutations in a sixth gene - ATF6 -<br />
can independently lead to the disease.”<br />
Mutations in ATF6 (activating transcription<br />
factor 6A) have been implicated in other<br />
conditions including diabetes and Alzheimer<br />
disease models, but this is the first time that<br />
they have been directly linked to human disease.<br />
The researchers estimate that ATF6 mutations<br />
account for only about one per cent of cases of<br />
the disease.<br />
“As we sequence more and more achromatopsia<br />
patients, we’re likely to identify other genes,”<br />
said Dr Tsang. “The important lesson of this<br />
study is that it demonstrates how advanced<br />
technologies are bringing precision medicine to<br />
the field of ophthalmology. Certain diseases may<br />
look the same based on the clinical diagnosis,<br />
but we’re finding that each patient is a little bit<br />
different and may benefit from a personalised<br />
approach to treatment.” ▀<br />
Special practice<br />
managers seminar<br />
to be held after RANZCO<br />
A<br />
specialty<br />
seminar is being held after the<br />
RANZCO practice managers conference<br />
in Wellington in November.<br />
The one-day event on Wednesday,<br />
November 4, is open to all optometry and<br />
ophthalmology practice managers. Seminar<br />
topics include how to become a practice leader,<br />
how to manage staff, the behaviours that build<br />
practice leadership, dealing with conflicts, and<br />
developing a leadership style .<br />
Organiser Simon Thiessen, CEO and learning<br />
facilitator of the Real Learning Experience, says<br />
he welcomes optometry practice managers to the<br />
event as similar problems arise across all kinds of<br />
practices.<br />
“Our experience working with hundreds of<br />
practice managers has made it clear: no matter<br />
how long you have been a practice manager,<br />
managing poor performance, dealing with poor<br />
behaviour and resolving conflict are among the<br />
greatest challenges.<br />
“These staff issues can consume more of your<br />
time than they should – and much more than<br />
you would like. However, success as a practice<br />
manager depends on your ability to address<br />
performance and behaviour that is below your<br />
expectations. Left unresolved, these issues<br />
have the potential to undermine performance,<br />
create conflict, frustrate team members and<br />
compromise patient outcomes.”<br />
A discounted registration rate is available<br />
for optometry practice managers, the same<br />
as RANZCO member managers. For more<br />
information and to register visit<br />
http://pm-wellington.eventbrite.com. Book before<br />
<strong>Oct</strong>ober 24 to receive the early bird rate. ▀<br />
Hong Kong expo<br />
focus on designer labels<br />
Organisers of the annual Hong Kong<br />
Optical Fair say the three-day event<br />
will feature more than 200 “wellknown<br />
brands” from around the world<br />
in its Brand Name Gallery, among the total 700<br />
exhibitors expected this year.<br />
The Optical Fair, organised by the Hong Kong<br />
Trade Development Commission (HKTDC)<br />
in conjunction with the Hong Kong Optical<br />
Manufacturers Association, runs from November<br />
4 to November 6. The event, in its 23rd year,<br />
will showcase frames, lenses, optometric<br />
instruments and equipment, and other products<br />
and services at the Hong Kong Convention and<br />
Exhibition Centre.<br />
The gallery will focus on designer and fashion<br />
labels, with Converse, Deep, Groover, ic! berlin,<br />
Italia Independent, Jaeger, L.G.R, Lee Cooper,<br />
Masaki Matsushima, Minima, Morgenrot, Moscot,<br />
Rochester Optical and others set to exhibit.<br />
The organisers will be holding the 17th Hong<br />
Kong Eyewear Design Competition with the<br />
general theme of “Cosmopolitan Glamour.”<br />
Design winners will be announced in <strong>Oct</strong>ober,<br />
with finalists on display at the fair.<br />
The fair also runs concurrently with the 13th<br />
Annual Hong Kong Optometric Conference on<br />
November 5 and November 6. The conference will<br />
focus on anterior ocular disorders and dry eye<br />
syndrome, featuring guest speakers from the US,<br />
UK, Australia and Sweden,<br />
For more information on the fair, and to register,<br />
visit www.hktdc.com/fair/hkopticalfair-en/.<br />
Optical Coherence Tomography (OCT) imaging revealed the loss of outer segments in foveal cone cells in the<br />
‘optical gap’ of a patient with ATF6A defects. Photo credit: Dr. Stephen Tsang, Columbia University Medical Centre<br />
Elective surgeries climb,<br />
with aging population<br />
The number of elective surgeries<br />
performed in District Health Boards grew<br />
42 per cent between 2007/2008 and<br />
2014/<strong>2015</strong>, according to New Zealand’s<br />
Health Ministry, while the number of all elective<br />
surgeries climbed from 117,954 to 167,188.<br />
Health Minister Jonathan Coleman says the<br />
government’s focus on elective surgery has been<br />
to address the fact that more New Zealanders<br />
are living longer and retirees are beginning to<br />
represent a larger part of the population. The<br />
Ministry of Social Development says 13 per cent<br />
of the population in 2009 was 65 and over, but<br />
in two short years that has increased to 14 per<br />
cent, as the first baby boomers reached 65. By<br />
June <strong>2015</strong>, the figure is estimated to be close to<br />
15 per cent.<br />
Elective cataract surgeries have grown over the<br />
years but not as steeply as all electives. The DHBs<br />
performed 12,093 cataract removals in 2007/2008<br />
and 15,203 removals in 2014/<strong>2015</strong>, a 25 per cent<br />
increase. Cataract removals represented about 10<br />
per cent of all electives in 2007/2008, falling slightly<br />
to nine per cent in 2014/<strong>2015</strong>.<br />
Health officials say the service had determined<br />
a desired intervention rate for cataract removals<br />
from 2005 to 2008 and has been meeting or<br />
exceeding targets since then.<br />
“The Cataract Initiative was established by<br />
the Ministry of Health in 2005 to increase<br />
cataract service levels and to reduce variation<br />
in intervention rates between DHBs,” says<br />
Clare Perry, manager of Electives and National<br />
Services for the National Health Board. “The<br />
recommended rate for cataract procedures was<br />
set as a standardised intervention rate (SIR) of 27<br />
per 10,000 population.<br />
“In 2008, when the Initiative was complete,<br />
a review was undertaken. It was agreed that<br />
cataract surgery should remain a priority and the<br />
target SIR has remained at 27 per 10,000.”<br />
The national interventation rate for cataracts<br />
has been over 30 per 10,000 since March 2011,<br />
and this year reached 33.41 per 10,000, according<br />
to the Ministry of Health.<br />
Meanwhile, Coleman said the government had<br />
targeted 4,000 more operations per year, and in<br />
2014/<strong>2015</strong> had exceeded that goal with 5,000<br />
electives performed. Other government releases<br />
suggest that funding for elective surgery is<br />
being used more for prevention and treatment of<br />
orthopaedic conditions, especially hip, shoulder,<br />
knee and spinal conditions.<br />
The Health Ministry announced in May that it<br />
had set aside money to continue elective surgery<br />
growth, with extra resources for hernia, vein and<br />
gall stone operations, and greater support for<br />
multi-disciplinary early intervention teams to<br />
manage and diagnose orthopaedic conditions. ▀<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>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 4<br />
9/18/<strong>2015</strong> 6:43:21 AM
Blur puts creative<br />
sensibility in second practice<br />
The owners of Blur Eyecare in Tauranga always knew they<br />
would expand their practice in the area. They just didn’t<br />
know what the timing would be.<br />
“There is never a right time,” says Blur’s co-owner, Stuart<br />
Laing. “We had been keeping an ear out for suitable options. An<br />
opportunity arose while speaking to a patient (a real estate agent)<br />
and the deal was done within a matter of weeks.”<br />
In August, Blur Eyecare officially opened its second practice in<br />
Mt Maunganui.<br />
Laing founded Blur in 2010 with his wife, Haidee Mannix, both<br />
optometrists who graduated together from Auckland University in<br />
2007, both with a therapeutics endorsement.<br />
Laing says after uni, he and Mannix locumed through Australia<br />
for a few years, before growing tired of living out of a suitcase.<br />
Laing grew up in Auckland, but his parents had owned a place<br />
in Mt Maunganui for decades. With close relatives in the area,<br />
the Bay of Plenty seemed the ideal place to put down their<br />
professional roots, and Laing says it didn’t take much to win<br />
Mannix over to the idea. So, with Devon Palairet on board as the<br />
dispensing optician, they launched the Blur brand two-and-a-half<br />
years ago.<br />
“The second practice allows for higher brand recognition in the<br />
region and a platform to try out different ideas and push some<br />
boundaries. We are not trying to be everything to everybody as we<br />
do not want to lose our direction,” says Laing.<br />
Blur has established itself as a practice that looks for distinctive<br />
brands and the interior of their Mt Maunganui practice reflects a<br />
similarly deep concern with materials and design sensibility.<br />
“Haidee, Devon and I had ideas of what we wanted and needed<br />
in the new space. Breaking the brief down to its core, we wanted<br />
trees, Corten (weathering steel) and butterfly cabinets,” Laing says.<br />
Corten’s earthy, controlled rusting look meshed perfectly with<br />
the concept of an earthy, arboreal interior. Blur enlisted sculptor<br />
Nic Clegg, who works with Paul Mossong, to bring the interior of<br />
the new practice to life in a highly collaborative process.<br />
“(Clegg) is a patient and friend of the practice who also happens<br />
to be a metal work artist, so the fit was very natural. The process<br />
was a very interactive collaboration of ideas from start to finish.”<br />
Laing says the new site brings with it some challenges and the<br />
need for more manpower. Blur has hired two new people who will<br />
be enrolled in the OTEN course, bringing the Blur staff to five. Staff<br />
split their time between the two practices.<br />
Laing says Blur looks for brands that capture the principals’<br />
imaginations, but the roster continues to change.<br />
“We are learning as we go: brands and wholesalers have<br />
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come and gone, as we are trying to achieve the right balance<br />
for the store. We sell product that we enjoy selling. We try and<br />
experiment with styles and aren’t afraid of taking some risks.”<br />
With some experience under his belt, Laing sees more plusses in<br />
working as an independent than negatives.<br />
“As a bricks and mortar, independent optometrist, our advantage<br />
lies in the ability to shape our surroundings to reflect our offer.<br />
Product selection is important to those of us who choose to<br />
differentiate ourselves in this way. Specialist services could be<br />
another, as long as there is a clear, focused direction. The ‘race<br />
to the bottom’ for consultation cost and product cost was an<br />
inevitable outcome of the industry events over the last decade.<br />
Independents should be adding value to products and services as<br />
opposed to stripping away quality to discount price.” ▀<br />
US approves<br />
device that<br />
“sees” with<br />
tongue<br />
The BrainPort V100<br />
The US FDA has given marketing<br />
clearance to a new device that<br />
when used along with a cane or<br />
guide dog can orientate the blind<br />
by enabling them to process visual<br />
images with their tongues. The<br />
BrainPort V100, manufactured<br />
by Wicab, is a battery-powered<br />
video camera mounted on a pair<br />
of glasses, and a small, flat intraoral<br />
device containing a series of<br />
electrodes the user holds against<br />
their tongue. The device processes<br />
optical signals to vibrations and<br />
sensations felt on the user’s<br />
tongue. Users must be trained to<br />
interpret the signals to determine<br />
the location, position, size and<br />
shape of objects, and to determine<br />
if objects are moving or stationary.<br />
Clinical data supporting the<br />
safety and effectiveness of the<br />
BrainPort V100 included several<br />
assessments, such as object<br />
recognition and word identification,<br />
as well as oral health exams to<br />
determine risks associated with<br />
holding the intra-oral device in the<br />
mouth. Studies showed that 69%<br />
of the 74 subjects who completed<br />
one year of training with the<br />
device were successful at object<br />
recognition. There were no serious<br />
device-related adverse events. ▀<br />
News<br />
in brief<br />
UK OPTOMETRIST CHARGED WITH MANSLAUGHTER<br />
Honey Rose, 34, a locum optometrist in the UK, has been charged with<br />
negligent manslaughter after allegedly failing to see a swelling on the<br />
optic nerve of an 8 year old boy during a routine eye examination. The<br />
youngster collapsed and died four months later. According to media<br />
reports, the UK’s Crown Prosecution Service is expected to claim Rose<br />
should have spotted the boy had papilledema as it is a feature of<br />
every sight test. The trial, the first of its kind involving an optometrist,<br />
is set to take place between January and March next year.<br />
CALIFORNIA OPTOMS TO PERFORM SOME MINOR SURGERY<br />
In a move designed to ease the physician shortage in California,<br />
the state senate has approved a bill to allow optometrists to<br />
perform minor eye surgeries and administer vaccinations to adults.<br />
Optometrists will be required to undertake 50 hours of post-doctoral<br />
education and training on human patients to qualify. They will be<br />
able to administer vaccinations to people aged 18 years and older for<br />
influenza, herpes zoster and pneumonia. They will also be eligible<br />
to perform laser procedures to treat glaucoma and to remove small<br />
lesions from the surface of the eyelid.<br />
AUSTRALIA APPOINTS NEW OPTOMETRY BOARD CHAIR<br />
South Australian optometrist Ian Bluntish has been<br />
appointed chairman of the Optometry Board of<br />
Australia effective September 1. He succeeds Colin<br />
Waldron who stepped down having held the inaugural<br />
Chair since 2009. A former president of Optometry<br />
Australia, Bluntish was an inaugural government<br />
Ian Bluntish<br />
appointee to the Optometry Board of Australia in<br />
2009. He is currently the chairman of ProVision. His<br />
appointment to the leadership role reflects the depth and breadth of<br />
his skills and experience.<br />
TOTAL EYECARE’S VESPA RAISES $5,600 FOR CHARITY<br />
Total Eyecare in Lower Hutt raised $5,600 for the Te Omanga Hospice<br />
from the sale of its donated Vespa at the Te Omanga Hospice Vintners’<br />
Lunch fundraiser. Total Eyecare won the slick, red Vespa Sprint 50<br />
(valued at $5,990) in a Transitions promotion and decided to donate<br />
the bike to a charity auction for the nearby hospice.<br />
TRUSSARDI LICENSE MOVES<br />
Well-known and long-established Italian brand Trussardi has signed on<br />
De Rigo Vision for the design, production and worldwide distribution of<br />
the Trussardi-branded optical and sun collection. The Trussardi Eyewear<br />
license had belonged to the Charmant Group from 2011.<br />
FEMTO LASER STUDY<br />
A study in progress in France aims to provide evidence to support the<br />
use of femtosecond laser in cataract surgery in lieu of phaco in the<br />
country’s national health service. News sources report 1,800 people<br />
have been enrolled in the study, which should be completed by mid-<br />
2016. The NZ$5.7 million research project compares femtosecond<br />
laser-assisted cataract surgery with phacoemulsification among 2,000<br />
patients across five participating universities in France, using Abbott<br />
Medical Optic’s CATALYS laser system. Preliminary analysis shows<br />
very good visual acuity results and a complication rate of 16 per cent<br />
among the first ten cases. The ultimate goal is to prove the procedure<br />
provides a better cost-utility ratio over phaco, despite higher costs of<br />
the procedure.<br />
NOT JUST DRY EYE?<br />
Two related studies published in Optometry and Vision Science suggest<br />
patients experiencing contact lens-induced dry eye symptoms may<br />
have a binocular vision disorder instead of, or in addition to, dryness.<br />
Researchers evaluated 104 normal and dry eye patients, and separately<br />
evaluated 29 myopic participants who wore soft contact lenses. In the<br />
first group, researchers found a significant correlation between dry<br />
eye and convergence insufficiency symptom survey (CISS) diagnostic<br />
results, as well as ocular surface disease index measures. In the<br />
second group, researchers found that 48.3 per cent had a BV disorder.<br />
Researchers say clinicians can use the results to address contact lens<br />
induced dry eye, and add binocular vision testing to their exclusion<br />
criteria and subject evaluations in order to eliminate subjects who do<br />
not have dry eye or have both dry eye and a BV disorder.<br />
FORMER FIRST LADY AWARDED PERSON OF VISION ACCOLADE<br />
Prevent Blindness, the US volunteer eye health and safety<br />
organisation dedicated to fighting blindness and saving sight, named<br />
former US First Lady Laura Bush as the recipient of the <strong>2015</strong> Prevent<br />
Blindness Person of Vision Award. The award recognises an individual<br />
for outstanding leadership and dedication in the field of vision and<br />
eye health. Bush has been a long time champion of children’s literacy<br />
and is a strong advocate for the importance of healthy eyesight to<br />
help a child succeed in school and beyond.<br />
“We want to honour her for her tireless efforts to improve the lives<br />
of our children through enriching literacy and educational programs<br />
and advocating for vision care to be part of the strategy,” said Mary<br />
Blankenship Pointer, chair of the <strong>2015</strong> Prevent Blindness Person of<br />
Vision Committee.<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
5<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 5<br />
9/18/<strong>2015</strong> 6:43:25 AM
Specsavers<br />
fourth clinical conference<br />
turns Brisbane green<br />
Specsavers fourth clinical conference (SCC4) literally turned<br />
Brisbane green. The company’s clever marketers arranged<br />
for the town hall to be flooded in emerald light for the<br />
evening drinks event, while the conference venue’s<br />
communal areas sported huge floating green light logos.<br />
The venue, the Brisbane Hilton, was at capacity with record<br />
attendance of more than 500 attendees. The majority were Specsavers<br />
partners (franchise holders), but 50 non-Specsavers optometrists from<br />
Australia and New Zealand, 50 students, and representatives of most of<br />
the associations also attended. A good complement of attendees from<br />
sponsors Alcon, Zeiss, Johnson & Johnson Vision Care, BOC Instruments<br />
and Cooper Vision were also present.<br />
Specsavers this year introduced an extra afternoon of clinical<br />
education sessions from some of Australasia’s key tertiary<br />
education providers. Participants had the option of attending three<br />
sessions on therapeutic optometry or three on clinical optometry,<br />
to bring their total CPD points to 10 (New Zealand).<br />
Charles Hornor, Specsavers director of communications, says the<br />
extra afternoon sessions were added as a direct result of participant<br />
feedback. “People said ‘wouldn’t it be nice if we had something on<br />
the first day’ and they wanted more opportunity to increase their<br />
CPD points. Sunday is about ophthalmologists imparting their<br />
knowledge, so we thought let’s make Saturday different.”<br />
Ben Ashby, Specsavers’ optometry development manager, says<br />
the event was unique in that all the content was being presented<br />
by optometrists to optometrists.<br />
About 100 to 150 participants were expected for the new<br />
afternoon, but more than 300 attended so Specsavers will definitely<br />
be keeping the new format, says Hornor, but given the popularity of<br />
this fourth conference, will be looking for a bigger venue next year.<br />
CLINICAL OPTOMETRY<br />
Dr Isabelle Jalbert, a senior lecturer at the University of New<br />
South Wales, whose research focuses on evidence-based eye care,<br />
eye care quality and health education, discussed the evidence<br />
for the Matrix FDT perimeter with an emphasis on glaucoma.<br />
With the majority of Specsavers optometrists using the Matrix<br />
perimeter, this talk was highly relevant to day-to-day practice.<br />
The talk confirmed the Matrix perimeter was comparable on most<br />
metrics to the HFA, considered by many to be the gold standard<br />
in perimetry, and, according to an analysis of the research, is even<br />
slightly more effective in detecting glaucoma earlier than the HFA.<br />
Dr Nicola Anstice, a senior lecturer in the School of Optometry<br />
and Vision Science at Auckland University, extolled the virtues of<br />
good record keeping and conducting regular clinical audits—a<br />
dry topic that Anstice made highly relevant with case examples<br />
of inadequate record keeping and the impact that had on patient<br />
care and professional standards. Clinical audits should be done<br />
reflectively not punitively to identify areas where change or<br />
improvement is needed, she said.<br />
The third and final speaker in the clinical optometry sessions,<br />
Dr Shelley Hopkins, optometry clinic co-ordinator at Queensland<br />
University of Technology Health Clinics, fought off a child-caused<br />
sore throat to discuss how to run effective vision screenings<br />
for kids. With increasing numbers of children attending stores,<br />
particularly in NZ, the talk was designed to equip optometrists<br />
with the tools to formulate their own vision screening tests and<br />
referral criteria, and confidently assess children who present as a<br />
result of failing a vision screening.<br />
THERAPEUTIC OPTOMETRY<br />
In the therapeutics stream, Professor Fiona Stapleton, head<br />
of optometry at the University of New South Wales, spoke on<br />
the contact lens red eye patient. Stapleton’s talk covered two of<br />
the most common contact lens-related complications in corneal<br />
infiltrates and eyelid-related issues. Particular areas of relevance<br />
included the role of storage cases in microbial disease, diagnosis<br />
of sterile or infective corneal infiltrates and the impact and<br />
management of meibomian gland dysfunction.<br />
In terms of CL-related disease, practitioners should first rule<br />
out microbial keratitis, while everything else is self-limiting, she<br />
said. Consider differential diagnoses, such as infiltrates and other<br />
ocular surface problems and if there is intercurrent disease related<br />
to lens wear.<br />
Professor Alex Gentle, course director of the optometry program<br />
in the School of Medicine at Deakin University, reviewed and<br />
interpreted clinical myopia control trials published since 2011. This<br />
included an in-depth look at the implications for myopia control<br />
using medications, lenses and light exposure.<br />
“Low dose atropine, multifocal contact lenses and<br />
orthokeratology are all promising interventions for mypoia control<br />
and offer sustainable reduction of progression between 25 per cent<br />
and 65 per cent,” he said.<br />
The verdict on low dose atropine was that myopia progression<br />
reduced by 40 per cent, with 0.01 per cent over two years with<br />
few side-effects and little evidence of progression on withdrawal.<br />
Younger children with higher myopia are at the greatest risk of<br />
continuing to show signs of significant myopia progression during<br />
atropine therapy.<br />
Recent clinical trials involving various designs of multifocal soft<br />
contact lenses are generating promising results in controlling<br />
progression. Studies have found that people of Asian ethnicity with<br />
higher myopia are most likely to benefit from orthokeratology in<br />
limiting the rate of axial length change.<br />
Richard Johnson, from Greenlane Hospital and the School of<br />
Optometry and Vision Science at Auckland University, discussed<br />
viral infections of the anterior segment. He covered the big three:<br />
herpes simplex, VZV/HZV and adenovirus, looking first at their<br />
aetiology, infection locations, their clinical presentation, diagnostic<br />
procedures and management.<br />
Useful tips include employing steroids for virus-associated<br />
inflammation less frequently than for non-viral (If the IOP is high<br />
or if there is conjunctival chemosis, it is likely to be viral) and taper<br />
off over several months.<br />
Red flags for optometry include stromal HSV/VZV, posterior<br />
involvement of viral infection, steroid drops on active epithelial<br />
disease, steroids without antiviral cover (because of their ability to<br />
reactivate) and not under-treating with topical antivirals.<br />
CLINICAL CONFERENCE OVERVIEW<br />
Specsavers Australia and New Zealand CEO Paul Fussey opened<br />
the conference proper, saying he was “blown away” by the high<br />
attendance and positive atmosphere.<br />
Peter Larsen, Specsavers professional services director,<br />
announced the launch of the new Oculo data-sharing platform<br />
(see separate story page 15), extolling the virtues of good<br />
communication between optometrists and ophthalmologists to<br />
boost productivity and provide better patient outcomes.<br />
Ophthalmologist Dr Angus Turner shared his experiences<br />
of and hopes for teleophthalmology for delivering better eye<br />
health to remote indigenous communities, while Dr Justin Mora,<br />
a paediatric ophthalmologist and strabismus surgeon dealing<br />
with binocular vision at Auckland Eye, covered three areas of<br />
paediatric ophthalmology: paediatric glaucoma, paediatric allergic<br />
Brisbane Town Hall turns green for Specsavers<br />
conjunctivitis and assessing vertical strabismus.<br />
Key points included:<br />
• Optic nerve cupping in paediatric glaucoma is reversible<br />
• Normal tension glaucoma does not exist in children – large cups<br />
can be normal<br />
• Surgery is key to managing paediatric glaucoma in children<br />
under three<br />
• Children under six are at higher risk of increased IOP with<br />
steroid use<br />
• Vertical strabismus is almost always a nerve or muscle problem<br />
• Don’t assume the fixating eye is the normal eye<br />
Dr Anthony Pane from the Queensland Eye Institute discussed<br />
investigation of diplopia, pupil dilation and motility in serious<br />
neuro-ophthalmology cases. Unexplained visual loss will lead to<br />
many questions: is visual acuity worse than expected, is colour<br />
vision normal, is there a visual field defect and are the optic discs<br />
normal (a late sign). Transient visual loss should raise particular<br />
alarms: if it presents without migraine, refer; if there’s loss in one<br />
eye only, refer urgently.<br />
Professor Stuart Graham, a glaucoma specialist with Macquarie<br />
University, looked at the practical aspects of perimetry for<br />
assessing progression, covering the use of the Humphries and<br />
Matrix instruments.<br />
Dr David Hilford, from the Toowomba Eye Clinic, outlined a new<br />
international (and more intuitive) classification system to describe<br />
diseases of the macula, the latest approach to the management<br />
of these conditions, and a new drug – ocriplasmin (traded Jetrea).<br />
The new classification system and associated management plan,<br />
including the new drug, could be summarised as follows:<br />
• VMA—Vitreomacular Adhesion—Observe<br />
• VMT—Vitreomacular Traction—Observe or Ocriplasmin<br />
• FTMH—Full Thickness Macular Hole—less than 400 um in size<br />
—Ocriplasmin or surgery<br />
• FTMH—Full Thickness Macular Hole—greater than 400 um in<br />
size—surgery<br />
Dr Michael Coote, a CERA lead investigator and the clinical<br />
director of ophthalmology at the Royal Victorian Eye and Ear<br />
Hospital, reminded delegates that 50 per cent of glaucoma patients<br />
have normal IOPs and that a significant proportion of glaucoma<br />
goes undiagnosed. He spoke about the Glaucomatous Optic<br />
Neuropathy Evaluation (GONE ) project, which more than 6,000 eye<br />
care professionals and trainees have registered with over the past<br />
six years, and showed how important good disc examination was<br />
to diagnosing and evaluating the severity of the disease.<br />
The conference was closed by the popular and well known<br />
Australian ophthalmologist Dr Charles Su who discussed the<br />
function of the tear film and eyelids and how they can be better<br />
managed to treat dry eye. ▀<br />
Dr Michael Coote extols the benefits of GONE<br />
Speakers Professor Stuart Graham, Dr Justin Mora, Dr Michael Coote, Dr Charles Su,<br />
flanked by Specsavers’ Peter Larsen and Paul Fussey<br />
6 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 6<br />
9/18/<strong>2015</strong> 6:43:27 AM
Debra and Richard Johnson, William Perriam, Rob Jacobs and Nicola Anstice<br />
David Anderson, Melinda Chen, Defini Tai, Megan Glover, David Hooker, Helen, Haslett with Niall McCormack at<br />
the front<br />
Get to the main<br />
cause of dry,<br />
irritated eyes*<br />
Jennifer Robinson, Ian Russell, Danny Gainford and Chris<br />
Specsavers Gisborne takes<br />
Top Shop award<br />
Trade organisation Retail New Zealand named Gisborne’s<br />
Specsavers supreme winner in the annual Top Shop awards.<br />
The shop edged out runners up Carvin Streetwear in Gore<br />
and Warehouse Stationery Royal Oak, in Auckland.<br />
“The judges that visited the store were impressed by the very<br />
professional layout and look. The staff were friendly and made<br />
customers feel welcome and at ease, while providing excellent<br />
advice,” says Retail NZ chief executive Mark Johnston.<br />
Winning applicants were selected over three “rigorous<br />
rounds of judging,” Johnston says, two in-store assessments by<br />
mystery shoppers and a panel selection.<br />
Tania Richards, a dispensing optician and Specsavers<br />
Gisborne director since its opening six years ago, says the store<br />
had won an in-house “champions league” in 2014, prompting<br />
them to apply for the Top Shop award.<br />
She says the award reflects the store’s focus on “excellent<br />
customer service” adding that helping clients is one of her<br />
favorite aspects of the job.<br />
“I love the interaction with our patients and helping them to<br />
choose the best style frames and lenses.”<br />
Specsavers Papanui took the Top Shop award for fashion and<br />
footwear in the upper South Island region. ▀<br />
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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. Reckitt Benckiser, Auckland. TAPS DA1541<br />
Optrex-miVisionFPC-0515.indd 1<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
10/08/<strong>2015</strong> 7:18 am<br />
7<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 7<br />
9/18/<strong>2015</strong> 6:43:32 AM
Eye Institute turns gaze on<br />
mysterious and intriguing cases<br />
Presenters at the recent Eye<br />
Institute seminar kept an audience<br />
of 141 optometrists riveted with<br />
a series of brief discussions and<br />
testing questions on a host of topics<br />
ranging from recognising melanoma to<br />
treatment of patients with rosacea.<br />
The format was far more interactive<br />
than previous seminars, with speakers<br />
actively and often amusingly challenging<br />
the audience on a host of subjects<br />
applicable to their practices. The Eye<br />
Institute’s second seminar of <strong>2015</strong>, held<br />
at the Ellerslie Events Centre in Auckland<br />
on August 25, and entitled A Night of<br />
Mystery and Intrigue, also broke the<br />
presentations into two hour-long slots,<br />
comprised of 15-minute presentations,<br />
with food and drink available before and<br />
in between.<br />
Attendees responded positively to<br />
the new format, telling organisers the<br />
faster-paced delivery and varying topics<br />
held the audience’s attention. They also<br />
appreciated the half-time break, and the<br />
fact that drinks were served earlier than<br />
at previous seminars.<br />
Attendees who applied for CPD earned<br />
two points. The evening was sponsored<br />
by Alcon.<br />
FACING A COMMON PROBLEM:<br />
ROSACEA<br />
Dr Trevor Gray started the evening with<br />
an overview of rosacea, a skin condition<br />
that will affect one-in-ten people at some<br />
time in their lives, which is marked by<br />
a chronic inflammatory response in the<br />
oil secreting sebaceous glands and in<br />
one sub-type, the anatomically similar<br />
meibomian glands.<br />
“It’s a very common condition that<br />
is easy to overlook, but once we clue<br />
ourselves into it and recognise the signs<br />
and symptoms, all of a sudden other<br />
aspects of a patient’s eye health care<br />
come into play,” Dr Gray said.<br />
In the ocular sub-type of rosacea,<br />
chronic inflammation of the meibomian<br />
glands, like inflammation of the<br />
sebaceous counterparts, causes the gland<br />
to secrete irritating long-protein chain<br />
oil, not normal soothing oils, which the<br />
resident microflora (staphycoccae) break<br />
down into free-fatty, pro inflammatory<br />
acids. The cycle of inflammation can lead<br />
to dilation of the blood vessels, which<br />
become spider vessels (telangiectasias).<br />
Rosacea may not be life threatening, but<br />
ocular rosacea can lead to perforation of<br />
the cornea.<br />
“When you see blood vessel invasion<br />
along the lower five o’clock and seven<br />
o’clock quadrants, that’s typical of ocular<br />
rosacea, and is a threat to vision.”<br />
Dr Gray said treatment breaks down<br />
into patient education with skin care<br />
advice, and topical and oral medication<br />
to treat the lesions. Dermatologists<br />
have also used intense pulse light (IPL)<br />
treatment, recognising it’s not an instant<br />
or complete remedy and can take threeto-six<br />
months to see its full benefits.<br />
Dr Gray said ocular rosacea would be<br />
explored in greater depth at the Eye<br />
Institute Conference in November.<br />
SLK: EASY TO OVERLOOK<br />
Dr Adam Watson took the attendees<br />
through a case study illustrating<br />
the symptoms of superior limbic<br />
keratoconjunctivitis (SLK), not nearly<br />
as common as ocular rosacea, and only<br />
first identified as a discrete clinical<br />
condition in 1963. SLK is characterised<br />
as inflammation of the superior<br />
bulbar conjunctiva with predominant<br />
involvement of the superior limbus,<br />
an adjacent epithelial keratitis, and a<br />
papillary hypertrophy of the upper tarsal<br />
conjunctiva.<br />
The patient in Dr Watson’s case study<br />
suffered dry eyes with burning, gritty<br />
sensation, reporting that blinking tended<br />
to make the condition worse, while<br />
lubricants provided only temporary relief.<br />
But, his eyes “looked pretty good, and<br />
nothing seemed to be there” to suggest<br />
MGD, dry eye disease, corneal erosions<br />
or other conditions related to those<br />
symptoms.<br />
“SLK is easy to overlook,” said Dr<br />
Watson. “Some of you want to keep it<br />
in the back of your mind for recalcitrant<br />
cases when you’ve done everything<br />
you’ve thought helpful with no<br />
improvements.”<br />
SLK seems to be a middle-age condition,<br />
commonly found among hyperthyroid<br />
patients. Targeted treatment can<br />
include viscous gel lubricants, tolerated<br />
ointment, punctal occlusion and<br />
supplements to promote tear film health,<br />
such as omega 3. Steroid treatment and<br />
even thermal cautery or conjunctival<br />
resection are necessary in some cases.<br />
“Interestingly, soft contact lenses have<br />
a potential place and best contemplated<br />
in people with no marked problems, if<br />
they’re amenable,” Dr Watson added.<br />
“Nobody knows why, but it’s been<br />
proposed that contact lenses may<br />
facilitate healing of the erosions of the<br />
surface of the conjunctiva, the way that it<br />
interacts on tear dynamics.”<br />
MELANOMAS AND HOPELESS CASES<br />
Dr Peter Hadden led an interactive<br />
session showing a series of eye scans and<br />
asking participants to decide if what they<br />
were seeing was benign or malignant,<br />
and whether it needed to be removed.<br />
While small melanomas at the 2.5mm<br />
thickness did not present problems in 99<br />
per cent of cases in five-year longitudinal<br />
studies, studies conducted over decades saw<br />
small melanoma eventually metastasize at<br />
which time it is too late to intervene.<br />
Still, Dr Hadden said, the effective<br />
treatment of medium sized melanoma<br />
(before metastasis) has not greatly<br />
improved over the last century, making it<br />
more important to treat small melanoma.<br />
Dr Hadden gave many examples of scans<br />
of eyes with suspicious nivae, which will<br />
be thicker than normal flat nivae, and<br />
will be surrounded by fluid that appears<br />
orange in scans. Any growth in the nivae<br />
should raise alarms.<br />
Dr Charles McGhee talked about hopeless<br />
cases he has come across in his practice,<br />
in particular a case study of a middleaged<br />
female, professional photographer<br />
who had suffered a string of bad luck<br />
in her vision: myopia, cataracts, retinal<br />
detachment and corneal deterioration. Her<br />
various conditions led to severe vision loss<br />
which not only kept her from working, but<br />
lost her driver’s license as well. Dr McGhee<br />
conducted a transplant of her right eye<br />
cornea to the left eye where most of her<br />
problems were. Following the operation,<br />
her vision improved, she was able to<br />
return to work and successfully reapply for<br />
her drivers license.<br />
SEEING DOUBLE AND MACULAR<br />
DEGENERATION<br />
Dr Peter Ring gave an overview of<br />
the causes of monocular and binocular<br />
double vision. He reminded optometrists<br />
the first question to ask when someone<br />
complains of seeing double was to ask<br />
in which eye, and to test for monocular<br />
versus binocular diplopia.<br />
Monocular diplopia cases mostly<br />
require optical fixes with sphere<br />
cylindrical corrections, rhinodialysis, and<br />
laser treatment. More serious are the<br />
ramifications of binocular diplopia, which<br />
can be a symptom of five major problems<br />
that can be much more serious, and even<br />
fatal. The first one is third nerve palsy<br />
occurring with papillary involvement,<br />
the eye pointing down and out, and can<br />
present with headache, retro-orbital<br />
pain, stiff nick, nausea and even loss<br />
of consciousness. The symptoms taken<br />
together can be a sign of an aneurism<br />
pressing on the third optic nerve where it<br />
emerges from the brain stem close to the<br />
basilar artery.<br />
“So why is it a warning sign?” Dr Ring<br />
asked. “Because the next thing that can<br />
Jill Mottram and Dr Simon Dean<br />
Wendy Hill, Paul Burchel, Jasha Morarji, Roger<br />
Tepuni, Caroline Perkinson and Jason Dhana<br />
Ilana Gutnik, Niti Todd and Phil Turnbull<br />
happen is a subarachnoid haemorrhage.”<br />
Dr Shanu Subbiah discussed the<br />
variation in size and shape of drusen and<br />
in what context optometrists should take<br />
them for a sign of macular degneration.<br />
“We want to put things into boxes<br />
and to give our patients a diagnosis,<br />
and sometimes we can’t. Macular<br />
degeneration is a very general term,<br />
so we may be putting a problem of the<br />
macular into a broad category.”<br />
While drusen tend to be the hall mark<br />
of age-related macular degeneration,<br />
they are present in patients from 19 years<br />
of age and up, with younger patients’<br />
drusen measuring 34.5 microns.<br />
“It’s acceptable and normal to see the<br />
odd drusen so you have to look at the<br />
drusen in context,” he said. “Generally,<br />
the smaller they are the less you have to<br />
worry about.”<br />
Drusen measuring between 31 microns<br />
and 65 microns, Subbiah said, are<br />
generally acceptable in patients, but<br />
bigger than that, at 65 years old and up,<br />
does suggest macular degeneration.<br />
“For a patient with drusen it’s best not<br />
to put them straight into the category<br />
of age related MD, because there are<br />
other conditions that promise a better<br />
diagnosis. Look at age, distribution of<br />
drusen, the shape and size, and as a<br />
general rule, the smaller the better. “<br />
DIAGNOSING, QUICK AND CORRECT<br />
Dr Nick Mantell spoke about a patient<br />
with acute angle closure, a case that<br />
underscored the necessity of getting<br />
the diagnosis right as soon as possible<br />
and illustrated the importance of giving<br />
a consistent and constant messaging<br />
from all involved. He provided tips for<br />
diagnosis and ongoing management of<br />
such patients.<br />
Dr Simon Dean gave a most descriptive<br />
case study titled Snap Crackle and Pop:<br />
Sight Threatening Orbital Emphysema<br />
centred on a case that illustrated how<br />
trauma around the orbit can result<br />
in multiple injuries to the globe and<br />
periorbital structures. The case-based<br />
presentation focused largely on a man<br />
suffering vision-threatening orbital<br />
trauma during a rugby match, illustrating<br />
the mechanism of orbital blowout<br />
fracture, and covered the therapeutic<br />
and surgical management options and<br />
choices that had to be considered in the<br />
emergency department. ▀<br />
Allergan recalls eye ointments<br />
in US and buys eye care Co.<br />
Pharmaceutical giant Allergan is voluntarily recalling three eye<br />
treatments following complaints from consumers about finding<br />
contaminants in the products.<br />
An announcement from the US Food and Drug Administration<br />
at the end of August said Allergan was recalling specific lots of its<br />
Refresh Lacri-Lube 3.5g and 7g for dry eye, Refresh P.M. 3.5g for dry eye,<br />
FML (fluorometholone ophthalmic ointment) 0.1% (sterile ophthalmic<br />
ointment topical anti-inflammatory agent for ophthalmic use, 3.5g), and<br />
Blephamide (sulfacetamide sodium and prednisolone acetate ophthalmic<br />
ointment, USP) 10%/0.2% sterile topical ophthalmic ointment<br />
combining an antibacterial and a corticosteroid, 3.5g.<br />
The FDA says Allergan initiated the recall based on a small number<br />
of customer complaints which reported “a small black particle” at the<br />
time of use. The particle, which is part of the cap, can be created by the<br />
action of unscrewing the cap from the aluminum tube.<br />
The recall was exclusive to the US market and Australasian representatives<br />
of Allergan would not comment on the problem on a local basis.<br />
In other news, Allergan announced it would purchase AqueSys Inc., a<br />
private medical device company focused on developing ocular implants<br />
that reduce intraocular pressure (IOP) associated with glaucoma.<br />
Under the agreement, Allergan will acquire AqueSys for US$300 million in<br />
an all-cash, upfront payment, with commercialisation milestone payments<br />
related to AqueSys’ lead development programmes, including XEN45.<br />
XEN45 is a soft shunt that is implanted in the subconjunctival space in<br />
the eye through a minimally invasive procedure with a single-use, preloaded<br />
proprietary injector. The XEN45 technology facilitates aqueous<br />
fluid flow to lower IOP while protecting against the potential for<br />
hypotony associated with current subconjunctival procedures.<br />
XEN45 has received a CE mark in the European Union where it is<br />
indicated for the reduction of IOP in patients with primary open angle<br />
glaucoma where previous medical treatments have failed. The CE mark<br />
allows treatment in conjunction with a cataract procedure or as a<br />
standalone procedure. XEN45 is also approved for use in Turkey, Canada<br />
and Switzerland. In the US, final approval for XEN45 is expected by late<br />
2016 or early 2017.<br />
The acquisition builds on Allergan’s efforts to expand its eye care portfolio.<br />
It bought Oculeve Inc., a development-stage medical device company<br />
focused on developing novel treatments for dry eye disease, for US$125<br />
million in July. Allergan’s eye treatment portfolio now ranks second among<br />
its portfolios with the most development candidates. ▀<br />
Big anniversaries see big<br />
donation to Blind Foundation<br />
The Freemasons of New Zealand have donated 125 DAISY players<br />
to the Blind Foundation in recognition of both organisations<br />
celebrating 125 years in the country.<br />
With under five per cent of printed material available to blind<br />
or low vision New Zealanders, thousands have come to rely on the Blind<br />
Foundation’s library to supply them with periodicals and books through<br />
DAISY (Digital Accessible Information System) devices.<br />
Blind Foundation chief executive Sandra Budd, who attended the<br />
Freemasons 125th anniversary celebration, expressed gratitude for the<br />
fundraising programme which saw every Lodge in New Zealand raise<br />
$500 for the purchase of the DAISY players.<br />
“To know that we have your support in such a milestone year is<br />
wonderful,” Budd said at the event. “I see this as a coming together of<br />
two iconic organisations who have stood the test of time and which<br />
both have a great future. This generosity and commitment to bringing<br />
this gift to fruition personifies the Freemasons spirit.”<br />
The Freemasons also recently provided major funding to enable<br />
BLENNZ - the Blind and Low Vision Education Network of New Zealand<br />
- build an outdoor facility at its Homai campus to help children there<br />
develop physical and sensory abilities. The project, called Freemasons<br />
Park, took three years to complete. ▀<br />
Freemasons Grand Master John Litton with Blind Foundation Chief Executive<br />
Sandra Budd and a happy recipient of a DAISY Player<br />
Dior has new distributor<br />
Vision Marketing & Distribution (VMD) has been tapped to act<br />
as the new distributor of Dior frames in New Zealand. The<br />
Safilo Group brand was previously carried by Pacific Eyewear.<br />
Nigel Butler, CEO of VMD, says Dior was a prestigious brand<br />
to add to the company’s portfolio, which includes several other Safilo<br />
licensed brands.<br />
“(Dior’s) new optical collection has arrived and will be offered to select<br />
practices in New Zealand,” says Butler.<br />
Dior unveiled its Montaigne collection in January, marking a change in<br />
direction for the fashion house’s frames category. Dior Montaigne is said<br />
to encapsulate the essence of the couture house, with layers of acetate<br />
reminiscent of the fabric layering in Dior’s ready-to-wear collections.<br />
The Dior oval code is featured on the temple and on the dedicated<br />
hinge, the grosgrain pattern is revealed in the transparency of the<br />
temple, and the Christian Dior plaque inside the temple evokes the label<br />
sewn inside Dior garments. ▀<br />
8 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 8<br />
9/18/<strong>2015</strong> 6:43:34 AM
Hoya debuts new<br />
vocational lens line<br />
Ophthalmologist<br />
awarded Churchill<br />
Fellowship<br />
Hoya introduced a new line of<br />
vocational lenses at workshops held in<br />
Auckland and Wellington.<br />
The company’s Workstyle V+ line is<br />
designed to give presbyopic patients a better<br />
option if they frequently switch focus from<br />
screen to desk to general office space through<br />
the workday.<br />
Speaking to a crowd of about 60 optometrists<br />
and DOs at the Langham hotel in Auckland in<br />
September, Hoya’s regional professional services<br />
manager Vivien Chiang presented the company’s<br />
case for offering patients vocational lenses as an<br />
alternative to progressive lenses.<br />
Chiang said that age, and more importantly<br />
the fact that we work and live using multiple<br />
screens, makes a strong case for offering patients<br />
a vocational lens that can accommodate near,<br />
intermediate and distant vision.<br />
“The way we live and play has changed.<br />
Gadgets have gone more sexy, you can put them<br />
in your pocket, so we’re stuck with it. It’s part<br />
of what we do, how we live and work, and that<br />
includes smartphones, tablets and laptops.”<br />
Chiang said the Workstyle V+ line gives patients<br />
choices that Hoya’s internal research says they<br />
want. Workstyle V+ Space is designed for people<br />
who want a large near zone, a wide intermediate<br />
zone and to see clearer beyond their own work<br />
desk. The V+ Screen is specifically for multiscreen<br />
users, and Hoya tested the line on bankers who<br />
often have to switch from screen to screen to<br />
monitor financial data from varied sources, while<br />
V+ Close is for people who want and need the<br />
near zone to be very clear.<br />
“If you don’t remember anything I’ve said,<br />
this is the key point, as an optometrist myself,<br />
even when I was a young optom out of school,<br />
I realized we aren’t telling our patients about<br />
options and many of them tell us they don’t<br />
want options, or they’re too expensive…but<br />
trials conducted with the V+ ranges showed<br />
more than 80 per cent wished they’d been told<br />
about vocationals before.”<br />
Hoya’s occupational options before V+ were<br />
fairly specific. The PC Pro for regular computer<br />
users had a digressive lens that extended<br />
working distance out from 60cm to 80cm<br />
compared to traditional readers. Later the<br />
company modified standard progressives to<br />
create the HoyaLux Desk, improving focus at<br />
near and intermediate distances. The company<br />
has improved on the Desk design by switching<br />
from a conventional, round cutting tool, that<br />
cuts vertically and horizontally along the surface<br />
of the glass, to a free-form cutting tool that<br />
added a Z-axis to cut into the lens to come up<br />
with the Workstyle V+ lines which “visibly<br />
increased” the lenses’ clear zones, said Chiang.<br />
Freeform design gives wearers a wider range<br />
in office settings, she added. The WorkStyle V+<br />
Close at +1.75D add has the potential of clear<br />
vision ranging from 40cm to 1.5m; V+ Screen<br />
from 40cm to 2.5m, and V+ Space from 40cm to<br />
6m and possible more.<br />
Chiang cautioned attendees, however, not to<br />
prescribe the V+ range as a progressive lens as it<br />
is meant for flexible indoor use.<br />
Hoya offers a selection of seven optical corridors<br />
for custom fits to give patients a wider selection<br />
of frames, from shallow to deep, as well as a<br />
standard 22mm corridor for the Space and Screen<br />
models, and 20mm corridor for the close design. ▀<br />
Vivien Chiang presents Workstyle V+<br />
Michael Yip, Paula Farrar and Stuart Whelan<br />
Lee Pittard, Jodie Lawford and Jeremy Wong<br />
Petra Hewitt, Emmaleen Sheriff, Alley Bissett, Katie Smyth and Christine Rae<br />
David Mackey<br />
Australian<br />
ophthalmologist Dr<br />
David Mackey, one of<br />
the world’s leading<br />
researchers in the genetics<br />
of eye disease, has received a<br />
<strong>2015</strong> Churchill Fellowship.<br />
Dr Mackey, managing<br />
director of the Lions Eye<br />
Institute at The University of<br />
Western Australia, will use the<br />
fellowship to visit ophthalmic<br />
gene therapy research centres<br />
in London and Oxford next<br />
year. He will determine how<br />
Australian patients with rare<br />
eye diseases might be able to<br />
participate in promising gene<br />
therapy research trials being<br />
conducted overseas.<br />
“I have been working on<br />
the genetics of eye disease for<br />
more than 25 years and have<br />
mainly been involved in the<br />
discovery of genes associated<br />
with different eye diseases,<br />
such as optic nerve diseases,<br />
retinal dystrophies and<br />
glaucoma,” says Dr Mackey.<br />
“In the last decade, several<br />
gene therapy trials have begun<br />
in Europe and North America<br />
for some specific rare eye<br />
diseases. Gene therapy offers<br />
hope to patients with a range<br />
of conditions for which there<br />
have not been conventional<br />
treatments or cures.” ▀<br />
These glasses have<br />
changed my life!<br />
Why?<br />
“<br />
I can now concentrate well beyond what I was previously<br />
capable of. When wearing my conventional multifocal lenses,<br />
I didn't realise how much of my attention was diverted into<br />
maintaining my posture. I spent so much subconscious energy<br />
keeping my head, neck and body in the exact position to maintain<br />
focus that my concentration span was compromised.<br />
My new WorkStyle V+ lenses allow me to relax and read and read<br />
and read! I love it. An added bonus is that I don't need to take them<br />
off all the time, and they don't look like bottle glass!<br />
I would not hesitate recommending them to others.”<br />
− Donna, Pharmacist at<br />
The Royal Children’s Hospital, Melbourne<br />
Donna is a customer of Scoogle Optometrist in Melbourne, VIC Australia<br />
NZOptics_V+Secret_180x280mm_OCT15.indd 1<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
14/09/<strong>2015</strong> 10:25:25 AM<br />
NEW ZEALAND OPTICS<br />
9<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 9<br />
9/18/<strong>2015</strong> 6:43:38 AM
Speciality<br />
Contact Lens Forum<br />
Bailey Nelson<br />
expands to<br />
Auckland<br />
Incorporating front surface toricity to correct residual<br />
astigmatism in a mini-scleral lens for monocular<br />
keratoconus<br />
BY ALEX PETTY*<br />
These days, more of our keratoconic patients<br />
are demanding improved levels of vision<br />
so that they may go about their days<br />
unhindered by blur and distortion. This is<br />
especially true in someone with monocular corneal<br />
disease, as these patients typically have a fellow<br />
eye with excellent vision, enabling sometimes<br />
unfair comparison. Fortunately with technological<br />
updates to contact lens technology, excellent vision<br />
is obtainable especially in patients with only mild<br />
to moderate levels of corneal ectasia and clear<br />
ocular media. This case describes how troublesome<br />
residual astigmatism in a non-rotationally<br />
symmetrical scleral lens can be alleviated with the<br />
use of a toric front optic-zone in a patient with<br />
moderate monocular keratoconus.<br />
The patient in question, a male in his mid 20s,<br />
presented to our practice after living in another<br />
part of the country for several years. He has an<br />
interesting case of monocular keratoconus in his<br />
left eye and has worn a KATT scleral lens from<br />
Capricornia in the past. However he lost this lens<br />
a year prior and has been getting by with using a<br />
spherical monthly silicone hydrogel lens to correct<br />
the low myopia in his normal right eye.<br />
Refraction was R -2.00/-0.25 x 90 (6/5), L -1.25/-<br />
6.50 x 132 (6/20+). Corneal topography revealed<br />
an essentially normal pattern in the right eye<br />
and a steep central area with surprisingly regular<br />
astigmatism in the left eye. Keratoconus was<br />
confirmed with pachymetry showing relative<br />
thinning in the left eye: R 562µm, L 530µm. Slitlamp<br />
examination revealed no corneal opacity in<br />
either eye.<br />
Axial maps of the right and left eye showing the<br />
significant curvature difference between the two eyes.<br />
Trial-fitting with the Eyespace Scleral lens was<br />
carried out with the aid of anterior OCT to assess<br />
central clearance and landing zone alignment.<br />
Despite his large corneal diameter (HVID) the lens<br />
size of 16.5mm was chosen as the larger 17.5mm<br />
size decentered inferiorly following insertion. This<br />
also matched the size of the KATT lens he has used<br />
in the past. I always assess flexure of the lens with<br />
over-topography during trial fitting as this gives<br />
me an idea of the level of scleral toricity. The Scleral<br />
Shape Study from Pacific University showed us that<br />
the majority of sclera are asymmetrical and tend<br />
to be flatter in the nasal aspect. Fitting a spherical<br />
scleral lens to an asymmetrical sclera often results<br />
in lens flexure, leading to residual astigmatism. In<br />
moderate-severe cases it can also cause the lens to<br />
be unstable on the eye.<br />
There are different schools of thought in<br />
scleral lens circles about how to deal with flex.<br />
Traditionally lenses were just made thicker to<br />
nullify the tendency to bend. However as shown<br />
by Michaud et al 2012 thicker lenses decrease the<br />
transmission of oxygen to the cornea. This means<br />
that theoretically only lenses with a thickness<br />
of 250µm and low clearance of 100µm satisfy<br />
the Holden-Mertz criteria for a material with a<br />
Dk of 100. It follows that trying to keep the lens<br />
thickness to a minimum is sensible.<br />
In my view a more elegant way to control flex is<br />
by using a lens with a higher sagittal height in the<br />
steep meridian (much like a toric-periphery corneal<br />
lens), thus evenly distributing the bearing of the<br />
peripheral scleral landing zone. A rule-of-thumb<br />
to estimate the degree of sagittal difference is<br />
200µm for every diopter of flex found with corneal<br />
topography. Of course some may point out that a<br />
thick spherical lens that does not flex may promote<br />
more tear exchange behind the lens, however that<br />
is a discussion for another day.<br />
Clinically, I find that most eyes that I fit with a<br />
scleral lens require a toric periphery to eliminate<br />
residual astigmatism and best stabilise the lens.<br />
Eef van der Worp’s excellent review of scleral lenses<br />
(now in it’s second edition and free to download<br />
from Pacific University) also comments that longer<br />
wearing time and better comfort is evident in wellfitted<br />
back surface designs.<br />
Anterior OCT of the lens showing 160µm of central<br />
clearance and well-aligned base curve.<br />
OCT of the inferior scleral landing zone showing limbal<br />
clearance and well-aligned landing angle.<br />
Using the data from the trial fitting process the<br />
patient’s first custom lens was designed with<br />
200µm of sagittal difference between meridians<br />
and a spherical base curve and power of 7.8mm<br />
and -3.50D respectively. On delivery the lens had<br />
even scleral alignment and after settling 160µm<br />
of central clearance. The lens was quick to align<br />
with the ‘flat’ meridian’s marking along 30 degrees,<br />
matching the principal meridians of flexure on the<br />
over-topography of the trial lens.<br />
Slit-lamp images of the lateral landing areas of the scleral<br />
lens showing the marking indicating the ‘flat’ meridian of<br />
the lens at 30 degrees.<br />
Vision however was only 6/12, improving<br />
significantly with refraction of plano / -1.25 x 85.<br />
No flexure was seen in this lens and no significant<br />
spherical aberration was present with retinoscopy.<br />
As the axis of lens stabilisation and residual<br />
astigmatism did not match up it is unlikely that<br />
modification of the peripheral lens parameters<br />
would assist here. Instead it was decided to<br />
incorporate front-surface toricity to correct the<br />
residual astigmatism.<br />
There are several ways to stabilise the rotation of<br />
a front surface toric scleral lens including double<br />
slab off prism (superior and inferior thin zones),<br />
inferior prism ballast and use of pinguculae<br />
notching. These techniques typically rely on<br />
a patient inserting the lens with the correct<br />
orientation (a nightmare for many visuallyhandicapped<br />
keratoconics) and in the cases I have<br />
witnessed, may still rotate during wear. The beauty<br />
of using a lens with a toric periphery is that, like a<br />
toric soft contact lens, the patient can insert the<br />
lens at any orientation and it will quickly rotate<br />
into the correct position.<br />
A new lens was ordered with a power of -3.50<br />
/ -1.25 x 55 and otherwise identical parameters.<br />
After delivery the lens once again rotated to 30<br />
degrees, bringing the axis of the front optic zone<br />
neatly to 85 degrees - the exact axis of the initial<br />
lens’ residual astigmatism.<br />
Axial over-topography of the final front-surface toric<br />
lens, nicely showing the -1.25D of astigmatic correction<br />
incorporated sitting with axis of 85.<br />
Vision in this eye had now improved to 6/5 and<br />
no residual refraction was found. The patient<br />
commented this was the best quality of vision he<br />
had seen with his left eye, and pleasingly noted<br />
similar acuity when compared to his right eye (now<br />
refitted into a -2.00D daily).<br />
Stay tuned for the next edition of Specialty<br />
Contact Lens forum where I will discuss a case of<br />
large diameter scleral lens for the management of<br />
debilitating dry eye. This case can be found online,<br />
along with other specialty lens reports, at<br />
www.eyespace.com.au/blog. ▀<br />
ABOUT THE AUTHOR<br />
Alex Petty is a Kiwi optometrist<br />
who graduated from the<br />
University of Auckland in<br />
2010. He has an interest in<br />
specialty contact lenses,<br />
orthokeratology and myopia<br />
control. He has no financial<br />
interest in the products<br />
mentioned.<br />
Global contact lens<br />
community ‘comes<br />
together’<br />
Attendees at the 39th British Contact<br />
Lens Association (BCLA) Clinical<br />
Conference & Exhibition described the<br />
event as “an exceptional conference”<br />
with a “fantastic buzz”.<br />
The May conference saw the global contact<br />
lens community “Come Together” in Liverpool<br />
for three days of education, networking and<br />
brainstorming.<br />
Optometrist Brian Tompkins was installed as<br />
BCLA president, and contact lens optician Keith<br />
Tempany as president elect.<br />
At the conference, Associate Professor Jennifer<br />
Craig presented a course titled “Effective lid<br />
therapies for tackling evaporative dry eye in<br />
practice,” developed with Dr Simon Dean.<br />
Eyelid conditions such as meibomian gland<br />
dysfunction (MGD) and anterior blepharitis<br />
are leading causes of evaporative dry eye that<br />
result in debilitating discomfort symptoms and<br />
contribute to unsuccessful contact lens wear.<br />
Craig told the delegates that optometrists can<br />
play a key role in managing lid margin disease<br />
by being proactive with their clients.<br />
The session also covered the<br />
pathophysiological changes that occur in lid<br />
margin and associated ocular surface disease,<br />
how these relate to the development of<br />
symptoms, and possible interventions to reduce<br />
the impact of these conditions. A full lid margin<br />
work up, including assessment of lid parallel<br />
conjunctival folds, lid wiper epitheliopathy<br />
and lid margin hyperkeratinisation, was<br />
Bailey Nelson’s Christchurch store<br />
Australia-based eyewear designer<br />
Bailey Nelson is on track to open two<br />
new locations in New Zealand after<br />
establishing its first site in Christchurch<br />
in July.<br />
The company, founded in Bondi Beach in 2012,<br />
now has more than 20 practices (which they call<br />
“boutiques”) in Sydney, Melbourne, Brisbane,<br />
Christchurch, the Gold Coast, London and Canada.<br />
Bailey Nelson sells eyewear of its own design,<br />
shunning fashion labels, and sourcing materials<br />
from around the world, working directly with<br />
particular manufacturers and material suppliers.<br />
The company opened its first New Zealand<br />
boutique in the Westfield Riccarton Shopping<br />
Centre in Christchurch. It is now looking for staff<br />
for its Ponsonby boutique, which is expected to be<br />
open by mid-November, according to New Zealand<br />
country manager, James Hinsley. The company is<br />
aiming to open a third boutique in Wellington by<br />
the end of <strong>2015</strong>.<br />
“For each boutique, we typically hire a team of<br />
five to seven people,” says Hinsley. “This includes at<br />
least one optometrist, a dispensing optician, a store<br />
manager and a team of passionate and genuine<br />
eyewear stylists.”<br />
Hinsley says the company sited its first New<br />
Zealand boutique in Riccarton because “we<br />
wanted to be a part of the exciting growth and<br />
expansion of the city as it rebuilds.<br />
“We felt that the timing was fantastic, and found<br />
our boutique at the Riccarton Mall to be one of<br />
the best places to be located. Bailey Nelson will<br />
continue to expand across New Zealand over the<br />
next couple years.” ▀<br />
A/Prof Jennifer Craig<br />
discussed. Lid cleansing, debridement and other<br />
therapeutic techniques were demonstrated<br />
with video footage, with instructions provided<br />
to encourage practitioners to adopt these<br />
diagnostic procedures within their own<br />
practices following the conference.<br />
Therapies for the condition were divided into<br />
three categories: optimising the lid margin;<br />
facilitating meibum release; and improving<br />
meibum quality. The presentation aimed to<br />
encourage practitioners to adopt a wider range<br />
of management strategies for evaporative<br />
dry eye caused by lid disease and to consider<br />
concepts such as the introduction of a trained<br />
ocular hygienist in practice. ▀<br />
10 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 10<br />
9/18/<strong>2015</strong> 6:43:39 AM
Job market toughens as new<br />
optometry programmes in Oz open for business<br />
Students want to<br />
begin their optometry<br />
career with an<br />
independent who will<br />
mentor them, preferably<br />
near where they want to live,<br />
with exposure to a variety<br />
of patients. That’s the ideal,<br />
anyway, says Ceecee Zhang,<br />
president of the New Zealand<br />
Optometry Student Society,<br />
and a fifth-year at University<br />
of Auckland. But with only<br />
so many practices in New<br />
Zealand, graduation time<br />
means students have to<br />
Ceecee Zhang<br />
make some hard decisions.<br />
“We talk about this a lot,” says Zhang. “Many want to stay in<br />
a metropolitan area, and a lot of us want to stay near family. But<br />
there is a limited number of jobs available in these locations.<br />
“A lot of it is finding the balance between what you want and<br />
what you’re willing to compromise: location, mentorship or<br />
therapeutics. As you go on the job hunt, you realise you don’t get<br />
everything you want.”<br />
Those kind of choices aren’t anything new. But, with two new<br />
optometry programmes recently launched in Australia, some New<br />
Zealand year-five students may soon find themselves with one<br />
avenue blocked or at least more difficult to take.<br />
Stu Allan, whose OpticsNZ business specialises in placing<br />
New Zealand graduates with independents and corporates here<br />
and in Australia, says he may place six-to-eight graduates with<br />
optometry practices across the ditch, in any given year.<br />
“A large part of their rationale is the adventure, and the wages<br />
are higher as well,” Allan says.<br />
Starting salaries in New Zealand can range from $65,000 to<br />
$70,000, higher in places like Dunedin. Students won’t find big<br />
pay packages in Melbourne, Sydney or Adelaide, but the more<br />
remote they are willing to go, the better the pay: upto $10,000 as a<br />
relocation bonus, especially for those heading to Western Australia.<br />
Allan says graduates are not motivated by money as much as the<br />
kind of practice they start out in.<br />
“They are looking for good mentors, two or three examination<br />
rooms. They’re looking for [good colleagues], because the first two<br />
years are the establishment of their career.”<br />
Allan’s suspicion is that there will be an excess of optometrists<br />
in 24 to 36 months, as the two new Australian programmes begin<br />
to turn out graduates, creating more competition in the overseas<br />
avenue for new, adventurous optometrists.<br />
Deakin University in Victoria and Flinders University in South<br />
Australia, have both launched optometry programmes in the<br />
last few years, and while the additional graduates have not yet<br />
created more competition, they will in the next two to three<br />
years, says Allan.<br />
The 320 optometry practices--both independents and corporates-<br />
-in New Zealand, meanwhile, will continue to be the prime<br />
placement targets for Kiwi graduates. The natural succession of<br />
optometrists retiring continues to open slots, but, as in Australia,<br />
the perfect job may not be in the bigger cities, Allan says.<br />
“My recommendation is to take opportunities as they open.<br />
From a business practice perspective, I’d say look in the provinces,<br />
because you’ll see the whole thing from paediatrics to gerontology.<br />
You’ll have a wider patient base, examination time will be longer<br />
and you’ll develop more of a relationship with your patients.”<br />
Students will continue to find opportunities among corporates.<br />
Charles Hornor of Specsavers says his company has recruited 130<br />
students in New Zealand over the past five years, placing them<br />
predominantly in their 50 plus New Zealand sites. Hornor does not<br />
foresee a glut of optometrists in New Zealand, but the opposite.<br />
“We are actually seeking more graduates than ever because we<br />
are experiencing an increasing level of demand in all our practices.<br />
With the average New Zealand Specsavers store now turning<br />
over $2.1 million plus each year, we are also forecasting demand<br />
will continue to rise. That is why we have stated that across<br />
New Zealand and Australia combined, we will look to enrol 200<br />
graduating optometry school students into our Graduate Program<br />
for each of the years to 2020.”<br />
Specsavers’s website describes the two-year developmental<br />
Graduate Program as an opportunity to participate in professional<br />
events, courses and experiences while developing optometry skills<br />
with maximum support from mentors and the clinical team, along<br />
with ongoing training opportunities and the chance to refine and<br />
grow your clinical and business skills.<br />
While Allan foresees a potential downward pressure on starting<br />
salaries in the coming years, from Specsavers ‘ point of view there<br />
isn’t anything to indicate the supply of optometrists is adequate.<br />
“For some years now every graduating optom who wants to<br />
work in practice has been able to pick and choose between roles<br />
– and nothing has changed in that regard because there are just<br />
not enough graduates to go round. In our view the kind of starting<br />
salaries being offered will continue to favour the graduate, as<br />
competition for their signatures continues.”<br />
Zhang, who sits her final exams in November and graduates in<br />
May, has time to decide where she wants to go. She says she’d<br />
like to work in Australia for a few years, and come back to New<br />
Zealand to continue her studies.<br />
While she admits there is a business aspect to making such<br />
decisions, Zhang isn’t convinced that is something an optometry<br />
programme needs to teach its students.<br />
“They’ve trained us well to treat our patients with the services<br />
they need. But they don’t prepare us for the business world. At the<br />
same time I don’t think that’s what a programme should be about.”<br />
OPSM also recruits graduates, but as of this writing, the<br />
company was unable to provide us with answers to our particular<br />
questions about the jobs market. ▀<br />
Charmant wins award<br />
XL 2063 GP is available in gold, black and purple<br />
The International Optical Exhibition OPTA <strong>2015</strong> in Brno,<br />
Czech Republic awarded Line Art Charmant the top<br />
award for the category: Optical frames - Design and<br />
Material Innovation.<br />
Model ‘XL 2063 GP’ was selected as the best exhibit in the<br />
hotly contested field. The model comes in three sizes—51/17<br />
135—and was lauded for beauty in design that is both elegant<br />
and 3-dimensional. The entire lightweight Line Art collection is<br />
made from high-grade titanium.<br />
The prestigious prize is awarded once a year. This was<br />
the first time that the competition has been held under<br />
the auspices of the Association of Czech Opticians and<br />
Optometrists and the Slovak Optical Union. ▀<br />
11th Annual Scientific Conference<br />
Thanks to our Conference Sponsors:<br />
CONFERENCE<br />
Sunday<br />
8 th November <strong>2015</strong><br />
8.00am - 5.00pm<br />
Venue:<br />
Waipuna Hotel &<br />
Conference Centre,<br />
58 Waipuna Rd,<br />
Mt Wellington, Auckland<br />
Registration:<br />
8.00am - 8.30am<br />
Light Meal & Beverages<br />
provided<br />
Margaret Lam, is our <strong>2015</strong> International Invited<br />
Lecturer, she is a highly sought-after speaker at<br />
conferences throughout the Asia-Pacific and is an<br />
owner/optometrist of a small group of successful<br />
independent optometry practices in Sydney,<br />
collectively called “theeyecarecompany”.<br />
Margaret's practice-enhancing lectures will include:<br />
• Ocular therapeutics and contact lenses - two peas in a pod<br />
• From Little Things, Big Things Grow - Practice Growth Strategies<br />
• Update on keratoconus management: optimal care guidelines<br />
for keratoconus patients, CL management of keratoconus<br />
and working with ophthalmologists<br />
Registrations:<br />
Phone. 09 522 2125 Fax. 09 522 5770<br />
Email. conference@eyeinstitute.co.nz<br />
Register Online. eyeinstitute.co.nz/optometry<br />
BOOK NOW!<br />
for your <strong>2015</strong>/2016 CPD Credits<br />
(including Therapeutics)<br />
GOLD SPONSORS<br />
SILVER SPONSORS<br />
CORNEAL LENS<br />
CORPORATION N.Z. LTD<br />
ideas into practice<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
11<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 11<br />
9/18/<strong>2015</strong> 6:43:40 AM
Google eyes OphthalmicDocs’<br />
3D printable retinal camera<br />
Google X, the semi-secret facility<br />
run by Google, dedicated to major<br />
technological advancements such as<br />
the driverless car and contact lenses<br />
that monitor diabetics glucose levels, may soon<br />
be considering better ways to test the health of<br />
people’s eyes in developing countries if the local<br />
Google team have anything to do with it.<br />
Dr Sheng Chiong Hong, an ophthalmic<br />
registrar at Gisborne Hospital, and co-founder<br />
of OphthalmicDocs (oDocs), a Kiwi-based social<br />
enterprise determined to bring better eye care<br />
to developing nations, says he was completely<br />
taken by surprise when Google contacted him<br />
last month asking if he could talk about his work<br />
at a Google NZ corporate gathering.<br />
“I thought I’d infringed a patent or something,”<br />
he laughs.<br />
The Google NZ team had actually tracked Hong<br />
down after hearing his TEDx talk in May on how<br />
he’s hoping to combat preventable blindness in<br />
the world with $5 and a smartphone.<br />
“They wanted speakers who have a vision<br />
of changing something, but doing it in an<br />
innovative way… and the aim is now to fly me<br />
to the States to connect me with the Google X<br />
team, who are interested in identifying global<br />
health problems and whether we can solve those<br />
problems with technology.”<br />
Whether Hong actually meets the Google X<br />
team remains to be seen, but oDocs’ Fundus,<br />
a 3D printable adapter that converts any<br />
smartphone into a retinal camera, is creating<br />
quite a stir in developing countries with more<br />
than 4,000 downloads since it was made<br />
available online in May.<br />
Talking at a recent Auckland dinner, supported<br />
by Alcon Surgical, Hong was able to relate<br />
numerous case studies and testimonials from<br />
health and eye care professionals in developing<br />
countries who were now able to better diagnose<br />
eye diseases using the affordable 3D printable<br />
The oDocs 3D printable Fundus<br />
device. “It’s not just a toy or a hobby anymore.<br />
This is pretty much making a change in eye care<br />
all over the world.”<br />
The oDocs Fundus and associated app that<br />
Hong and his oDocs co-founder, Ben O’Keeffe,<br />
a senior house officer in ophthalmology at<br />
Wellington Eye Clinic, have developed basically<br />
provide a very cheap and easy to produce<br />
alternative to a portable slit lamp microscope<br />
and a fundus camera, that can be downloaded<br />
and printed by anyone with access to a 3D<br />
printer.<br />
And it doesn’t just have applications for<br />
better diagnosis and thus treatment in<br />
developing countries, others are interested in<br />
the technology closer to home for GPs and other<br />
primary care providers to help them quickly<br />
discover if someone needs to be referred to<br />
an ophthalmologist or optometrist for further<br />
diagnosis and treatment, with studies showing<br />
that even here, around 40 per cent of eye<br />
problems are misdiagnosed by GPs.<br />
oDocs is currently carrying out and planning<br />
further studies with optometrists and GPs in<br />
Gisborne using the Fundus and a new app<br />
designed to locate the nearest ophthalmologist<br />
on call, with the hope of helping people far<br />
more quickly to reduce the number of “too late”<br />
referrals, says Hong.<br />
Though providing help to people in developing<br />
countries and combating the burden of<br />
preventable blindness is at the heart of oDocs’<br />
being, Hong and O’Keeffe are investigating more<br />
commercial options for their product in order<br />
to provide a sustainable income stream for the<br />
business.<br />
One day Hong says oDocs may replace<br />
the “very, very old” and inefficient direct<br />
ophthalmoscope, which is the bane of GPs and<br />
eye professionals’ lives, he says.<br />
For more visit: www.ophthalmicdocs.com ▀<br />
From left to right, Ben O’Keeffe, oDocs co-founder, Jonathan Spencer, surgical account manager, Alcon, and<br />
oDocs co-founder Sheng Chiong Hong<br />
New Zealand’s first<br />
trainee ophthalmologist referee<br />
If developing a revolutionary new eye disease<br />
diagnostic tool for the developing world (see<br />
accompanying story) and completing your<br />
ophthalmological training wasn’t enough,<br />
OphthalmicDocs co-founder Ben O’Keeffe is<br />
the country’s first ophthalmologist to become<br />
a professional referee, and at 26, one of the<br />
country’s youngest trainee.<br />
O’Keeffe made the decision to focus on<br />
refereeing (instead of playing) seven years ago<br />
while studying at Otago and realising he wasn’t<br />
going to go much further in his playing career.<br />
The decision was bolstered by his father, Peter<br />
O’Keeffe, also a referee, who said if he wanted to<br />
become a professional referee he’d have to start<br />
early rather than waiting until his playing career<br />
had ended.<br />
“I just wanted to continue to be involved in the<br />
game…so that’s what I did,” says O’Keeffe.<br />
Since then O’Keeffe, has worked his way up<br />
through club, Heartland and ITM Cup ranks,<br />
gaining experience as a Super Rugby assistant,<br />
and refereeing the final of the 2014 Junior World<br />
Championship, before making his international<br />
debut in Argentina in June this year, when<br />
Argentina took on the notorious French<br />
Barbarians, and lost 28-22.<br />
Currently a senior house officer at<br />
ophthalmology at Wellington Eye Clinic, O’Keeffe<br />
says he’s often away at weekends, flying out at 4<br />
pm on a Friday to referee an international match<br />
or one of the Super Rugby games.<br />
“I like to be busy, but the great thing for me<br />
is they really complement each other… I deal<br />
oDocs in running for NZ Innovation award<br />
OphthalmicDocs (oDocs), is a finalist in three<br />
categories of the New Zealand Innovators<br />
Awards <strong>2015</strong>.<br />
Dr Sheng Chiong Hong, oDocs co-founder,<br />
says it’s very exciting to be nominated and he’s<br />
hoping that support from the Kiwi ophthalmic<br />
community will tip the balance in the People’s<br />
Choice award.<br />
As well as being up for the People’s Choice<br />
award, oDocs is a finalist in Innovation in Health<br />
& Science, Excellence in Social Innovation,<br />
and Export Innovator of the Year. Hong is also<br />
personally nominated as a finalist in the Most<br />
Inspiring Individual category.<br />
Organised by the NZ Innovation Council and<br />
supported by Bayer NZ, the awards aim to<br />
recognise and celebrate innovative, high-growth<br />
New Zealand organisations.<br />
In a press release announcing the finalists,<br />
organisers says <strong>2015</strong> saw a 24 per cent increase<br />
in entries. “The finalists represent game<br />
with patients during the week, telling them<br />
things they often don’t want to hear about their<br />
vision and then on Saturday I’m also dealing<br />
with people and giving them bad news if I’m<br />
penalising them,” he laughs.<br />
As for the pink strip, O’Keeffe says it’s taken a<br />
bit of getting used to. “The first time I walked<br />
out in it, I felt like everyone was looking at me.<br />
But it does help us not be hit on the field.”<br />
O’Keeffe, won’t be donning the pink for this<br />
year’s world cup, however, as he’s fully occupied<br />
with Super Rugby and the ITM Cup competition,<br />
but he is aiming to be at the 2019 world cup in<br />
Japan, he says. ▀<br />
Ben O’Keeffe swaps white coat for pink shirt<br />
changing innovation from every corner of<br />
the country…these are ordinary Kiwis doing<br />
extraordinary things.”<br />
NZ Innovation Council CEO Louise Webster<br />
says one of the biggest changes this year was a<br />
rise in entrants focused on making the world a<br />
better place. “We saw a new wave of innovative<br />
businesses focused on solving social issues.<br />
These organisations are still profit making<br />
entities, but are driven by a purpose to help solve<br />
the world’s problems and have a global impact.”<br />
Bayer New Zealand managing director Holger<br />
Detje says the quality of entrants is impressive.<br />
“The aim has always been to recognise great<br />
Kiwi talent and the commercialisation of<br />
innovative New Zealand products and services,<br />
and the awards certainly achieve that.”<br />
The winners of the <strong>2015</strong> awards will be<br />
announced at a cocktail evening on <strong>Oct</strong>ober 21 at<br />
The Cloud on Queens Warf in Auckland. ▀<br />
Change of Leadership<br />
at Save Sight Society<br />
The Save Sight Society’s last AGM saw<br />
a host of changes to the 49-year-old<br />
organisation’s leadership.<br />
Attendees bid farewell to Gordon<br />
Sanderson, associate professor in the Department<br />
of Ophthalmology at the University of Otago,<br />
Dunedin, who stepped down as a director for the<br />
Society. Dr Heath Wilms also stepped down as<br />
Society treasurer.<br />
Dr Stephen Ng stepped down from his role<br />
as chair, remaining a director, and passing<br />
the baton to Associate Professor Dipika Patel.<br />
Additional changes included the appointment<br />
of Dr Shuan Dai as a new director and Stephanie<br />
Ward as treasurer.<br />
AGM attendees expressed a desire for greater<br />
engagement with optometrists in the society,<br />
with a plan to recruit a new director with a<br />
background in optometry.<br />
The meeting highlighted the Society’s recent<br />
successes over two days at the Waikarei Resort<br />
in Taupo at the end of May. A range of delegates<br />
attended, including nurses, optometrists,<br />
ophthalmologists and vision scientists. The event<br />
raised approximately $50,000 to go towards<br />
funding research and education in New Zealand.<br />
The 2016 Save Sight Society conference will be<br />
held in Tauranga and will be convened by<br />
Dr Sam Kain. ▀<br />
Dipika Patel<br />
NEW OFFICERS ELECTED AT THE SAVE SIGHT<br />
SOCIETY AGM.<br />
Postions are held four years.<br />
Chairperson: Dipika Patel<br />
Treasurer: Stephanie Ward<br />
Directors: David Dalziel, Charles McGhee,<br />
Shuan Dai, Mary Jane Sime, Bronwyn Ward,<br />
Sam Kain, Hussain Patel and Stephen Guest.<br />
12 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 12<br />
9/18/<strong>2015</strong> 6:43:41 AM
11th Annual Scientific Conference<br />
Focus on<br />
Eye Research<br />
Cataract Surgery and AMD<br />
REVIEWED BY DAVID WORSLEY*<br />
d<br />
s<br />
E<br />
Cataract and AMD often coexist. When considering cataract<br />
surgery for a patient with AMD there are several important<br />
unresolved issues which include:<br />
• Does cataract surgery increase the risk of progression of early<br />
Thanks to our Conference Sponsors:<br />
to late AMD?<br />
Eye<br />
• Is cataract surgery safe for patients with wet AMD?<br />
Margaret Lam,<br />
Institute<br />
is our <strong>2015</strong> International<br />
conference<br />
Invited<br />
to<br />
GOLD SPONSORS<br />
• Will cataract surgery improve vision for low-vision patients<br />
with bilateral late AMD?<br />
Lecturer, she is a highly sought-after speaker at<br />
Three recent publications have provided some useful guidance on<br />
these questions.<br />
examine<br />
conferences throughout the<br />
everyday<br />
Asia-Pacific and is an<br />
practice<br />
For patients with early AMD and co-existent cataract, there has<br />
owner/optometrist of a small group of successful<br />
been concern that cataract surgery may increase the risk of<br />
progression to late AMD and in particular to wet AMD. There are<br />
independent optometry practices in Sydney,<br />
theoretical reasons for this. For example, there is strong evidence<br />
collectively called “theeyecarecompany”.<br />
of a pathogenic role for inflammation in AMD. So, could the<br />
The Eye Institute’s 11th Annual Scientific Conference happy is close, confidential, friendly consultation, nipping<br />
normal inflammatory response due to routine cataract surgery<br />
will be held in November with the focus: Diagnostics & problems in the bud.”<br />
SILVER SPONSORS<br />
hasten progression to late AMD? Another popular unresolved<br />
Margaret's Therapeutics practice-enhancing in everyday practice. lectures will include: Finally, Lam will give an update on keratoconus management, concern is that permissive absorption of blue light following<br />
The conference aims to expose optometrists to advances with optimal care guidelines for keratoconus patients, CL<br />
removal of the crystalline lens may accelerate AMD.<br />
in diagnostics, therapeutics, shared-care management and surgical management of keratoconus and working with ophthalmologists.<br />
• Ocular therapeutics and contact lenses - two peas in a pod<br />
• From Little Things, Big Things Grow - Practice Growth Strategies<br />
• Update on keratoconus management: optimal fantastic care collaboration.” guidelines<br />
for keratoconus patients, CL management of keratoconus<br />
and working with ophthalmologists<br />
advances in New Zealand.<br />
It will be held at the Waipuna Hotel and Conference Centre<br />
in Auckland on Sunday 8th November. Delegates will receive<br />
CPD points and for the first time will also include a parallel<br />
conference for dispersing opticians and support staff.<br />
At the main conference special guest Margaret Lam, founder of<br />
the Eye Care Company in Australia, will give three presentations,<br />
including her keynote address on ocular therapeutics, looking at<br />
compliance strategies in reduction of infiltrative and infective<br />
events with CL wear, CL related infiltrative keratitis and<br />
Registrations:<br />
management.<br />
innovative materials, advancement in reduction of discomfort and<br />
reduction of infiltration, but on the other side of the fence, we<br />
also have CL wearing habits slipping,” says Lam. “CLs are very fast<br />
becoming a de facto OTC commodity, which wearers feel they can<br />
get whenever they want. The concern is that the more CLs become<br />
a commodity,<br />
BOOK<br />
the more we will<br />
NOW!<br />
see complications because of a<br />
laissez faire attitude where people self-prescribe. It can grow or<br />
diminish based on what we do now.”<br />
Lam is a contact lens specialist, an educator and lecturer and<br />
works in an advisory capacity for several CL companies. She also<br />
serves as the New South Wales chapter president of the Cornea<br />
and Contact Lens Society of Australia.<br />
Lam will also give a short presentation titled From Little Things,<br />
Big Things Grow—Practice Growth Strategies, a discussion on<br />
utilising CL as a practice growth tool.<br />
Online purchasing of contact lenses is a competitive threat to<br />
brick-and-mortar optometry practice, but the bigger concern is that<br />
CLs are perceived by patients as an over the counter commodity,<br />
which can lead to lax habits and potential eye problems when<br />
patients avoid seeing optometrists regularly, she says.<br />
“What optometrists need to realise is sometimes we don’t give<br />
ourselves enough credit. What is essential to keep a CL wearer<br />
Snowvision scholarship<br />
winners announced<br />
The Snowvision Charitable Trust announced the winners of<br />
this year’s scholarship programme, which pays their way<br />
for a research trip to the State University of New York<br />
(SUNY) School of Optometry in the heart of New York City.<br />
As in previous years, the Trust committee selected one graduate<br />
and one experienced practitioner to spend four weeks in research<br />
and study. This year’s Snowvision scholarship recipients are<br />
final year student Alyssa Lie and Callum Milburn, a partner with<br />
Milburn & Neill Optometrists in Dunedin.<br />
A third recipient was selected this year due to additional financial<br />
support from the New Zealand Association of Optometrists (NZAO).<br />
For this scholarship, the committee selected Lily Chang, a doctoral<br />
candidate in optometry at the University of Auckland.<br />
Hamish Caithness, who co-manages the Snowvision Charitable<br />
Trust, says the trustees of the charity pick the scholarship winners<br />
in consultation with the University of Auckland Optometry and<br />
Vision Science programme for student applicants and referees for<br />
experienced optometrist applicants.<br />
“The criteria include whether the applicant is a suitable person<br />
to travel to New York and spend time at SUNY; whether they<br />
will benefit from the experience; whether they will be a good<br />
ambassador for New Zealand optometry; and whether they<br />
practice optometry in a professional and ethical manner.<br />
“I’ve found New Zealand optometrists have a wonderful depth<br />
of knowledge and a really good co-management relationship with<br />
ophthalmologists. They work synergistically with each other. It’s a<br />
With more than 270 optometrists attending last year, the<br />
conference is one of the more popular educational events on the<br />
optometric calendar. Last year the conference was awarded 5.50<br />
CPD and 0.25 general points. Eye Institute plans for just as many<br />
to be awarded for this year’s event.<br />
An industry exhibition is being held in conjunction with the<br />
event and will include Alcon, Abbott Medical Optics, Bausch<br />
+ Lomb, Corneal Lens Corporation, Designs for Vision, Device<br />
“Contact Phone. lens technology 09 522 is 2125 improving at Fax. such a fast 09 rate 522 with 5770<br />
Email. conference@eyeinstitute.co.nz<br />
Register Online. eyeinstitute.co.nz/optometry<br />
The Eye Institute’s 11th Annual<br />
for your <strong>2015</strong>/2016 CPD Credits<br />
(including Therapeutics)<br />
Scientific Conference now includes<br />
a parallel conference for dispensing<br />
opticians and support staff<br />
Technologies, Humanware, Ophthalmic Instrument Company,<br />
Optimed, Optrex, Toomac Ophthalmic, Glaucoma NZ and MDNZ. ▀<br />
Time: 8.00am to 5.30pm. Light meal and beverages<br />
provided.<br />
Venue: Waipuna Hotel and Conference Centre, 58<br />
Waipuna Rd, Mt Wellington, Auckland<br />
Cost: $80 incl. GST<br />
To register or find out more, visit: www.eyeinstitute.<br />
co.nz or email: conference@eyeinstitute.co.nz<br />
CPD available for both optometrists and dispensing<br />
opticians<br />
“The aims of the Trust are to improve the clinical skills of<br />
New Zealand optometrists and we take the applicants’ likely<br />
contribution to the aims of the Trust into account when reaching<br />
our decision.”<br />
The programme commenced in 1997 and since then 39<br />
scholarships have been awarded. The value of the scholarship is<br />
currently at $7000, which covers SUNY tuition, return airfare and<br />
part of the attendee’s accommodation costs.<br />
The programme’s track record attracted the NZAO to add its<br />
support this year.<br />
“The Snowvision Charitable Trust under the management of<br />
Hamish Caithness and Dave Robinson does an excellent job,” says<br />
NZAO Executive Director Lesley Fredrickson. “If funding were<br />
available from NZAO, the feedback from NZAO members was<br />
to spend it on educational opportunities that might otherwise<br />
be unobtainable. Funding the NZAO Snowvision Scholarship is<br />
therefore a practical way for NZAO to support an outstanding<br />
educational opportunity for practitioners that might otherwise be<br />
unobtainable.”<br />
Applications for the 2016 Snowvision Scholarship will open at<br />
the end of March and close at the end of June. Recipients will be<br />
announced at the popular, biennial Snowvision conference, which<br />
is scheduled to be held from the 4th to the 6th August 2016 in<br />
Queenstown. ▀<br />
CATARACT SURGERY AND AGE-RELATED MACULAR<br />
DEGENERATION: AN EVIDENCE-BASED UPDATE<br />
Kessel L et al. Acta Ophthalmol. <strong>2015</strong> [Epub ahead of print]<br />
The authors performed a systematic literature search of studies<br />
on the risk of AMD progression following cataract surgery. Quality<br />
of the studies was assessed using a risk of bias tool, data extracted<br />
and meta-analysed. The authors conclude that cataract surgery<br />
doesn’t increase the 6 to 12 month risk of progression to wet AMD.<br />
However, the quality of the evidence is only moderate as the few<br />
available studies provide an insufficient number of subjects. There<br />
remains a need for more research, however the current evidence<br />
provides some reassurance.<br />
Patients may present with co-existent wet AMD and cataract<br />
or cataract may develop at some point during ongoing anti-<br />
VEGF therapy. There are very reasonable concerns that cataract<br />
surgery may have a negative impact on the wet AMD, perhaps<br />
worsen choroidal neovascularization, lead to geographic atrophy,<br />
increase anti-VEGF therapy requirements or lead to a specific postoperative<br />
adverse outcome such as macular haemorrhage.<br />
CORNEAL LENS<br />
CORPORATION N.Z. LTD<br />
ideas into practice<br />
THE EFFECTS OF CATARACT SURGERY ON PATIENTS<br />
WITH WET MACULAR DEGENERATION<br />
Saraf S. et al. Am J Ophthalmol. <strong>2015</strong> Sep;160(3):487-492<br />
This retrospective review compared outcomes in patients with<br />
active wet AMD on anti-VEGF therapy who had cataract surgery<br />
with those who did not have surgery. The authors found that<br />
cataract surgery significantly improved vision, didn’t increase the<br />
risk of an adverse outcome and didn’t significantly increase anti-<br />
VEGF treatment requirements. However, the authors recommend<br />
careful monitoring post surgery as they found a trend toward<br />
increased central macular thickness as well as the presence or<br />
worsening of intraretinal cysts in the three months following<br />
surgery. This appears to be a transient issue, is amenable to<br />
increasing the frequency of anti-VEGF therapy and doesn’t appear<br />
to compromise the visual gain from surgery.<br />
The authors conclude that in controlled wet AMD, cataract<br />
surgery appears to be safe and the visual acuity gain is maintained<br />
on continued anti-VEGF therapy. To avoid a worsening of OCT<br />
features, a temporary increase in the frequency of anti-VEGF<br />
therapy is recommended.<br />
Late AMD with low vision is often considered a negative<br />
predictor for visual outcome after cataract surgery. Most<br />
publications have used an improvement in central visual acuity as<br />
their endpoint. This is unfortunate as visual acuity is a very poor<br />
tool for the assessment of visual function in low vision patients.<br />
Vision-related quality of life (VQOL) is now the gold-standard<br />
measure and should be used to measure effectiveness of cataract<br />
surgery in patients with low vision due to macular disease.<br />
CATARACT SURGERY IN PATIENTS WITH BILATERAL<br />
ADVANCED AGE-RELATED MACULAR DEGENERATION:<br />
MEASUREMENT OF VISUAL ACUITY AND QUALITY OF LIFE<br />
Ma Y. et al. J Cataract Refract Surg. <strong>2015</strong> Jun;41(6):1248-55.<br />
The authors conducted a prospective case series measuring<br />
change in visual acuity and vision-related quality-of-life factors<br />
after cataract surgery in low-vision patients with bilateral late<br />
AMD and cataract. Corrected distance visual acuity (CDVA) and<br />
vision-related quality of life measured by a Low Vision Quality of<br />
Life (LVQOL) questionnaire were measured.<br />
Both the CDVA and LVQOL scores improved significantly<br />
following surgery. The worse the preoperative CDVA, the greater<br />
the chance of cataract surgery results in an improvement in VQOL.<br />
The authors conclude that low-vision bilateral late AMD patients<br />
with coexistent cataract benefit from cataract surgery with both<br />
VA and VQOL improving significantly.<br />
*About the author: Dr David Worsely is an<br />
ophthalmologist, a visiting specialist at Waikato<br />
Hospital and is in private practice at Hamilton Eye<br />
Clinic. He is currently involved in research into<br />
automated retinal imaging with colleagues at the<br />
University of Waikato. ▀<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
13<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 13<br />
9/18/<strong>2015</strong> 6:43:42 AM
SPECIAL FEATURE: RANZCO<br />
<strong>2015</strong><br />
47th Annual Scientific Congress - Wellington, New Zealand<br />
RANZCO is hosting<br />
this year’s Annual<br />
Scientific Congress<br />
in Wellington from<br />
<strong>Oct</strong>ober 31 to<br />
November 4.<br />
It promises delegates a wealth of networking<br />
and learning activities. There’s a stellar line-up<br />
of international speakers, and a number of social<br />
events--including the black-tie Congress Dinner<br />
at Wellington’s Parliament House. Anyone keen<br />
to rise before five Sunday morning can join the<br />
Rugby World Cup breakfast. There will be a dinner<br />
for younger fellows and one for senior and retired<br />
fellows, plus a day out mountain biking, and the<br />
Registrars Club returns this year.<br />
The congress will be held at Wellington’s TSB<br />
Bank Arena, the largest indoor, pillar-free, flat floor<br />
venue in Wellington’s CBD. A range of programmes<br />
and events will appeal to the variety of delegates<br />
expected, including practice managers (see<br />
separate story), vision scientists, orthoptists and<br />
ophthalmologists.<br />
With topics such as glaucoma, cataract, cornea,<br />
uveitis and surgical retina featured in the packed<br />
scientific programme, delegates will be able to<br />
explore cutting-edge scientific developments<br />
and leave with a wealth of knowledge, promise<br />
the organisers.<br />
Key speakers and topics include:<br />
• Associate Professor John Grigg, head of the<br />
Discipline of Ophthalmology at The University<br />
of Sydney’s Save Sight Institute, will give<br />
the Council Lecture on Childhood vision<br />
impairment: helping children see the future.<br />
• Professor Peter McCluskey, the current chair<br />
of ophthalmology at the University of Sydney<br />
and director of the Save Sight Institute at<br />
Sydney Eye Hospital, and an inflammatory eye<br />
disease specialist with 30 years’ experience, will<br />
present Getting the red out: 30 years of scleritis<br />
research.<br />
• Professor Dao-Yi Yu, director of the Physiology<br />
and Pharmacology Centre in the Centre for<br />
Ophthalmology and Visual Science at the<br />
Lions Eye Institute, the University of Western<br />
Australia, will give the Ida Mann Lecture<br />
Research discoveries to clinical application:<br />
developing a new glaucoma filtration surgery.<br />
• Dr Neil Murray from The Fred Hollows<br />
Foundation in New Zealand, will be giving the<br />
Hollows Lecture: Progress through innovation –<br />
the Hollows effect.<br />
• Ike Ahmed from Credit Valley EyeCare in<br />
Canada, a fellowship-trained glaucoma,<br />
cataract, and anterior segment surgeon with<br />
a practice focus on the surgical management<br />
of glaucoma, complex cataract and intraocular<br />
lens complications, will be giving the Cataract<br />
Update Lecture.<br />
• Dr Randall Olson, chair of the department of<br />
ophthalmology and visual sciences, University<br />
of Utah School of Medicine, author of more than<br />
300 professional publications, will be giving the<br />
Cornea Update Lecture: Phaco vs The Cornea:<br />
the saga. (See separate interview p18).<br />
• Professor Tin Aung, director of the Singapore<br />
Eye Research Institute, whose main research<br />
interests include angle closure glaucoma and<br />
the molecular genetics of eye diseases, will be<br />
giving the Glaucoma Update Lecture: Current<br />
updates in Angle Closure Glaucoma. (See<br />
interview p22).<br />
• Dr Douglas Jabs, professor of ophthalmology<br />
and medicine, and chair emeritus of<br />
ophthalmology at the Icahn School of Medicine<br />
at Mount Sinai, USA, will be presenting: Longterm<br />
drug-free remissions in Uveitis. (See<br />
interview p16).<br />
• Professor David Wong, a consultant<br />
ophthalmologist at the Royal Liverpool University<br />
Hospital and honorary chair to the University of<br />
Liverpool, and inaugural chair to the department<br />
of ophthalmology at Hong Kong University, will<br />
be giving the Surgical Retina Update Lecture:<br />
Which silicone oil should we use? New evidence<br />
to shed light on our choices.<br />
• Chai Chuah, director-general of Health NZ,<br />
will deliver the RANZCO Plenary: Ethics and<br />
Professionalism.<br />
As well as the main scientific programme,<br />
there is a range of other meetings and additional<br />
educational sessions presented by key sponsors<br />
Novartis, Allergan, Alcon and Bayer. Places are<br />
limited for these breakfast-events, however, and<br />
organisers note these are only suitable for fellows,<br />
registrars and other medically-qualified delegates.<br />
The list of other meetings includes workshops for<br />
registrars; an international development workshop<br />
on diabetic eye disease in a low resource setting; a<br />
CPR refresher course; a commercial business skills<br />
session; an ANZSRS retinal satellite meeting; risk<br />
management workshops for fellows on Caring for<br />
Our Colleagues and Looking forward-Looking back:<br />
communication and complaints; as well as a host<br />
of other topics.<br />
For the full scientific programme, visit:<br />
http://www.ranzco<strong>2015</strong>.com.au/images/<strong>2015</strong>/<br />
RANZCO%20<strong>2015</strong>%20Preliminary%20Program.pdf<br />
A list of other meetings can be found at: http://<br />
www.ranzco<strong>2015</strong>.com.au/program/other-meetings<br />
While for a list of RANZCO-organised social<br />
activities, visit:<br />
http://www.ranzco<strong>2015</strong>.com.au/socialevents#CongressDinner<br />
▀<br />
Welcome<br />
to RANZCO<br />
<strong>2015</strong><br />
By Dr Brad Horsburgh, president RANZCO<br />
Staying abreast of developments in the complex<br />
and ever-changing world of ophthalmology<br />
requires our diligent attention so that we ensure<br />
our professional standards and commitment to<br />
patient care are always first-class.<br />
That we can stimulate our thinking and challenge<br />
our perceptions in the company of colleagues<br />
and friends at a Scientific Congress makes this<br />
responsibility a very pleasant one. And that we can<br />
do so in the delightful surrounds of Wellington this<br />
year promises a gathering full of warm memories.<br />
We owe a vote of thanks to all those involved<br />
in organising this great event. Their attention to<br />
detail and success in arranging a world-class lineup<br />
of international leaders in ophthalmology will<br />
make this a terrific learning event.<br />
As always, the generosity of our sponsors enables<br />
us to share the benefits of such packed programmes.<br />
On your behalf, I thank them sincerely. ▀<br />
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14 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 14<br />
9/18/<strong>2015</strong> 6:43:44 AM
Oculo to transform industry communication<br />
Communication between optometrists and ophthalmologists in<br />
Australia and New Zealand is finally being shunted into the 21st<br />
century with a new secure online platform called Oculo.<br />
“There’s been this digital revolution in technologies available to<br />
diagnose, treat and manage eye disease, but communication remains in<br />
the era of fax, paper and letters,” says Kate Taylor, chief executive of Oculo.<br />
Oculo provides a secure, online system for optometrists to identify<br />
ophthalmologists with particular specialities and to safely share with<br />
them clinical records, including patient data, photos and scans for<br />
referrals or requests for opinions.<br />
The system is the brainchild of Professor Jonathan Crowston,<br />
managing director of the Centre for Eye Research Australia (CERA),<br />
and Peter Larsen, director of CERA and Specsavers professional<br />
services director. It was developed by Taylor for CERA, before being<br />
spun out as a newly formed private company.<br />
Larsen and Taylor announced the launch of the Oculo system at<br />
the recent Specsavers Clinical Conference in Brisbane. At the launch,<br />
Larsen said that if Oculo is adopted widely by the industry it will<br />
change the fabric of eye care in Australia and New Zealand. “There’s<br />
all this interaction between optometry and ophthalmology and it’s all<br />
ad hoc; there’s no level of consistency in the communication.”<br />
Even worse, Taylor says, current communication practices often<br />
mean material is lost, duplicated or misinterpreted.<br />
“When you take a visual field, that is a grayscale image, and then<br />
you photocopy it and fax it and you’ve got a grayscale of a grayscale<br />
of a grayscale, so you end with some not very good data. Duplications<br />
are problematic for the patient because it means time and money<br />
and extra anxiety and inconvenience. Duplications are bad for the<br />
health system because it’s just inefficient. But it’s the gaps in the data<br />
that are vision threatening.”<br />
In a statement released at the conference, Crowston says as an<br />
ophthalmologist he often gets referrals that have little detailed<br />
information and arrive with poor quality photocopies or test results.<br />
“This makes triage difficult and it is not easy to provide early feedback<br />
to the referrer who often waits weeks before hearing back. What I<br />
really want is a quality image of the optic nerve and retina and, if<br />
possible, some earlier images that allow me to determine whether<br />
the disease is progressing.”<br />
A survey Oculo ran earlier this year found that 64 per cent of<br />
optometrists thought poor communication among themselves,<br />
ophthalmologists and hospitals was negatively affecting patient<br />
outcomes.<br />
“What is needed to facilitate shared care between our professions<br />
is a practical way to work together and to build trust, focusing on<br />
what is best from a patient perspective,” Larsen says. “Efficient<br />
communication is critical to providing quality shared care.”<br />
Oculo may also facilitate mentoring of junior optometrists, while<br />
more timely and more detailed feedback from ophthalmologists<br />
should aid optometrists’ ongoing education, says Larsen. “The best<br />
ophthalmologists are good teachers and through this they can coach<br />
better practice and optometrists can learn and improve the accuracy<br />
of their referrals, which is better for the patient.”<br />
Oculo is currently being trialled by 14 Specsavers, OPSM and Bupa<br />
Optical stores and five ophthalmic practices in Melbourne, and there<br />
are plans for similar trials in New South Wales, ACT and New Zealand.<br />
“We will be coming to New Zealand very soon,” says Taylor. “We’re<br />
just finishing all of the last touches for compliance so as soon as they<br />
are in place we will be similarly engaging to get it in use across<br />
New Zealand.”<br />
Taylor says optometrists at the Specsavers conference — which<br />
included 50 non-Specsavers practitioners in attendance — responded<br />
positively to the announcement. Oculo’s stand was busy from<br />
beginning to end as people registered their interest, she says.<br />
The Oculo system will retail for A$245 a month for a per store<br />
licence, allowing unlimited data, however many individuals in the<br />
store use it, or patients need it.<br />
Oculo is majority-owned by CERA, with additional shareholdings<br />
owned by Taylor, through an employee share ownership scheme, and<br />
Australian angel investor and logistics business entrepreneur Peter<br />
Gunn, who provided the company with seed capital.<br />
With most profits made returned to CERA, Oculo has big potential<br />
for the future of health research in Australasia, says Taylor. “This<br />
is part of the multi-faceted vision of Jonathan Crowston, solving<br />
a clinical problem and then supporting CERA’s research in a way<br />
that frees it up from dependence on grant cycles in such a difficult<br />
research environment. So it is really exciting… for CERA this is the first<br />
cab off the rank so we really want it to succeed.”<br />
Dr Kate Taylor will be presently Oculo to delegates at RANZO <strong>2015</strong> ▀<br />
OPTOS<br />
SPECIAL FEATURE: RANZCO<br />
Optos’ core devices produce ultrawidefield,<br />
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images or optomap images.<br />
Our optomap technology captures<br />
200 degrees or approximately 82 per<br />
cent of the retina, allowing eyecare<br />
professionals to see 50 per cent<br />
more of the retina compared with<br />
other imaging devices. Optos is once<br />
again expanding the boundaries<br />
of ultra-widefield imaging: our<br />
Optos’ California, designed<br />
California device is specifically<br />
for vitreo-retinal specialists<br />
designed for general ophthalmologists<br />
and ophthalmologists.<br />
and vitreoretinal specialists. It is the<br />
first retinal imaging device to offer<br />
ultra-widefield indocyanine green (ICG) angiography, in addition<br />
to colour, autofluorescence and fluorescein angiography. Taking<br />
advantage of the latest imaging technology, the California is the<br />
most comprehensive ultra-widefield retinal imaging device on<br />
the market. These new features have been specifically designed<br />
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guide their treatment decisions even more effectively.<br />
Visit Optos at RANZCO in Wellington from the 31st <strong>Oct</strong>ober—<br />
4th November. ▀<br />
Dr Kate Taylor explains the benefits of new, online communication platform Oculo<br />
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Visit the Optos booths 43 and 44 at this year’s RANZCO Congress in Wellington, NZ<br />
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P: +61 8 8443 4533 E: auinfo@optos.com<br />
optos.com<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
15<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 15<br />
9/18/<strong>2015</strong> 6:43:45 AM
SPECIAL FEATURE: RANZCO<br />
Tackling the<br />
uvetides and AMD<br />
— Dr Douglas Jabs<br />
An interview with RANZCO keynote speaker Dr Douglas Jabs,<br />
professor of ophthalmology and medicine and chair emeritus of<br />
ophthalmology at the Mount Sinai School of Medicine in New York.<br />
Are there any controversial views<br />
that challenge the way you think<br />
about uveitis ?<br />
A somewhat contrarian view, of<br />
which I am a big proponent and which<br />
appears to be gaining traction, is that<br />
our traditional approach to diagnosis,<br />
namely the “etiologic diagnosis” of<br />
uveitis in which one looks for the<br />
“cause” of the uveitis, is flawed.<br />
Most diseases in medicine are<br />
“complex disorders” which are<br />
multifactorial in nature and for which<br />
we know risk factors and pathogenesis, but for which we do not know<br />
a singular “cause”. The diseases for which we truly know the “cause”<br />
are Mendelian genetic disorders, infectious diseases and drug-related<br />
toxic or allergic reactions. Diseases such as sarcoidosis and juvenile<br />
idiopathic arthritis are, in fact, idiopathic (ie. of “unknown cause”) so<br />
finding them in a patient with uveitis is important for the patient’s<br />
systemic health, but does not actually tell us the “cause”.<br />
The uveitides are a collection of more than 30 diseases characterised<br />
by intraocular inflammation, each with its own features, risk factors,<br />
course, treatment and prognosis. As such we should be diagnosing the<br />
specific uveitic disease as it is critical to management. The laboratory<br />
should be used to eliminate infections, which would be treated<br />
differently (ie. with antimicrobial agents) and to identify any relevant<br />
associated systemic disease that could affect the patient’s health.<br />
Exhaustive laboratory testing with tests of low positive predictive value<br />
when there is no evidence of end-organ disease is unwarranted.<br />
One area of your expertise is in the ocular complications of autoimmune<br />
disease. What have been some interesting discoveries in this area?<br />
Many of our therapies for the uveitides have been introduced<br />
for treatment of rheumatic diseases first and then adopted by the<br />
ophthalmic community. The success of rituximab for the treatment<br />
of rheumatoid arthritis and for vasculitides, such as granulomatosis<br />
with polyangiitis, has forced us to rethink our ideas about<br />
pathogenesis of these diseases. Traditionally, they were thought to<br />
be cell-mediated immune disorders, but the success of a monoclonal<br />
antibody directed against B cells suggests that the pathogenesis is<br />
more complicated. Furthermore, the apparent response of vasculitisassociated<br />
scleritis to rituximab suggests a role for this approach in<br />
the treatment of some cases of scleritis.<br />
What new surgical techniques will enable treatment to be more<br />
efficient and successful?<br />
The treatment of the uveitides is largely medical and surgery,<br />
typically, is needed for the structural complications of the uveitides<br />
such as cataract and glaucoma. Modern cataract surgery with<br />
intraocular lens placement can result in very good outcomes for<br />
uveitic cataracts if the eye has had inactive uveitis for a sufficient<br />
time (ie. more than 3 months) and a short course of perioperative<br />
systemic corticosteroids, started prior to surgery, is used.<br />
In addition, paracentesis for polymerase chain reaction and<br />
diagnostic vitrectomy for polymerase chain reaction, cytology, flow<br />
cytometry and culture all are an important part of the diagnostic<br />
armamentarium. Modern vitreoretinal surgical techniques have<br />
made diagnostic vitrectomy a reasonable early diagnostic option.<br />
The therapeutic surgical development is long-lasting surgical<br />
corticosteroid implants (such as the fluocinolone acetonide implant),<br />
which last three years, are US Food and Drug Administrationapproved<br />
and appear to be more effective at controlling the<br />
inflammation than systemic approaches for severe, non-infectious<br />
intermediate, posterior and pan-uveitides. However, systemic<br />
approaches are effective in the large majority of patients and local<br />
corticosteroid implants come at a cost of an increased rate of ocular<br />
hypertension and cataract versus systemic approaches.<br />
Are there aspects of uveitis which you would like to investigate<br />
further, to satisfy your professional curiosity?<br />
The Multicenter Uveitis Steroid Treatment Research Group, an<br />
international, US National Institutes of Health-funded multi-centre<br />
clinical trials group is engaged in a long-term follow-up study of the<br />
original Multicenter Uveitis Steroid Treatment Trial to determine the<br />
long-term outcomes of these different treatment approaches (longlasting<br />
local corticosteroid implants vs. systemic corticosteroids and<br />
immunosuppression) and is embarking on new clinical trials of the<br />
management of uveitic macular edema.<br />
We hope to do additional trials on the management of severe<br />
intermediate, posterior and panuveitides.<br />
In addition, I recently have become interested in the immunology of<br />
age-related macular degeneration (AMD), as it appears that chronic<br />
systemic inflammation is a risk factor for AMD. The Studies of the<br />
Ocular Complications of AIDS Research Group recently reported<br />
that antiretroviral-treated, immunorestored patients with AIDS<br />
have a four-fold increased age-adjusted prevalence of intermediatestage<br />
AMD compared to an HIV-uninfected cohort. Antiretroviraltreated,<br />
immune-restored HIV-infected persons have accentuated/<br />
accelerated aging and immunosenescence, and chronic immune<br />
activation and systemic inflammation appear to play a major role in<br />
this accentuated/accelerated aging. We believe that further study<br />
of this population with an increased prevalence of AMD can help<br />
us better understand the roles of immune activation and systemic<br />
inflammation in AMD in HIV-uninfected older persons. ▀<br />
OPTIMED<br />
OptiMed is a New Zealand and Australian owned, fully<br />
independent wholesaler of ophthalmic diagnostic and therapeutic<br />
instruments as well as surgical and pharmaceutical supply.<br />
We are committed to providing quality products and excellent<br />
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OptiMed represent quality and innovation in our partner<br />
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At RANZCO <strong>2015</strong> we will have a great range of equipment on<br />
display and invite you to come and view our booth along the<br />
entrance wall. ▀<br />
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NO ANTIBIOTICS<br />
NO PRESERVATIVES<br />
Oculocin Propo is a natural based dry<br />
eye drop that also treats conjunctivitis with<br />
no known side effects<br />
KEY INGREDIENTS:<br />
Propolis<br />
Aloe Vera<br />
Chamomilla<br />
TM<br />
NEW!<br />
OTC<br />
approved - no<br />
prescription<br />
required<br />
IMPORTANT ACTIVE AGENTS:<br />
• Phenols<br />
Antimicrobial properties<br />
• Aloins and emodins<br />
Has Analgesic (painkiller) and powerful virucidal and<br />
antibacterial properties<br />
• Alfa-bisabolol and it’s oxides. Azulens*<br />
Anti-inflammatory, anti-irritant and antimicrobial properties<br />
DOSAGE:<br />
1 - 2 Drops in each eye as required or as<br />
recommended by your eyecare professional<br />
ANTI-VIRAL AND ANTI-BACTERIAL<br />
PROPERTIES<br />
*UAB ORIGMED is using high activity extract normally double in<br />
values compared to standard pharmacopeia values. For<br />
example, propolis water extracts that is normally used,<br />
holds 0.5% phenols and Oculocin -1-1.5%. Because of<br />
natural origin chemical components which are important<br />
in product activity are more than 50 active Ingredients<br />
ZEISS<br />
RANZCO this year will give clinicians the<br />
opportunity to see some new and exciting<br />
technologies from ZEISS.<br />
With its recent clearance from the US Food and<br />
Drug Administration (FDA), ZEISS is soon to release<br />
AngioPlex OCT Angiography on the CIRRUS HD-<br />
OCT and will have it on show at the conference,<br />
both on the stand and during a symposium<br />
on Monday November 2. Using a single scan,<br />
AngioPlex OCT Angiography takes just seconds<br />
to produce OCT images for the assessment of the<br />
retinal vasculature — without the need for an<br />
injected contrast dye.<br />
Other new instruments on show will be the<br />
new Humphrey Field Analyzer 3 (HFA3), the SL220<br />
tower-style slit lamp and the new software for<br />
the IOLMaster 700 swept-source biometer.<br />
ZEISS will be represented by the surgical team<br />
who will be holding discussions about the proven<br />
outcomes and stability achieved with the ZEISS<br />
MICS range of IOLs including the innovative AT<br />
LISA trifocal. ▀<br />
AFT PHARMACEUTICALS<br />
Hylo-Fresh and Hylo-Forte eye drops provide a<br />
systematic approach to dry eye treatment through<br />
the patented Comod multi-dose application<br />
system. This ingenious airless system protects the<br />
sodium hyaluronate solution from contaminated<br />
ambient air for up to six months after opening, and<br />
ensures the precisely measured delivery of at least<br />
300 sterile drops without the use of preservatives.<br />
Hylo-Fresh (sodium hyaluronate 0.1% w/v,<br />
10mL) offers long-lasting lubrication for dry eyes<br />
of moderate or medium severity, while Hylo-Forte<br />
(0.2% sodium hyaluronate w/v, 10mL) is suitable<br />
for the treatment of severe or chronic dry eye. Both<br />
are also phosphate-free, suitable for use postsurgery,<br />
and can be used with all contact lenses.<br />
AFT Pharmaceuticals will be showcasing our<br />
preservative-free range of eye treatments at<br />
RANZCO <strong>2015</strong>. Visit our stand and discover more<br />
about our dry eye range: Hylo-Fresh and Hylo-Forte<br />
eye drops, and VitA-POS eye ointment, along with<br />
Cromo-Fresh for itchy allergic eyes. ▀<br />
AngioPlex image of branch retinal vein occlusion<br />
16 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 16<br />
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TECNIS<br />
®<br />
EXTENDED RANGE<br />
OF VISION IOL<br />
A NEW ERA HAS BEGUN,<br />
AND IT LOOKS AMAZING.<br />
INTRODUCING TECNIS SYMFONY ® IOL,<br />
THE FIRST AND ONLY PRESBYOPIA-CORRECTING<br />
EXTENDED RANGE OF VISION IOL.<br />
At last, your patients can enjoy increased spectacle independence with a true<br />
extended range of vision. 1<br />
• A full range of continuous, high-quality vision in all light conditions. 2<br />
• TECNIS Symfony® Toric IOL also available.<br />
The world will never look the same.<br />
Visit us at the Abbott booth to learn more about TECNIS Symfony®<br />
1. 166 Data on File_Extended Range of Vision IOL 3-Month Study Results (NZ). 2. TECNIS Symfony® DFU. TECNIS Symfony® Extended Range of Vision Lenses are indicated for primary implantation for the<br />
visual correction of aphakia and preexisting corneal astigmatism in adult patients with and without presbyopia in whom a cataractous lens has been removed by extracapsular cataract extraction, and aphakia<br />
following refractive lensectomy in presbyopic adults, who desire useful vision over a continuous range of distances including far, intermediate and near, a reduction of residual refractive cylinder, and increased<br />
spectacle independence. These devices are intended to be placed in the capsular bag. For a complete listing of precautions, warnings, and adverse events, refer to the package insert.<br />
TECNIS and TECNIS SYMFONY are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW<br />
2113. AMO Australia Pty. Limited (Incorporated in Australia) PO Box 401, Shortland Street, Auckland, 1140. ©<strong>2015</strong> Abbott Medical Optics Inc. www.AbbottMedicalOptics.com PP<strong>2015</strong>CT1013. WH AMO19938<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
17<br />
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SPECIAL FEATURE: RANZCO<br />
A passion of the<br />
profession<br />
— Dr Randall Olsen<br />
An interview with RANZCO keynote speaker Dr Randall Olsen,<br />
chair of the department of ophthalmology and visual sciences<br />
at the University of Utah School of Medicine and of the John A.<br />
Moran Eye Center.<br />
In your long career, what stands<br />
out as the single most important<br />
innovation?<br />
What advice would you give to young ophthalmologists looking to<br />
specialise in cornea?<br />
Make sure you get the best training possible, and never lose your<br />
fascination with the field nor your curiosity about what we know.<br />
Questioning the accepted rationale is the only way we advance and<br />
get better.<br />
How do you continue to learn in your professional life?<br />
Read all the literature and always be open-minded. The perceived<br />
authority of the old guard continues to be a major barrier to needed<br />
advancements. IOLs and phaco fought a huge battle with the authority<br />
figures of the time, and it was all so needless. So be open-minded and<br />
sceptical. I see many exciting breakthroughs on the horizon and feel our<br />
true golden days as a field are still in front of us. ▀<br />
HEIDELBERG ENGINEERING<br />
New from Heidelberg Engineering: the Spectralis Widefield OCT and<br />
Fundus Imaging Module.<br />
Heidelberg’s Spectralis Widefield Images<br />
Practice managers’<br />
conference to focus on<br />
current issues<br />
The Practice Managers’ annual conference is being held in<br />
conjunction with the RANZCO congress in Wellington and will<br />
take place from November 1-3 in the Featherston Room at the<br />
InterContinental.<br />
The aim of this year’s event is to provide information to<br />
help managers manage and enhance their career in practice<br />
management, says Lisa Hartley, chair of the Practice Managers<br />
Group. “Practice management has come a long way and in today’s<br />
healthcare practice, the practice manager plays a key role in the<br />
success and sustainability of the practice.”<br />
Sponsored by Southern Cross Healthcare, the conference is<br />
expected to attract delegates from across Australia and NZ.<br />
A number of RANZCO fellows will present to the conference from<br />
a doctor’s perspective; back by popular demand, an open forum<br />
discussion will take place with an emphasis on sharing ideas and<br />
experiences; and Simon Thiessen from The Real Learning Experience<br />
will facilitate an interactive session ‘One of the team or leading the<br />
team?’.<br />
Healthcare practice consultant Colleen Sullivan will present on ‘Is<br />
The delivery of the Spectralis Widefield Imaging Module has<br />
begun and will be exhibited at RANZCO. It provides an expanded<br />
By far it would be phaco, followed by<br />
field of view for all Spectralis fundus and OCT imaging modalities,<br />
foldable IOLs. I was trained in the days<br />
simplifying diagnostic protocols and facilitating the detection of<br />
of ICCE with aphakic spectacles where<br />
our cataract patients spent three<br />
peripheral pathology.<br />
days of absolute bed rest in hospital.<br />
The Widefield Imaging Module provides a 55° field of view for all<br />
It was about the only way we did it<br />
Spectralis fundus imaging modalities including MultiColor, BluePeak,<br />
back then. My first bilateral patient,<br />
infrared reflectance, angiography, and also OCT. Covering the macula, the<br />
after waiting four months to finally<br />
optic nerve head and areas beyond the vessel arcades in a single image,<br />
get her aphakic spectacles, was so<br />
the Widefield Imaging Module facilitates comprehensive diagnostics. The<br />
disenamoured she asked if I could put<br />
high-resolution, high-contrast scanning laser images captured with this<br />
her cataracts back.<br />
®LenSx® LenSx®<br />
Spectralis module offer diagnostic capabilities superior to conventional<br />
No wonder we made patients wait a long time to consider a<br />
treatment almost as bad as the disease. Our great success today is<br />
fundus photography.<br />
taken for granted by too many.<br />
E-Learning Module: for doctors and other operators to familiarise<br />
themselves with the Widefield Imaging Module, Heidelberg Engineering<br />
What inspires you to continue to work in this field? ®<br />
there a career path for a practice manager and what are the steps<br />
Academy has just launched an interactive video tutorial at<br />
We are all about quality of life and have so many exciting things to<br />
to achieve this?’ This session will explore the opportunities available<br />
LASER<br />
www.heidelbergengineering.com/international/academy/<br />
cover I find it hard to not consider being involved. My biggest focus is<br />
▀<br />
maintaining the team that is aggressively working on the core disease<br />
triggers of macular degeneration. It has been a fascinating journey<br />
and it is clear that there will be two totally different treatments for<br />
OIC<br />
the two major genetic underpinnings of this awful disease. Also,<br />
seeing the John A. Moran Eye Centre blossom from a one person<br />
division of surgery to a centre with over 50 faculty and 500 employees<br />
has been a dream literally come true. Most of my day-to-day activity<br />
goes into building this institution and seeing that it has the resources<br />
to continue to thrive and survive.<br />
Belinda, Kevin, Chris and Tim look forward to welcoming you on<br />
to the Ophthalmic Instrument Company (OIC) stand at RANZCO<br />
where we will have many exciting new items of equipment and<br />
instrumentation on display from our international partners.<br />
Come and view EVA, the revolutionary new phaco and vitrectomy<br />
system from D.O.R.C, the new hand held auto refractor/<br />
keratometer HandyRefK and RS-330 Duo Combined Retinal<br />
Camera and OCT from Nidek. We will also have the new VUPad<br />
Combined A/B Scan from Sonomed and Spot Vision Screener<br />
from Welch Allyn on display along with new instruments from<br />
Katena and MST.<br />
RANZCO will also double as our ophthalmology launch for<br />
Avenova, the innovative new solution for daily lid and lash<br />
hygiene, blepharitis and dry eye.<br />
See you in Wellington. ▀<br />
for a career as a practice manager and will include how to raise your<br />
qualification and experience levels to demonstrate this.<br />
Tanya Parsons, RANZCO Professional Standards and CPD Manager,<br />
along with Moira McInerney, CEO of Auckland Eye and Professional<br />
Standards Committee Member, will present an important update<br />
from the RANZCO Professional Standards Committee on the current<br />
progress of the practice accreditation project, future plans and how<br />
your practice can get involved.<br />
Other sessions include an insight into the role of ophthalmology<br />
practice staff in reducing risk and optimising patient care; a practice<br />
issues forum; a keynote address from Southern Cross Health Society<br />
on the systems they use to process claims and the support services<br />
available to practices; RANZCO CEO David Andrews sharing his<br />
insights on developing a strong HR function in a medium-sized<br />
business; and Julie Heraghty from Macular Disease Foundation<br />
Australia and Phillippa Pitcher from Macular Degeneration New<br />
Zealand team up to present the latest news on MD within an<br />
Australian and New Zealand context.<br />
There will also be some open-forum sessions where practice<br />
managers get a chance to ask experienced managers difficult<br />
questions, such as “what would you do in this situation?” ▀<br />
An evolution in medical software<br />
183880_bp_RANZCO_AD_280X190.indd NEW ZEALAND OPTICS <strong>Oct</strong>ober 1 <strong>2015</strong><br />
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Alcon NZ
Advan<br />
REFRACTIVE SU S<br />
UltraSert <br />
PRE-LOADED DELIVERY SYSTEM<br />
Advancing<br />
CATARACT SURGERY<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
19<br />
Alcon NZ Optics UltraSert-ORA single page 420x297_099-15_4 outlines.indd 1<br />
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9/18/<strong>2015</strong> 6:43:47 AM
SPECIAL FEATURE: RANZCO<br />
Fighting glaucoma<br />
— Professor Tin Aung<br />
An interview with RANZCO keynote speaker Professor Tin Aung,<br />
executive director of the Singapore Eye Research Institute, deputy<br />
medical director (research) and head of the glaucoma department<br />
at the Singapore National Eye Centre and Professor at the<br />
department of ophthalmology at Yong Loo Lin School of Medicine,<br />
National University of Singapore.<br />
What type of new thinking is leading the way in glaucoma<br />
management and research?<br />
There is a lot of interest in several exciting areas of glaucoma research.<br />
For instance, genetics of glaucoma, new medications and sustained<br />
drug delivery, better methods of imaging to diagnose and monitor<br />
glaucoma, new forms of surgery (such as minimally invasive glaucoma<br />
surgery) and patient related disability and outcomes.<br />
Why are you inspired to work in this field?<br />
I am driven by the blindness and visual disability I see in the<br />
patients under my care. It is a tragedy to have people with advanced<br />
undiagnosed glaucoma today or have patients go progressively blind.<br />
What has been the main inspiration in your career?<br />
I am inspired by my mentors who have advised me and pointed me in<br />
the direction of being a clinician scientist in glaucoma. ▀<br />
CLC<br />
Oculocin Propo is a new product to the NZ and Australian markets<br />
targeting two key areas: chronic conjunctivitis and periodic<br />
inflammation; and dry eye.<br />
It’s a sterile, natural pharmaceutical grade extracts-based eye drop,<br />
which contains no preservatives. Other key points are:<br />
• Contains glycerin, propolis, aloe vera and chamomile extracts; is<br />
rich in phenols, aloins, amodins, alfa-bisabolols and its oxides and<br />
azulenes;<br />
• Composition is dedicated for proper lubrication, antibacterial,<br />
antiviral, antifungal, pain relief, immune boost and faster healing<br />
effects;<br />
• Works like soft wide range antibiotic and NSAID together covering a<br />
lubrication and easy pain and spasmolytic relief properties<br />
• Can be used long term with no potential side effects and other<br />
harm, but it provides symptomatic relief together with light<br />
antibacterial and anti-inflammatory action<br />
• Can be used in the period after antibiotic or anti-inflammatory<br />
treatment when prolonged use of chemical drug puts patient at risk<br />
• Can be used inconjunction with antibiotic or anti-inflammatory<br />
treatment (drop time may differ) for better effect and irritation<br />
relief; and<br />
• Due to its antibacterial properties it is a effective product for long<br />
term dry eye antiseptic management ▀<br />
DEVICE TECHNOLOGIES<br />
Device Technologies is celebrating 15 years as a NZ-based independent<br />
supplier of medical equipment and is proud to showcase the following<br />
products at RANZCO Wellington:<br />
• New and unique Swept Source OCT: Topcon Triton; scans through<br />
haemorrhages and increased depth scanning helps show full<br />
choroidal detail<br />
• Topcon Maestro OCT on a new space saving instrument column<br />
table Topcon IC-1<br />
• Multispot Micropulse 577nm retinal laser: Quantel Supra Scan (Slit<br />
Lamp and Bio mounted)<br />
• Compact 532nm retinal laser: Quantel Vitra<br />
• Combo laser YAG/SLT: Quantel Fusion<br />
• Compact Ultrasound devices from Quantel: Compact Touch A&B +<br />
UBM scan & Nano A Scan<br />
• Topcon KR-1W 5 in 1 Wavefront analyser with Auto refractor,<br />
Keratometer, Pupillometer, topographer & Aberrometer<br />
We look forward to seeing you at RANZCO ▀<br />
Top 10 medical<br />
advances over the<br />
past 20 years for<br />
ophthalmologists<br />
International medical information company, Medscape,<br />
polled medical experts and advisors about what they thought<br />
the biggest healthcare advances have been over the past two<br />
decades.<br />
The following is a list of the top 10 compiled with regard to<br />
their relevance to ophthalmologists:<br />
10. Ophthalmology: anti-VEGF therapy for macular<br />
degeneration<br />
9. Oncology: Cancer Genome Atlas<br />
8. Public health: advancement of palliative care<br />
7. Diabetes: medications and monitoring<br />
6. Allergy and immunology: biologics<br />
5. Emergency medicine: ultrasound<br />
4. Paediatrics: vaccines as cancer prevention<br />
3. Primary care: the rise of corporate healthcare<br />
2. Business of medicine: the information revolution meets<br />
healthcare<br />
1. Neurology: genomics ▀<br />
Source: www.medscape.com<br />
ALCON<br />
Today’s patient has different needs and visual goals. At Alcon we<br />
are proud to be your trusted eye care partner every step of the<br />
way from glaucoma, dry eye management and contact lens care<br />
to the latest in surgical and refractive technology. Join us on<br />
the Alcon stand at RANZCO <strong>2015</strong> as we advance together. Learn<br />
about the latest advancements in presbyopia correcting and IOL<br />
delivery systems technology with the AcrySof IQ PanOptix lens<br />
and UltraSert pre-loaded delivery system. Book a demonstration<br />
of the ORA System with VerifEye+ technology, the world’s first<br />
Intraoperative wavefront aberrometer; and register for the<br />
Alcon dinner on Monday the November 2 to hear about the latest<br />
“Strategies for Today’s Cataract Refractive Needs.”<br />
Together we can go further than ever before.<br />
OA-2000<br />
SWEPT SOURCE OCT<br />
OPTICAL BIOMETER &<br />
TOPOGRAPHY-KERATOMETER<br />
Optical biometry can be that good!<br />
The OA-2000 integrates topography, axial length, lens<br />
thickness and pachymetry to yield the perfect data set<br />
for ray tracing. This assures best results even in<br />
exceptional eye conditions or toric IOL calculation.<br />
Handheld Tonometer<br />
THE measurement system for<br />
• Corneal Topography<br />
• Contact lens fitting<br />
• TF-Scan, tear<br />
meniscus height<br />
• Imaging<br />
• Oxi-Map<br />
Complete Dry Eye assessment<br />
From the only authorised<br />
ICARE dealer in NZ<br />
DV758-0615<br />
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0800 338 800<br />
phone: 09 443 0072<br />
email: info@oic.co.nz<br />
20 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
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The moment you benefit from the latest medical technology.<br />
ZEISS Innovations: Trusted and Proven.<br />
Visit<br />
ZEISS at<br />
RANZCO<br />
<strong>2015</strong><br />
// INNOVATION<br />
MADE BY ZEISS<br />
Visit ZEISS at the <strong>2015</strong> RANZCO Annual Scientific Congress to discover our range, featuring:<br />
ZEISS AngioPlex OCT Angiography –<br />
New Generation of Vascular Imaging<br />
• With a single scan that takes just seconds, ZEISS AngioPlex OCT<br />
Angiography on the CIRRUS HD-OCT delivers high-resolution, depthresolved<br />
visualisation of the retinal layers with a clarity never before<br />
achieved – all without the need for an injected contrast dye.<br />
ZEISS AT LISA ® Tri Family – Proven Clinical Results<br />
• The innovative preloaded trifocal platform from ZEISS is highly<br />
esteemed by surgeons for its proven outstanding results for cataract,<br />
presbyopic and astigmatic patients. Confidence for you and your<br />
patients.<br />
Scan here to receive<br />
a free IOL USB at RANZCO<br />
www.zeiss.com.au/ranzco<strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
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SPECIAL FEATURE: RANZCO<br />
Spotlight on<br />
Wellington<br />
Often called the world’s “coolest little capital,” Wellington is known<br />
for its vibrant arts scene, world class café and restaurant culture,<br />
and active outdoor lifestyle.<br />
Set around an attractive waterfront, you’ll be hard pressed to find<br />
a city in the world that’s easier to navigate. Wellington enjoys more<br />
cafes, bars and restaurants per capita than New York City, and its<br />
coffee and craft beer producers are internationally recognised. A<br />
creative, cosmopolitan city, Wellington combines the sophistication<br />
of a capital with the warmth and personality of a village.<br />
Whether you’re into shopping, eating, sight-seeing or relaxing,<br />
Wellington has a host of treats on offers for RANZCO delegates who<br />
have a little extra time on their hands. ▀<br />
Houses on Mt Victoria<br />
Eat and drink Wellington<br />
Wellington is said to have more bars and restaurants per capita than New York City. Tucked between<br />
two of New Zealand’s finest wine regions, the City also sits at the heart of the Classic New Zealand<br />
Wine Trail, and is home to some of New Zealand’s top craft beer brewers, including Garage Project,<br />
ParrotDog and Tuatara.<br />
Some of the City’s top restaurants include:<br />
Ortega Fish Shack & Bar - Focusing on fresh New Zealand seafood, the highly awarded chef and<br />
owner creates dishes of quality, flavour and integrity.<br />
Logan Brown - Housed in a stunning 1920s banking chamber, Logan Brown’s food is innovative,<br />
generous and full flavoured, with emphasis on cooking perfection and seasoning; the bar is also a<br />
salt water fish tank.<br />
Whitebait - This elegant and refined restaurant has a seafood-focused menu, which is translated<br />
into Maori to pay homage to the regional kai moana (seafood) used.<br />
The Bresolin - The newest restaurant venture from Wellington food personalities Lorenzo and<br />
Leonardo Bresolin. Focusing on shared dining, the Bresolin’s menu features small plates and large<br />
feasts.<br />
WBC - The newest restaurant from the Capitol restaurant team, WBC focuses on local, seasonal fare<br />
and specialises in seafood and shellfish.<br />
Prefab - An all in one eatery, coffee roastery, community hub, events facility and showcase for New<br />
Zealand design. The ACME & CO’s breads and bakery items are baked and served warm from the<br />
Prefab oven throughout the day<br />
Zibbibo - The food is a fusion of styles from around the Mediterranean, including rustic cuts of<br />
meat from a rotisserie and a much-feted tapas platter. Zibbibo recently took out the coveted DINE<br />
Wellington award in <strong>2015</strong>’s Visa Wellington On a Plate festival.<br />
RANZCO NZ Optics 1/4 AD <strong>2015</strong>_Layout 1 10/09/<strong>2015</strong> 2:17 pm Page ▀<br />
1<br />
RANZCO Patient Education<br />
The Gold Standard in Treatment Information<br />
online orders<br />
www.mitec.com.au<br />
Top things to do in<br />
Wellington<br />
1.Discover New Zealand’s stories at Te Papa<br />
The national museum of New Zealand, Te Papa’s<br />
exhibits are innovative and interactive, telling<br />
stories of New Zealand’s unique geological,<br />
biological, cultural and social history. The brand<br />
new Gallipoli: The Scale of our War exhibition tells<br />
the story of New Zealand’s involvement in historic<br />
conflicts with complex digital and visual effects.<br />
2.Enjoy 360-degree views from the top of<br />
Mt Victoria<br />
Discover a panoramic view of city and harbour at<br />
the Mount Victoria Lookout.<br />
3.Ride the historic Wellington Cable Car<br />
The Cable Car is a Wellington icon. It runs from<br />
Lambton Quay up to Kelburn, with a lookout,<br />
the Cable Car Museum and Space Place at Carter<br />
Observatory at the top. Come back down to earth<br />
(and the city) through the beautiful Botanic<br />
Garden.<br />
4.Visit the Zealandia sanctuary in Karori<br />
Just a 10-minute drive from downtown<br />
Wellington you’ll find Zealandia, a 225 hectare<br />
section of bush being returned to its pre-human<br />
state. Take a walk and hear the songs of the<br />
flourishing native bird population or book a night<br />
tour for a bit of kiwi spotting.<br />
5.Tap Wellington’s movie-making magic<br />
Get a behind-the-scenes glimpse into the<br />
artistry behind some of the world’s most<br />
spectacular movies at the Weta Cave mini-museum<br />
or put yourself in the picture with a The Lord of the<br />
Rings location tour.<br />
6.Wander the waterfront to Oriental Bay<br />
Wellington’s waterfront is a beautifully<br />
walkable public space, dotted with cafes, parks,<br />
sculpture, bars and ice cream vendors.<br />
7.Cruise down Cuba Street<br />
Home to hipsters, artists and lovers of<br />
vintage, Cuba Street is a bohemian haven with<br />
some of the city’s most colourful shops, bars and<br />
cafes. Street entertainers play percussive guitar, put<br />
on a marionette show, or play with fire and then<br />
there’s the Bucket Fountain.<br />
8.Pause at the Pukeahu National War Memorial Park<br />
Officially opened in April, the park is a place of<br />
remembrance. The War Museum within the park,<br />
houses Sir Peter Jackson’s Great War Exhibition,<br />
which tells the story of World War I, honouring the<br />
role many Kiwis played. ▀<br />
BEST PRACTICE SOFTWARE<br />
Since acquiring the New Zealand and Australian<br />
operations of Houston Medical’s VIP Software<br />
in April, Best Practice Software has continued<br />
to evolve as a leading Australasian medical<br />
software provider. VIP Software is widely used by<br />
ophthalmologists in New Zealand and Australia,<br />
and Best Practice has been engaging with users to<br />
discuss their current and future needs.<br />
Chief operating officer Craig Hodges said:<br />
“We’re relocating to brand new state of the art<br />
premises in Hamilton which will become our<br />
New Zealand operations centre, and expanding<br />
our team of highly skilled IT professionals. We’re<br />
excited to provide locally developed software and<br />
support to our existing and future ophthalmology<br />
specialist customers. Best Practice Software<br />
directors, Dr Frank and Mrs Lorraine Pyefinch will<br />
be attending the Congress in Wellington and<br />
they look forward to introducing delegates to<br />
members of our Best Practice Team.” ▀<br />
Cataract<br />
surgery<br />
benchmarks<br />
proposed<br />
The International Consortium for Health<br />
Outcomes Measurement (ICHOM) is calling for<br />
a proposed minimum standard set of outcome<br />
measures for cataract surgery that enables<br />
global comparisons.<br />
Dr Stephen Best, a cataract surgeon,<br />
glaucoma specialist and neuro-ophthalmology<br />
specialist from Auckland Eye, says cataract<br />
benchmarking and audit is an excellent idea.<br />
“RANZCO has recognised this and has created<br />
RCAT as part of CPD. The potential beauty of<br />
such data sets, provided anonymity is carefully<br />
preserved, is that it will allow comparison to<br />
preserve standards that can be measured by<br />
way of benchmarking. I would encourage all<br />
NZ RANZCO fellows to participate in the RCAT<br />
programme.”<br />
Ideally, this should be done at a professional<br />
and collegial level rather than having an<br />
external agency, he says, as an external agency<br />
would simply add compliance requirements.<br />
“However, one must recognise that there will<br />
be additional data input required that may<br />
need additional resourcing.”<br />
The ICHOM committee members published<br />
their recommendations in JAMA Ophthalmology<br />
in August.<br />
The ICHOM standards include two dozen<br />
points that could be used to evaluate the<br />
success of phacoemulsification, sutured<br />
manual extracapsular cataract extraction,<br />
sutureless manual extracapsular cataract<br />
extraction, and intracapsular cataract<br />
extraction.<br />
Doctors, patients or administrators<br />
would gather information about the<br />
patients’ demographics, ocular history and<br />
comorbidities, preoperative visual acuity,<br />
and patient-reported visual function prior<br />
to surgery. They would report capsulerelated<br />
problems, dislocation of lens nucleus<br />
fragments into the vitreous, and other<br />
complications that occur during surgery, and<br />
they would note refractive error, patientreported<br />
visual function, and early and late<br />
complications for up to three months after<br />
surgery.<br />
The new standards could be useful for<br />
payers and patients who want to more<br />
accurately rank physicians, wrote Dr Bonnie<br />
An Henderson, a clinical professor at Tufts<br />
University School of Medicine in Boston, in an<br />
editorial accompanying the study.<br />
Already many insurance companies use<br />
limited data, such as the cost of care, to<br />
create tiered provider plans. If they had more<br />
complete data, they could evaluate physicians<br />
more appropriately, she said. Training<br />
programmes could also use the standards<br />
to evaluate how well they are preparing<br />
ophthalmologists to do cataract surgery,<br />
while residency programmes would be able<br />
to compare applications from prospective<br />
residents trained abroad to those from<br />
residents trained domestically and researchers<br />
could more easily gather data to study diseases<br />
and treatments, especially for rare diseases<br />
such as endophthalmitis, she said.<br />
“In today’s global world, collaboration<br />
between countries to create a universal set of<br />
guidelines is an honourable pursuit.”<br />
The ICHOM committee also suggested the<br />
data could be used as part of an approval<br />
process for devices used in cataract surgery.<br />
The International Consortium for Health<br />
Outcomes Measurement (ICHOM) is a nonprofit<br />
organisation founded by Harvard<br />
Business School’s Institute for Strategy &<br />
Competitiveness, the Boston Consulting Group<br />
and the academic medical research centre, the<br />
Karolinska Institutet in Stockholm, Sweden, to<br />
transform health care systems worldwide by<br />
measuring and reporting patient outcomes in a<br />
standardized way.<br />
For more information visit: http://www. ichom.<br />
org/download/cataracts-reference-guide/ ▀<br />
O<br />
M<br />
22 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 22<br />
9/18/<strong>2015</strong> 6:43:51 AM<br />
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NEW ZEALAND OPTICS<br />
23<br />
<strong>Oct</strong>ober Info_ad-v3 <strong>2015</strong>.indd 3.indd 23 1<br />
9/18/<strong>2015</strong> 14/09/15 6:43:510:13 AM AM
with<br />
Prof Charles McGhee<br />
& A/Prof Dipika Patel<br />
Series Editors<br />
Causes of optic nerve head oedema —<br />
from the benign to the sight and life threatening<br />
BY AARON WONG AND HELEN DANESH-MEYER*<br />
L<br />
R<br />
INTRODUCTION<br />
Optic nerve head swelling has a wide range of causes; from the sinister to the benign. In this<br />
article we briefly review some of the diagnoses that should come to mind when faced with a<br />
patient with optic nerve head swelling and ways to differentiate between them. To highlight<br />
the importance of testing visual acuity, colour vision and visual fields we have separated these<br />
causes by their propensity to cause optic nerve dysfunction.<br />
CAUSES NOT ASSOCIATED WITH PROMINENT OPTIC NERVE DYSFUNCTION<br />
i. Optic nerve head drusen<br />
Optic nerve head drusen (ONHD) are calcific deposits found in the anterior portion of the optic nerve. They<br />
are present in approximately 0.3-2% of individuals and are bilateral in 65 to 90%. 1 Buried ONHD represent<br />
a diagnostic challenge as their clinical appearance can easily be mistaken for optic nerve swelling and<br />
papilloedema. Patients have preserved visual acuity (VA) with mild visual field (VF) defects. Using B-scan<br />
echography, drusen can be identified as highly reflective rounded shadows at the optic nerve head. ONHD<br />
are autofluorescent and hence fundus photography with fluorescent filters can reveal buried ONHD not<br />
obvious on fundoscopy (Figure 1a and 1b)<br />
1a<br />
Not associated with prominent<br />
optic nerve dysfunction<br />
Pseudopapilledema<br />
-Optic disc drusen<br />
-Tilted optic discs<br />
Vascular<br />
-GCA<br />
-NAION<br />
-CRVO/CRAO<br />
-Behҫet’s disease<br />
Optic nerve head swelling<br />
Inflammatory<br />
-Anterior or<br />
Intermediate Uveitis<br />
-Posterior Scleriti<br />
-VKH<br />
Infiltrative<br />
-Sarcoidosis<br />
-Tumours of the<br />
optic nerve<br />
Associated with<br />
optic nerve dysfunction<br />
Raised ICP<br />
-Idlopathic intracranial<br />
hypertension<br />
-Secondary intracranial<br />
hypertension<br />
Inflammatory<br />
-Optic neuritis<br />
-Neuromyelitis Optica<br />
-TINU<br />
- White dot syndromes<br />
Figure 1. Fundus photograph of a left optic disc with drusen (a) and autofluoresence imaging of the same optic disc (b)<br />
ii. Tilted optic discs<br />
A tilted optic disc refers to the fundoscopic appearance of an oblique entrance to the optic nerve that can<br />
occur in 0.4-3.5% of the population.2 Angulation of the optic nerve head gives an elevated appearance to one<br />
side of the disc. There is a positive relationship between increasing myopia and the presence of tilted discs.2<br />
iii. Anterior or Intermediate Uveitis with disc oedema<br />
Disc oedema occurs in between 1.2-8.3% of cases of anterior and intermediate uveitis. 3 Children are<br />
particularly at risk, approximately 29% of all cases of paediatric uveitis are associated with disc oedema. 4<br />
iv. Posterior scleritis<br />
Posterior scleritis refers to inflammation of the sclera posterior to the insertion of the rectus muscles.<br />
Approximately 13-18% of patients have associated disc oedema. 5 Typically patients are in their fourth<br />
decade and there is a preponderance for females.<br />
A prominent symptom is severe periocular pain which can wake patients from sleep. They may also<br />
report pain on eye movements. Very few patients have visible anterior segment inflammation. B-scan<br />
echography is a key adjunct, showing thickening of the slcera and fluid in the subtenons space. When this<br />
is around the optic nerve it is referred to as the ‘T-sign’.<br />
CAUSES ASSOCIATED WITH PROMINENT OPTIC NERVE DYSFUNCTION<br />
Normal ICP<br />
Infectious<br />
-Taxoplasmosis<br />
-Cat Scratch Disease<br />
-Syphillis<br />
i. Raised intracranial pressure<br />
Papilledema refers to optic disc swelling due to raised intracranial pressure (ICP). Symptomatically,<br />
patients can present with headache, nasuea, pulsatile tinnitus and diplopia. Transient visual obscurations<br />
are an ominous symptom as they are thought to represent transient ischemia of the optic nerve. Severe<br />
papilledema can result in disc haemorrhages, choroidal folds radiating from the optic disc (Paton’s lines),<br />
obscuration of disc vessels and macula oedema. 6<br />
A normal VA may not reflect the severity of papilledema and decreased colour vision and VF defects are<br />
better indicators of optic nerve function. OCT of the RNFL may be useful in confirming swelling as well as<br />
monitoring progression.<br />
Patients require neuroimaging to investigate secondary causes of raised ICP such as tumours, infection<br />
and vascular malformations. Specific imaging of the blood vessels is often included for central venous sinus<br />
thrombosis which can obstruct the outflow of cerebrospinal fluid (CSF). A lumbar puncture is required to<br />
confirm the presence of raised ICP and also to evaluate for markers of infection or malignancy in the CSF.<br />
If no secondary causes are identified, patients may be diagnosed with idiopathic intracranial<br />
hypertension (IIH), previously known as benign intracranial hypertension and pseudotumour cerebri. IIH is<br />
4-8 times more common in women and the mean age of onset is 30. 6 Obesity is also associated with IIH;<br />
weight gain is associated with a worsening in VF defects and weight loss associated with improvement<br />
of papilledema. Medications including oral contraceptives, tetracyclines, isotretinoin and corticosteroids<br />
have been associated with IIH. 6<br />
ii. Giant cell arteritis<br />
All patients with disc swelling over the age of 50 should have giant cell arteritis (GCA) excluded as it<br />
is a life and sight threatening vascular inflammatory condition. Typical symptoms include: temporal<br />
headache, scalp tenderness, fevers and weight loss. Jaw claudication, often described as a cramping pain<br />
increasing with continued mastication or speech is highly specific for GCA. 7<br />
Vision loss in GCA is often profound with between 60-80% having a VA worse than 6/60. Colour vision<br />
and VFs are severely compromised. Although findings at the optic nerve are variable, ‘chalky white’<br />
oedema is highly suggestive of GCA and disc haemorrhages are uncommon. 7<br />
1b<br />
Figure 2. Fundus photos of chalky white swelling of the left optic disc in giant cell arteritis with a normal right disc for comparison<br />
Blood inflammatory markers such as an erythrocyte sedimentation rate and C-reactive protein are<br />
particularly useful for ruling out GCA, and when used in together have a reported sensitivity of 99%. 8<br />
Temporal artery biopsy is the gold standard for diagnosis of GCA.<br />
iii. Non-arteritic ischemic optic neuropathy<br />
Non-arteritic ischemic optic neuropathy (NAION) is the most common cause of an acute optic neuropathy in<br />
patients over the age of 50 but unlike GCA can present in patients younger than 50. Patients typically present<br />
with an acute decrease in vision, have a moderate to severe VF defects and colour vision is mildly impaired. 9<br />
Approximately 75% of eyes affected by NAION will have either diffuse or focal disc swelling and unlike<br />
GCA is often associated with disc haemorrhage (72%). 9 A small optic disc size and a small or absent<br />
physiological cup are risk factors for NAION.<br />
iv. Central retinal vein occlusion and central retinal artery occlusion<br />
Both central retinal vein occlusions (CRVO) or central retinal artery occlusions (CRAO) can present with<br />
concomitant disc oedema. Disc oedema is more common in CRVOs (81-93%) compared to CRAOs (22%). 9 In<br />
ischemic CRVO 99% present with VA worse than 6/60 compared to only 22% of non-ischemic eyes. In CRAO<br />
74% of patients present with a VA of counting fingers (CF) or worse, and 90% had VF defects. 9<br />
v. Sarcoidosis<br />
Sarcoidosis is a multisystem granulomatous disorder which can be associated with uveitis and/or optic<br />
neuropathy. Evidence of active or previous uveitis is present in 42% of cases. 10 Granulomas at the iris,<br />
choroid or optic disc are relatively rare but highly specific for sarcoidosis. Diagnostic workup for suspected<br />
sarcoidosis should include a chest X-ray and serum ACE level.<br />
vi. Demyelinating optic neuritis<br />
In young adults, demyelinating disease is a common cause of an acute optic neuropathy. After an episode<br />
of isolated optic neuritis, around half of patients will progress to develop multiple sclerosis (MS) over 15<br />
years. 11 The median age of onset is 29 years and females are affected twice as often as males.<br />
Patients often present with a rapid decrease in VA and painful eye movements. As well as oedema of<br />
the optic nerve head, examination may reveal decreased colour vision, variable VF defects and a relative<br />
afferent pupillary defect. Investigation of an isolated episode of optic neuritis should include an MRI of<br />
the brain to evaluate for demyelinating lesions. The presence of these increases the patient’s likelihood of<br />
progression to MS to around 72% at 15 years. 11<br />
vii. Neuromyelitis optica<br />
Previously thought of a as a variant of multiple sclerosis, neuromyelitis optica (NMO) or Devics disease is<br />
being increasingly recognised as a distinct entity since the identification of the causitive antibody (NMO-<br />
IgG). 12 The median age at presentation is 39 years and women are affected nine times more commonly.<br />
Non-caucasian ethnicities are more likely to be affected. 12 Patients can present with optic neuritis with or<br />
without neurological symptoms. The diagnosis can be confirmed by a blood test for NMO-IgG or evidence<br />
of demyelinating spinal cord lesions on MRI.<br />
viii. Ocular Toxoplasmosis<br />
Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide. Due to infection by<br />
the protozoan Toxoplasma Gondii, studies have shown that this pathogen is present in 25-30% of<br />
the population. 13 Age, immune status, and genetic factors contribute to the risk of developing ocular<br />
toxoplasmosis. 13 Approximately 5-13% of patients develop disc swelling. 14 This often associated with<br />
vitritis, an area of chorioretinitis or neuroretinitis (disc swelling and a macula star). Most cases with optic<br />
nerve swelling have a VA worse than 6/12 and arcuate or a central scotomas to VF testing. The diagnosis is<br />
often made clinically and confirmed with serological testing for antibodies against Toxoplasma.<br />
ix. Cat Scratch Disease<br />
Cat scratch disease (CSD) is a systemic illness caused by the bacteria Bartonella henselae. CSD is the most<br />
common cause of neuroretinitis. In patients with CSD and optic disc oedema, initial VA is often poor; in<br />
one study half of the patients presented with a VA worse than 6/48. 15 Serological testing for antibodies<br />
against Bartonella are used for confirmation of the diagnosis.<br />
x. Syphilis<br />
Syphilis is a sexually transmitted infection caused by the spirochaete Treponema Pallidum. In the past decade<br />
there has been resurgence in the incidence of syphilis and worldwide, coinciding with advent of antiretroviral<br />
therapy for HIV. 16 Syphilis is also known as the ‘great imitator’ and ocular syphilis can present with almost any<br />
form of ocular inflammation. Serological testing is effective in identifying active and past infections.<br />
CONCLUSION AND IMPORTANT POINTS<br />
Optic nerve swelling is associated with a wide spectrum of diagnoses. A thorough history and examination<br />
including testing optic nerve function is key to identifying potentially life or sight threatening causes and<br />
appropriate triage of the referral to an ophthalmologist.<br />
REFERENCES<br />
1. Auw-Haedrich, C., F. Staubach, and H. Witschel, Optic<br />
disk drusen. Survey of Ophthalmology, 2002. 47(6): p.<br />
515-532.<br />
2. Witmer, M.T., C.E. Margo, and M. Drucker, Tilted Optic<br />
Disks. Survey of Ophthalmology, 2010. 55(5): p. 403-428.<br />
3. Wakefield, D. and J.H. Chang, Epidemiology of uveitis.<br />
International ophthalmology clinics, 2005. 45(2): p. 1-13.<br />
4. Rosenberg, K.D., W.J. Feuer, and J.L. Davis, Ocular<br />
complications of pediatric uveitis. Ophthalmology,<br />
2004. 111(12): p. 2299-2306.<br />
5. McCluskey, P.J., et al., Posterior scleritis - Clinical features,<br />
systemic associations, and outcome in a large series of<br />
patients. Ophthalmology, 1999. 106(12): p. 2380-2386.<br />
6. Chan, J.W., Optic nerve disorders. 2007: Springer.<br />
7. Chew, S.S.L., N.M. Kerr, and H.V. Danesh-Meyer, Giant<br />
cell arteritis. Journal of Clinical Neuroscience, 2009.<br />
16(10): p. 1263-1268.<br />
8. Parikh, M., et al., Prevalence of a normal C-reactive<br />
protein with an elevated erythrocyte sedimentation<br />
rate in biopsy-proven giant cell arteritis.<br />
Ophthalmology, 2006. 113(10): p. 1842-5.<br />
9. Hayreh, S.S., Ocular vascular occlusive disorders:<br />
Natural history of visual outcome. Progress in Retinal<br />
and Eye Research, 2014. 41: p. 1-25.<br />
10. Frohman, L.P., et al., Sarcoidosis of the anterior<br />
visual pathway: 24 new cases. Journal of Neuro-<br />
Ophthalmology, 2003. 23(3): p. 190-197.<br />
11. Toosy, A.T., D.F. Mason, and D.H. Miller, Optic neuritis.<br />
Lancet Neurology, 2014. 13(1): p. 83-99.<br />
12. Wingerchuk, D.M., et al., The spectrum of neuromyelitis<br />
optica. Lancet Neurology, 2007. 6(9): p. 805-815.<br />
13. Maenz, M., et al., Ocular toxoplasmosis past, present<br />
and new aspects of an old disease. Progress in Retinal<br />
and Eye Research, 2014. 39: p. 77-106.<br />
14. Bowermaster, R., et al., Application of the Aviation<br />
Black Box Principle in Pediatric Cardiac Surgery:<br />
Tracking All Failures in the Pediatric Cardiac Operating<br />
Room. Journal of the American College of Surgeons,<br />
<strong>2015</strong>. 220(2): p. 149-+.<br />
15. Chi, S.L., et al., Clinical Characteristics in 53 Patients<br />
with Cat Scratch Optic Neuropathy. Ophthalmology,<br />
2012. 119(1): p. 183-187.<br />
16. Almdahl, S.M., et al., Postoperatively Increased Serum<br />
Alanine Aminotransferase Level Is Closely Associated<br />
with Mortality after Cardiac Surgery. Thoracic and<br />
Cardiovascular Surgeon, <strong>2015</strong>. 63(1): p. 67-72.<br />
ABOUT THE AUTHOR<br />
* Aaron Wong is the Allergan<br />
Optic Nerve Clinical Research<br />
Fellow at the University of<br />
Auckland. He has previously<br />
worked as an ophthalmology<br />
non-training registrar at<br />
Auckland and Waikato DHBs<br />
and studied medicine in<br />
Dunedin and Wellington.<br />
24 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 24<br />
9/18/<strong>2015</strong> 6:43:52 AM
Tempering concerns over VR<br />
An article in the August <strong>2015</strong> NZ Optics<br />
suggested that virtual reality (VR) is a<br />
technology with the potential to have<br />
a serious negative impact on a user’s<br />
vision. As a new consumer technology, there is<br />
a lack of direct evidence about the widespread<br />
adoption of VR. However, a considerable body<br />
of research 1,2 in VR usage, from the early 90s on,<br />
has addressed some of the concerns mentioned<br />
in the article.<br />
Some issues raised—such as diplopia and<br />
headaches—are symptomatic of an imperfectly<br />
calibrated system, or of a binocular vision<br />
disorder that would warrant a trip to your local<br />
optometrist.<br />
Suggestions that VR headsets could increase<br />
myopia progression through prolonged near<br />
accommodation are based on a misunderstanding<br />
of how VR headsets work. Unlike a computer<br />
screen, which is viewed at near distance, VR<br />
headsets use lenses to relax both accommodation<br />
(the distance the eye focuses on) and convergence<br />
(how much the eyes point inwards towards<br />
the nose). Consequently there is less proximal<br />
demand on vision than there would be with<br />
alternative video gaming technologies, such as<br />
VDU, tablets and smartphones.<br />
Another concern raised was exposure to blue<br />
light, which may cause damage to the retina.<br />
VR screens use OLED technology, where each<br />
RGB pixel emits light so that (a) the screen does<br />
not require a backlight, and (b) pixels emit zero<br />
light when black. This enhancement of contrast,<br />
coupled with the fact that the blue pixel spectrum<br />
stops at wavelengths greater than 415nm, means<br />
that a user will be exposed to far more blue light<br />
looking out a window than at a VR screen.<br />
It is certainly true that early VR headsets<br />
were limited in many respects offering a<br />
restricted field of view, long latency of tracking<br />
(meaning the image lagged behind the users’<br />
movements), and poor graphical capabilities all<br />
making for a poor and potentially disorientating<br />
experience. 3,4 These days, even at the lowest<br />
end of the market (such as Google Cardboard—a<br />
$20 virtual headset that exploits smartphone<br />
graphics capability), VR headsets are much more<br />
immersive and capable than even those used in<br />
the literature from five years ago.<br />
VR does produce a mismatch between what<br />
your eye sees and what your body tell you are<br />
doing (vestibular-ocular imbalance) which can<br />
be nauseating to some, but this is no difference<br />
than any other kind of motion sickness, and can<br />
be alleviated almost instantly by removing the<br />
headset. This is also no different to the experience<br />
of many people who are unable to play firstperson<br />
video games presented on traditional<br />
display technology. We would anticipate that<br />
better game design—similar to the maturation<br />
seen in 3D movies—will reduce such issues in<br />
the future. Further, and perhaps surprisingly,<br />
BY STEVEN DAKIN AND PHILIP TURNBULL*<br />
VR systems are being used to improve balance<br />
in patients with multiple sclerosis 5 following<br />
stroke 6,7 as well as improving postural stability<br />
control in those with glaucoma. 8<br />
Certainly the technological improvements<br />
leading to better experiences are ongoing - the<br />
consumer version of the Oculus Rift VR headset,<br />
due to arrive in 2016, has a fast, high resolution<br />
screen, and can track head position with submillimeter<br />
accuracy, which helps to better<br />
translate real world movement into the virtual<br />
environment. To address concerns regarding<br />
binocular systems, it will also have adjustable<br />
eye relief and adjustable interpupillary distance<br />
(IPD) for both the lens optics and the in-game<br />
representation of IPD (the separation of your<br />
“virtual pupils”). This, in combination with<br />
software adjustable convergence, will allow for<br />
comfortable viewing for a wide range of distance<br />
phorias and fusional reserves. However, when<br />
viewing “near” objects in VR, there would still be<br />
a discrepancy between the accommodative and<br />
vergence systems. This however can be reduced<br />
either through user-controlled software or by<br />
periscopic lenses to reduce the effective IPD.<br />
A newer headset, Fove, will additionally<br />
incorporate eye tracking within the headset<br />
to make real time determination of fixation<br />
possible (and focal distance) allowing simulated<br />
accommodation and convergence to dynamically<br />
adjust with fixation.<br />
As vision scientists, we see VR as an exciting<br />
opportunity to provide an immersive setting<br />
to people, while simultaneously being able to<br />
control all aspects of their visual environment.<br />
In terms of clinical application, VR will have<br />
application as a screening tool for detecting<br />
binocular vision disorders.<br />
Coupled with the immersive experience it<br />
provides, VR has huge potential for testing vision<br />
in children. As optometrists, we are unaware<br />
of any compelling evidence that VR poses any<br />
risk to vision that is greater than any consumer<br />
display system. Protracted, daily viewing of any<br />
video-based display is probably not something<br />
we want for our children, but in the sense of<br />
optometric risk we do not judge VR to be worse<br />
than currently-available alternatives. ▀<br />
*Professor Steven Dakin is head of Optometry & Vision Science at<br />
the Auckland University, while Dr Phil Turnbull is a reasearch fellow<br />
in the same school, with a particular interest in virtual reality.<br />
REFERENCES<br />
1.www.nvidia.com/content/GTC-2010/pdfs/2010_GTC2010.pdf<br />
2.static.oculus.com/sdk-downloads/documents/Oculus_Best_<br />
Practices_Guide.pdf<br />
3.10.1111/j.1475-1313.1993.tb00496.x<br />
4.10.1016/S0003-6870(98)00044-1<br />
5.10.1179/1743132815Y.0000000013<br />
6.www.ncbi.nlm.nih.gov/pubmed/25448245<br />
7.cre.sagepub.com/content/29/3/261.abstract<br />
8.www.ncbi.nlm.nih.gov/pubmed/25892017<br />
Research shows choline is important to<br />
eye development and vision<br />
A<br />
US-based<br />
researcher says experiments<br />
suggest a critical link in humans<br />
between choline and eye health.<br />
“This is the frontier of research being<br />
done right now,” says Professor Steven Zeisel,<br />
director of the Nutrition Research Institute at the<br />
University of North Carolina. “Early studies show<br />
that retina development in the foetus depends<br />
on the choline intake of the mother.”<br />
Choline supports stem cell development that<br />
forms the retina, Zeisel says. Insufficient choline,<br />
especially for the developing foetus and infant,<br />
means vision will be less than optimal for the<br />
adult and throughout the aging process. Zeisel<br />
says fewer retinal cells form in foetuses if their<br />
mothers have a relatively low choline intake.<br />
Research indicates most people in the US<br />
population do not meet the recommended intake<br />
for choline: 550 mg/day for men; 425 mg/day for<br />
women. Choline-rich foods include eggs and liver,<br />
while plant sources are relatively low in choline.<br />
For more information visit The Choline<br />
Information Council website:<br />
www.thecholineinformationcouncil.com.<br />
Food sources for choline include:<br />
• One egg yolk contains about 115 mg of<br />
choline.<br />
• 140 gms of raw liver contains 423 mg of<br />
choline.<br />
• 225 gms of fresh milk, yogurt, and kefir<br />
contain about 40 mg of choline.<br />
• Legumes such as lima and garbanzo beans and<br />
lentils have about 70 mgs of choline per cup.<br />
• Sunflower seeds, pumpkin seeds and almonds<br />
have around 60 mgs of choline per cup.<br />
• Cruciferous vegetables such as cauliflower,<br />
cabbage, bok choy and broccoli contain<br />
around 65 mg of choline per cup cooked. ▀<br />
US report shows extent<br />
of bad CL habits<br />
A<br />
study<br />
of contact lens wearers in<br />
the US confirms what optometrists<br />
everywhere know from experience.<br />
People tend to be unhygienic about<br />
their contacts and a lot of them suffer for it.<br />
In a survey of 1,000 contact lens wearers<br />
conducted by the Centers for Disease Control,<br />
at least 50.2 per cent said they have slept<br />
overnight with their CLs on; 55.1 per cent said<br />
they have topped-up their solution instead of<br />
cleaning their cases and replenishing with new<br />
solution; and 84.9 per cent said they showered<br />
without taking out their lenses.<br />
More than 90 per cent of rigid contact lens<br />
wearers reported having rinsed their CLs in<br />
tap water and one-third reported storing their<br />
lenses in tap water.<br />
The consequence seems too obvious. One<br />
third of the same wearers reported suffering<br />
red or painful eyes that required a doctor’s<br />
visit. The CDC, which published the results of<br />
its survey in August, estimates that contact<br />
lens complications cost US$175 million<br />
annually. The problem is significant enough for<br />
the government health organisation to run an<br />
annual contact lens awareness campaign.<br />
Such bad habits are universal, according to<br />
optometrist Greg Nel, a partner with Total<br />
Eyecare in Wellington, who was asked to look<br />
at the CDC’s summary of the most common<br />
examples of unhygienic practices and state<br />
which ones he has seen in his work most often.<br />
“Overwear is generally the worst problem,<br />
but ‘all-of-the-above’ really.”<br />
Nel says the worst case he has seen resulting<br />
from bad contact lens hygiene has been<br />
microbial keratitis.<br />
“It’s bad for everyone concerned,” he says.<br />
“The most complacent patients are generally<br />
the most at risk.”<br />
Complacency may be the key to much of the<br />
bad CL habits. Nel sees the internet supply of<br />
EYLEA ® (aflibercept)<br />
Now approved for wet AMD,<br />
Diabetic Macular Oedema (DME) &<br />
Macular Oedema secondary to CRVO<br />
REVEAL LIFE BEYOND THE LETTERS<br />
REVEAL LIFE BEYOND THE LETTERS<br />
NZ ABRIDGED PRODUCT INFORMATION<br />
EYLEA ® (aflibercept)<br />
EYLEA: Prescription medicine, aflibercept 40 mg/mL solution for intravitreal injection. INDICATIONS: EYLEA (aflibercept)<br />
is indicated for the treatment of neovascular (wet) age-related macular degeneration (wet AMD), visual impairment<br />
due to macular oedema secondary to central retinal vein occlusion (CRVO), diabetic macular oedema (DME). DOSAGE<br />
REGIMEN AND ADMINISTRATION: Injection volume of 50 μL EYLEA (equivalent to 2 mg aflibercept). For wet AMD: one<br />
intravitreal injection per month for three consecutive months, followed by one injection every two months. For CRVO:<br />
one intravitreal injection per month. After the first three monthly injections, the treatment interval may be extended<br />
based on visual and anatomic outcomes. For DME: one intravitreal injection for five consecutive months, followed<br />
by one injection every two months. CONTRAINDICATIONS: Known hypersensitivity to aflibercept or excipients; ocular<br />
or periocular infection; active severe intraocular inflammation. PRECAUTIONS: Endophthalmitis, increase in intraocular<br />
pressure; arterial thromboembolic events, see full Data Sheet for effects on fertility, pregnancy, lactation, effects on ability<br />
to drive or use machines. INTERACTIONS: No formal drug interaction studies have been performed. ADVERSE EFFECTS:<br />
Very common: conjunctival haemorrhage, eye pain. Common: retinal pigment epithelium tear, detachment of retinal<br />
pigment epithelium, cataract, cataract nuclear, cataract subcapsular, corneal erosion, corneal abrasion, intraocular<br />
pressure increased, vision blurred, vitreous floaters, corneal oedema, vitreous detachment, injection site pain, foreign<br />
body sensation in eyes, lacrimation increased, eyelid oedema, injection site haemorrhage, conjunctival hyperaemia,<br />
ocular hyperaemia. Others: see full Data Sheet. FUNDING INFORMATION: EYLEA is not funded, a prescription charge will<br />
apply. FURTHER INFORMATION: Before prescribing, please review full Data Sheet for further information on the risks and<br />
benefits. Full Data Sheet is available from www.medsafe.govt.nz or Bayer New Zealand Limited, 3 Argus Place, Hillcrest<br />
North Shore, Auckland 0627. Telephone 0800 233 988.<br />
Bayer New Zealand Limited<br />
3 Argus Place, Hillcrest, Auckland 0627.<br />
Telephone 0800 233 988<br />
DA1555BI<br />
L.NZ.MKT.07.<strong>2015</strong>.0228<br />
contact lenses as complicating matters since<br />
buying CLs online allows patients to “side-step<br />
the built-in audit and supervision that normal<br />
supply channels provide.”<br />
“For example, if someone stops ordering<br />
lenses as often, they are probably not wearing<br />
them as often, or are over-wearing them. Both<br />
problems are easily identified when lenses are<br />
purchased through practices.”<br />
Nel says he believes the solution to the<br />
internet supply wrinkle is to develop a model<br />
that re-routes lens supply back through<br />
optometry in an industry-practitioner<br />
collaborative effort, recognising that the<br />
pracitioner-supply chain has been slow to react<br />
to online competition.<br />
But is complacency itself universal? Nel says<br />
he suspects his patients are “self-selected” to<br />
be more proactive in their eye care.<br />
“Most of the patients I see are more on-board<br />
than they’ve ever been and feel that they have<br />
a vested interest in paying for our advice, and<br />
generally take it too. We do have a few ‘hardarses’<br />
who like to come in and shock us with<br />
how they’ve defied our advice, but most of<br />
those have chosen the easy route and accessed<br />
the cheapest eye care options, including<br />
accessing free care and self-prescribing lenses<br />
to themselves.”<br />
So what do you do about those patients who<br />
won’t follow your directions for proper CL<br />
maintenance, wear and hygienic practices?<br />
“I usually laugh,” says Nel. “Look them in<br />
the eye and explain that statistics and luck are<br />
different things. Because they’ve rolled a five,<br />
doesn’t mean they’re always going to roll a<br />
five, there are other numbers on the die. It’s<br />
actually been a while since the sale of contact<br />
lenses has core to practice profitability and<br />
at the moment, selling good advice is more<br />
profitable.” ▀<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
25<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 25<br />
9/18/<strong>2015</strong> 6:43:54 AM
Awesome<br />
It’s shaping up to be one of my most hectic<br />
periods of travel, with a few weeks of presenting<br />
behind me and way too much long-haul travel<br />
ahead. Late August involved a Dailies Total1<br />
launch in Singapore, and as I pen this column, I have<br />
just finished a Sunday master-class RGP series of<br />
workshops and lectures at the BHVI in Sydney.<br />
The day was arranged largely by Margaret Lam,<br />
one of Sydney’s successful independent practice<br />
owners and contact lens gurus. Margaret is the<br />
NSW President of the CCLS (AU). She’s fuelled<br />
by the same power source as the sun, and has<br />
incredible drive and passion for optometry and<br />
contact lenses. Despite one of the chains having an<br />
annual conference on the same weekend, we had a<br />
full house of around 100 delegates who seemed to<br />
really enjoy the sessions.<br />
Following my opening talk on corneal RGPs,<br />
the legendary Paul Rose took the podium and, as<br />
always, managed to explain keratoconus fitting<br />
in a really straightforward, logical manner with<br />
interactive Medmont topography. He followed<br />
this up with some live keratoconus fittings, which<br />
always takes balls to do. I was lucky, as I just had<br />
to drive the video slit lamp while Paul did the hard<br />
stuff. It was great to be part of the Kiwi team. Of<br />
course, I did have a go at the Aussies with a few<br />
digs about rugby and the fact that we in NZ fit<br />
around 19 per cent RGP lenses whereas in OZ it is<br />
only six per cent. In general our contact lens market<br />
penetration is around 10 per cent whereas in<br />
Australia it is only about five per cent. I always tell<br />
the Aussies that’s because they are all so one-eyed<br />
they only need half as many lenses. There are of<br />
course many reasons, and the Medicare system<br />
seems to be one of the factors. There were a few<br />
Kiwis in the audience. One or two super-dedicated<br />
practitioners flew over while many Aussies<br />
travelled long distances to be there. It’s great to<br />
see that there are seemingly growing numbers<br />
of practitioners keen to get more involved in RGP<br />
fitting and management, to hone their skills, while<br />
sacrificing their Sunday after a full-on working<br />
week. There were numerous other optometry and<br />
anterior segment ophthalmology lectures with<br />
shared optometry-ophthalmology cases. Great stuff.<br />
There was no peace for the wicked and Margaret<br />
kept cracking the whip. In the afternoon session<br />
we had five clinic rooms in the BHVI with five<br />
complex RGP patients, who also gave up their<br />
Sunday to let 100 people shine bright lights<br />
in their eyes and discuss their complex cases.<br />
Margaret asked me to present one of her RoseK2IC<br />
cases, as I’ve been fitting the RK2IC since its<br />
inception some nine years ago. Generally I don’t<br />
do many of these lenses and remain a committed<br />
“small” lens guy. I have however had some great<br />
successes for some tricky eyes with the 2IC. I don’t<br />
generally like presenting other people’s cases, but<br />
Margaret can be quite convincing. When she asked<br />
her patient if he would mind me presenting his<br />
case he told her he’d be delighted. It turns out I<br />
was his optometrist in Auckland in 1999 and had<br />
fitted his lenses before he moved to Sydney. So it<br />
worked out perfectly.<br />
I took his old records along and demonstrated<br />
how stable his RE keratoconus was. He’d had<br />
an 0.50D K-change in 16 years, and that was<br />
comparing B&L manual keratometry with modern<br />
Oculus topography. We also showed how his bestcorrected<br />
RGP acuity was identical over this period,<br />
and discussed the pros and cons of my 1999,<br />
8.7mm diameter toric RGPs vs the recent, large<br />
11.2mm RK2IC. On balance, he found the comfort<br />
near- identical, and even noted improved night<br />
vision with the RK2IC, which has an optic zone just<br />
over 8mm versus 6.8mm on the smaller RGPs.<br />
After going through the case--with 10 groups of<br />
around seven keen and enthusiastic practitioners<br />
over about two hours--there was still no respite.<br />
Margaret wanted to have another go at me in a<br />
debate on scleral versus corneal RGPs. She and<br />
Brien Holden remain the only people to beat me in<br />
debates. Full credit.<br />
I was pretty hammered after presenting pretty<br />
much all day with no breakfast, but a superb<br />
crayfish in Chinatown for dinner saw me right.<br />
Full credit to Margaret and the CCLS (AU)<br />
organisers, the fantastic BHVI team, industry<br />
sponsors and equipment suppliers, who all<br />
gave up their valuable Sunday to make this RGP<br />
educational day such a remarkable success. Some<br />
optonerds quickly provided enthusiastic feedback<br />
on Facebook with many others verbally expressing<br />
their satisfaction with the format and subject<br />
matter. Here are a few of the first Facebook Posts.<br />
Margaret had this to say:<br />
“Deliriously tired and deliriously happy. Slept<br />
half an hour in the last two days prepping for this<br />
hands (on) and live conference with live patients<br />
and 109 people and coordination... and I’m so glad<br />
it went off so amazingly and that everyone had an<br />
amazingly nerdy great time.”<br />
Others had these thoughts to share:<br />
• “Margaret you are one huge ball of energy!!<br />
Well done it was a complete success!! Xxx”<br />
• “Well done Margaret: Excellent event - fun and<br />
informative! Many thanks to you and all the<br />
fabulous speakers and workshop presenters!”<br />
• “Thank you Margaret for organising such an<br />
amazing event!! We all loved it!!”<br />
The cockles of the heart<br />
Apart from always learning something new at<br />
conferences, what I was very pleased to note was<br />
the enthusiasm, knowledge and passion shown<br />
by the many younger delegates. Of course, the<br />
age range was early twenties to late sixties, but<br />
the median group was probably in the 24 to 36<br />
year age range. Quite a few of the organisers and<br />
speakers are also around the thirty mark, and they<br />
are damn good. They embrace new technologies<br />
and incorporate their TPA skills and more medical<br />
training to enhance outcomes and lift the game.<br />
It pleases me to see a groundswell of enthusiasm<br />
towards RGP lenses and contact lenses in general<br />
as for probably a decade things seemed a bit flat<br />
and the focus was all on TPAs. It seemed to me that<br />
for a while that contact lens subspecialty had lost<br />
the sex appeal it had exhibited from the late 1950s<br />
to the turn of the century.<br />
So it was great to be part of a passionate group<br />
and be able to share the love. That it took place<br />
at the BHVI was also fitting, as Brien was always<br />
one who shared his love for research, contact<br />
lenses and people and enthused those around<br />
him. It does however work both ways and I am also<br />
enthused by the keen young practitioners. Having<br />
a recent graduate join the practice has been<br />
great. Her enthusiasm has rubbed off on me and<br />
discussing fittings and thinking things through has<br />
been great for both of us. #totesamazeballs<br />
Margaret Lam will be presenting as the overseas<br />
keynote at the forthcoming annual Eye Institute<br />
conference so many of you will be able to benefit<br />
from her passionate presentations.<br />
For now I am about to hop on a plane to<br />
Melbourne to present to the final year students.<br />
After that it’s back in NZ for a few days, then<br />
off to Paris for SILMO. Finally it’s off to the AAO<br />
conference in New Orleans in early <strong>Oct</strong>ober and<br />
that’s one massive tick on my bucket list.<br />
More on that in the next edition.<br />
Yeeehah!<br />
“The legendary” Paul Rose by Kelly Hodel<br />
Luxottica reorganisation<br />
impacts NZ<br />
Luxottica Retail Australia and New Zealand<br />
has made some major changes to its<br />
business structure in a move to “adapt<br />
and change to remain relevant in the<br />
market,” according to a statement the company<br />
released in August.<br />
Most of the changes have to do with Luxottica’s<br />
back-office support for its two retail brands<br />
in Australia--OPSM and Laubman & Pank. The<br />
restructure saw the elimination of OPSM’s<br />
national eyecare director, and made state-level<br />
sales managers responsible for state-level<br />
eyecare managers.<br />
Luxottica ANZ president Anthea Muir told NZ<br />
Optics the restructure had impacted New Zealand<br />
staff as well, but without identifying what roles<br />
have been eliminated.<br />
“With these changes, we’ve unfortunately had<br />
to make two redundancies in the New Zealand<br />
head office. However the restructure hasn’t<br />
impacted stores or retail staff,” she said.<br />
Luxottica employs 276 people in New Zealand<br />
and has 50 OPSM stores, overseen by an<br />
executive based in Australia.<br />
Moira McInerney<br />
to leave Auckland Eye<br />
Moira McInerney, Auckland Eye’s chief<br />
executive of more than four years<br />
formally tendered her resignation in<br />
September.<br />
McInerney will be leaving her role in late<br />
<strong>Oct</strong>ober or early November and relocating to<br />
Brisbane, Australia, to be closer to her family.<br />
“Auckland Eye has greatly benefitted from<br />
her huge enthusiasm for our practice,” says<br />
glaucoma and neuro-ophthalmology specialist<br />
Dr Stephen Best. “She has championed sound<br />
governance to encourage better business<br />
practices for our group.”<br />
Under McInerney’s leadership, Auckland<br />
Eye commissioned its Oasis Surgical site, a<br />
comprehensive facility for private surgery<br />
in Remuera. McInerney also reviewed and<br />
restructured its board and governance model,<br />
undertook a three-year refurbishment project of<br />
its central facility, entered a joint venture with Eye<br />
Specialists in Whangarei and enhanced its quality<br />
accreditation, among other new and ongoing<br />
projects.<br />
“Most importantly with Moira’s and Auckland<br />
Eye’s Board input, we have undertaken the<br />
expansion of our Auckland Eye facilities with<br />
the completion of the stage one rebuild and the<br />
stage two renovation of our existing clinic, due<br />
for completion in December <strong>2015</strong>,” says Dr Best.<br />
“Moira plans to return to Brisbane to be closer<br />
to her family, but Auckland Eye will always be<br />
indebted to her great contributions to our group.<br />
“Derek Shearer continues to hold responsibility<br />
for heading up operations for Australia and New<br />
Zealand as the VP of Operations,” Muir said.<br />
OPSM will continue to recruit optometrists, she<br />
added, though former recruitment head Cheryl<br />
Nichols is no longer with the company. Muir did<br />
not say whether Nichols’ departure was related<br />
to the restructure.<br />
“The professional services manager in<br />
New Zealand, Hirdesh Nair, will look after all<br />
recruitment. Hirdesh has been with Luxottica<br />
for more than 11 years and comes with a<br />
wealth of experience across the business<br />
including working as a clinical optometrist<br />
in New Zealand, working as an optometry<br />
learning consultant at the Institute of Learning<br />
and working within the product team across<br />
Australia and New Zealand.”<br />
With an increasing number of franchisee<br />
partners, Luxottica’s Institute of Learning was<br />
also closed as part of the restructure, with the<br />
company encouraging optometrists to work with<br />
associations and industry bodies to continue<br />
their professional development. ▀<br />
Moira McInerney, CEO of Auckland Eye<br />
Transitions ad<br />
campaign a success<br />
A<br />
regional<br />
campaign that culminates<br />
in <strong>Oct</strong>ober with a prize draw has<br />
so far generated millions of hits for<br />
Transitions Optical, the lens maker<br />
announced.<br />
The Celebrate life in the best light campaign began<br />
in July through online, television and social<br />
media channels, including the Yahoo network,<br />
and during Channel 7’s Sunrise breakfast show in<br />
Australia.<br />
The campaign uses real-life stories from<br />
three Transitions lens wearers, including hot<br />
air balloon operator Michael Oakley from New<br />
Zealand. In video presentations, the company<br />
shows how Transitions lenses have played a<br />
role in these customers’ pursuits of personal<br />
passions. The videos are meant to encourage<br />
customers to enter a prize draw by writing a<br />
little bit about their own passions.<br />
“Using their stories as inspiration, our major<br />
prize contest asks entrants to tell us about their<br />
passion (in their job, hobby or daily life) and how<br />
As the current chair of Auckland Eye and on<br />
behalf of all our shareholders I wish Moira all the<br />
very best for her ongoing career, recognising her<br />
very significant contribution to our practice.”<br />
McInerney says she regards her role as<br />
Auckland Eye’s CEO as “her best job ever”.<br />
Auckland Eye has already launched the<br />
recruitment process to find a new CEO.<br />
Operations will continue as usual. ▀<br />
seeing through Transitions lenses could help<br />
them to enjoy it even more,” says Stuart Cannon,<br />
Transitions optical general manager, Asia Pacific.<br />
“The campaign is designed to generate more<br />
discussion about healthy vision as a part of<br />
everyday lifestyle, which we hope to promote<br />
further by amplifying stories we receive from real<br />
glasses wearers.”<br />
Transitions says the campaign has generated<br />
more than 30 million online impressions.<br />
The video productions about Oakley, an<br />
architect from Hong Kong and a teacher from Bali<br />
can be found at www.transitions.com/en-au/lifein-the-best-light/<br />
The prize contest for a holiday for two to<br />
Fiji will be drawn on <strong>Oct</strong>ober 14. Entries can<br />
be submitted through www.transitions.com/<br />
en-au/celebratelife/ or www.facebook.com/<br />
transitionsanz.<br />
Eye care professionals can re-fresh Transitions<br />
Optical point of sale materials through their local<br />
lens supplier. ▀<br />
26 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 26<br />
9/18/<strong>2015</strong> 6:43:54 AM
J&J brings new<br />
multifocal CLs to ANZ market<br />
Johnson & Johnson Vision Care rolled out<br />
the company’s new 1-Day Acuvue Moist<br />
multifocal contact lens at a launch event in<br />
Auckland on September 7.<br />
More than 40 optometrists attended the<br />
event, featuring the head of J&J’s research and<br />
development department in the US, Kurt Moody,<br />
who was on an eight-city tour promoting Acuvue<br />
Moist.<br />
Moody, said the goal of Acuvue Moist, when his<br />
team began work on it in 2010, was to address<br />
the discomfort multifocal CL-wearers reported in<br />
studies.<br />
“Wearers were ok with the lenses they had,<br />
but couldn’t keep them in their eyes past two or<br />
three in the afternoon.”<br />
Research out of the University of Waterloo in<br />
Canada showed that 48 per cent of the people in<br />
the study prescribed multifocal lenses for a year<br />
discontinued use after two months because of<br />
dryness and discomfort.<br />
The team developed the 1-Day Acuvue Moist<br />
combining material J&J has used since the<br />
late 1980s, etalificon A, with a “permanent<br />
wetting agent” known as polyvinyl pyrrolidone<br />
(PVP), which chemically attracts and maintains<br />
moisture throughout the lens. The lenses were<br />
also designed to take into account pupil size due<br />
to both refractive error and age, based on a study<br />
J&J conducted that measured the relationship<br />
of pupil size to age, lighting conditions and<br />
refractive error in 609 patients ranging in age<br />
from 18 to 78 years old.<br />
“The data shows that with age, the pupils<br />
become smaller and less responsive: not a big<br />
‘ah-ha’ moment. But what became important<br />
in the data about pupil diameter, was it gave<br />
our designers a positive correlation in regard to<br />
refractive range: hyperobes have smaller pupils,<br />
myopes, bigger,” explained Moody<br />
This led to the development of a large number<br />
of designs to accommodate the range of<br />
refractive correction needs for people with pupils<br />
of varying sizes. Acuvue Moist’s basic range of<br />
refractive power lenses go from +6D to -9D in<br />
.25D increments, or 61 lenses, each with three<br />
add variations--low, middle, and high--adding to<br />
183 lenses in total.<br />
Coupled with the flexible range of refractive<br />
power in the lenses, optometrists can follow the<br />
Acuvue Moist fitting guide to keep patient “chair<br />
time” to a minimum. Following a subjective<br />
refraction and correction for vertex difference<br />
for greater than +/- 4D, Moody recommended<br />
optometrists use the sensory method, not<br />
the more commonly used sighting method, to<br />
determine dominant eye.<br />
“Once you have the patient’s proper correction,<br />
do a +1D test in front of each eye. This makes<br />
the vision in each eye blurry, and ask the patient<br />
which eye is more comfortable with the change.<br />
If the left is more comfortable, the right eye is<br />
dominant. It’s a more accurate test with our<br />
system.”<br />
The next step is to determine the reading add,<br />
using whatever method your practice typically<br />
employs, and then give the patient settling<br />
time, by making them look out the window, at a<br />
screen, at various distances.<br />
The company accelerated delivery of the<br />
product to the region due to anticipated<br />
popularity, according to Paul Griebel, general<br />
manager of Johnson & Johnson Vision Care for<br />
ANZ. Acuvue launched in the States in May,<br />
which going by previous circumstances would<br />
have meant a May 2016 launch in Australasia.<br />
“We knew we have these highly trained<br />
clinicians here, and there will be a high demand<br />
for this product, so we wanted to get it here as<br />
soon as we could,” Griebel said.<br />
Renee Edgar, of McClellan Grimmer Edgar<br />
in Wellington, was among a small group of<br />
regional optometrists who participated in a prelaunch<br />
programme in Sydney earlier this year,<br />
subsequently trialing Acuvue Moist on a number<br />
of patients. Edgar gave a presentation at the<br />
Auckland launch event discussing the generally<br />
positive results.<br />
“I generally tend to be honest with patients and<br />
say we’re not going to get it perfect all the time,”<br />
she said. “There might be some blurring in the<br />
distance, but I tend to undersell, and the product<br />
ends up over delivering, and the patient is really<br />
happy. Expectation is the biggest thing.”<br />
Of the eight patients Edgar prescribed Acuvue<br />
Moist, six were women aged 48 and over, one<br />
younger female, and one male. The majority were<br />
happy with the purchase, and the fitting process<br />
required minimal chair time, she said. ▀<br />
Angeline Ng, Lynden Mason, Shirley Ip and Trevor Skinner<br />
Paul Griebel, Jeremy Wong, Nicholas Jobson, Sean McKiernan and Rochelle Yukich<br />
Speakers at the JJVC ‘Innovating for multifocal contact lens success’ seminar from left: Dr Kurt Moody, Dr Emma<br />
Gillies and Renee Edgar<br />
Acuvue Moist promotional shot<br />
Ormonde gives<br />
keynote at ACO<br />
conference<br />
Auckland Eye’s Dr Sue Ormonde will<br />
give one of the keynote addresses<br />
at the Australian College of<br />
Optometry’s National Conference<br />
in Melbourne, which runs from <strong>Oct</strong>ober 24 to<br />
<strong>Oct</strong>ober 25.<br />
“Dr Ormonde will fly across the Tasman to<br />
get the ball rolling with her keynote address<br />
on the refractive treatment of keratoconus”<br />
as the first speaker of the event,” said<br />
conference organisers.<br />
“She will be back later to encourage<br />
[attendees] to participate in a discussion on<br />
cutting-edge treatments in anterior segment<br />
surgery. Last but not least, Sue will return Dr Sue Ormonde<br />
to the stage on Sunday afternoon for the<br />
concluding lecture of the conference.”<br />
The conference is being held at the Melbourne Cricket Ground and includes a cocktail party on<br />
Saturday afternoon to launch Barry Cole’s book, History of Australian Optometry.<br />
For more information, visit www.aco.org.au/professional-development/aco-national-conference ▀<br />
<strong>Oct</strong>ober <strong>2015</strong><br />
NEW ZEALAND OPTICS<br />
27<br />
<strong>Oct</strong>ober <strong>2015</strong>.indd 27<br />
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SPECIALIST SHOPFITTERS & DESIGNERS TO THE OPTOMETRIC PROFESSION<br />
TEL:(09) 486-2070 MOB:(0274) 798-798<br />
Email: tony.maddocks@xtra.co.nz<br />
RARE OPPORTUNITY<br />
We have a lifestyle practice serving a semi-rural community<br />
for sale not far from central Auckland. Ideally suited for an<br />
optometrist wanting to work for themselves and have all the<br />
flexibility that goes with being an owner operator. Could also be<br />
ideal business opportunity for a mum wanting to return from<br />
maternity leave providing the flexibility that is needed. Double<br />
digit earnings with potential for further growth earnings.<br />
If you think this sounds like you, please apply in the strictest<br />
confidence c/- NZ Optics, info@nzoptics.co.nz Code PFSS1.<br />
PERIMETER FOR SALE<br />
Opto AP100 Perimeter for sale. Excellent instrument which came from<br />
our city practice after the Feb 11 earthquake. As-new condition and<br />
complete with table. Perfect for both in depth Visual Field examinations<br />
or for routine screening. $2,600 + GST. Contact Julia Saulsbury,<br />
PH 03-3480008 or js.visioncare@xtra.co.nz<br />
PRACTICE FOR SALE<br />
Long established, fully equipped, independent Invercargill<br />
practice with loyal patient base. Several options open for<br />
ownership of practice and building(s) at sensible Non-Auckland<br />
prices. Merger also an option in which situation optometrist<br />
and manager would assist with transition. For more info phone<br />
Alan on 03 214 5500 or 021 263 1001 or email with your contact<br />
details to greenwelloptom@xtra.co.nz.<br />
EQUIPMENT FOR SALE<br />
Zeiss Lensmeter (old), Maddox unit, Bernell aperture rule, Javal Schiotz<br />
keratometer. Email mollymat@xtra.co.nz<br />
BUSINESS DEVELOPMENT MANAGER<br />
Little Peach is seeking the services of an Auckland based business<br />
development manager.<br />
Little Peach market the following optical frame brands: C-ZONE,<br />
DILEM, EYEFUNC, FACE & CIE, GLARE, JOHN LENNON, PAUL & JOE<br />
and SALT.<br />
The successful applicant will have a strong desire to help our<br />
current and potential customer base of optical outlets grow their<br />
business utilizing certain Little Peach brands.<br />
Based in Auckland the successful applicant would work on<br />
an 8 week call cycle and consequently be out of town for<br />
approximately 7-8 nights per month. A company car and<br />
competitive remuneration package is offered to the right person.<br />
This is a great opportunity to join a progressive, and forward<br />
thinking company. Little Peach, is Christchurch based and we<br />
market some of the finest eyewear available, however we<br />
don’t do conservative we don’t do boring and the successful<br />
applicant will certainly be a extension of this. We are looking for<br />
a driven person with a high work ethic, and a friendly easy going<br />
personality. A high level of self discipline, good fitness with a good<br />
sense of humor, will turn a good job into a sound career.<br />
If this sounds like you then please apply in total confidence to<br />
david@littlepeach.co.nz.<br />
WANT YOUR OWN PRACTICE?<br />
Owner/optometrist Jan Thompson is selling her West Auckland<br />
practice, Westgate Optometrists. Those interested in taking over<br />
an independent practice that has been established in its current<br />
location for over a decade is welcome to send a confidential<br />
enquiry to westopt@ihug.co.nz or stu@opticsnz.co.nz.<br />
LOCUM OPTOMETRIST AVAILABLE<br />
Bharat Raniga. Call 021424253 or Email: bharatraniga@yahoo.com<br />
RARE OPPORTUNITY TO JOIN OUR TEAM!<br />
EXPERIENCED DISPENSING OPTICIAN OR OPTICAL<br />
ASSISTANT - FULL TIME, PERMANENT ROLE<br />
An opportunity has arisen for a dispensing optician to join the<br />
School of Optometry and Vision Science supporting students<br />
participating in the only optometry programme in New Zealand.<br />
The School of Optometry provides the on-site clinical teaching<br />
component for a range of academic programmes, including the<br />
Bachelor of Optometry (BOptom). Graduates of the programme<br />
are able to apply for registration to enable them to work as<br />
optometrists in New Zealand and Australia. We provide a wide<br />
range of assessment, treatment and dispensing services to adults<br />
and children. Services are offered to the general public, staff and<br />
students on a fee-for-service basis.<br />
The optometry teaching clinic operates at the Grafton and Tamaki<br />
campuses. Both locations have modern, well equipped consulting<br />
rooms and large, attractive dispensing areas. It is an independent<br />
practice and stocks a wide range of frames and lenses.<br />
OPT<br />
A full<br />
or ex<br />
The jo<br />
it wo<br />
If you<br />
like to<br />
pleas<br />
This role will ideally suit an experienced dispensing optician who<br />
wishes to combine working in a busy, client-centred practice<br />
with the stimulation and challenge of working in a teaching<br />
environment. We are seeking candidates who are already<br />
registered, or are eligible for registration, as a dispensing optician<br />
with the NZ Optometrist and Dispensing Opticians Board under<br />
the Health Practitioners Competence Assurance Act.<br />
We are also open to hearing from exceptional candidates who<br />
have significant experience in an optical assistant role and wish<br />
to train and become registered as a dispensing optician. These<br />
candidates must be able to demonstrate sound experience<br />
and knowledge together with a commitment to continuing<br />
professional development.<br />
You must be focused on customer service, be highly professional,<br />
interested and experienced in the business aspects of service<br />
delivery and understand the need for ongoing development to<br />
ensure we deliver best practice service to students and clients.<br />
A commitment to the teaching and development of students is<br />
essential. We provide financial support towards professional fees<br />
and continual education.<br />
You will work with a highly experienced, full time dispensing<br />
optician colleague and will work closely with the clinical director<br />
of the BOptom programme and staff at the School of Optometry<br />
and Vision Science.<br />
Please see the website www.optometry.auckland.ac.nz for more<br />
information on the school.<br />
We look forward to hearing from you. Please see the University of<br />
Auckland’s website www.opportunities.auckland.ac.nz for a job<br />
description and to apply for the position.<br />
Closing date: 15 <strong>Oct</strong>ober <strong>2015</strong><br />
TRACEY JONES OPTOMETRIST<br />
Seeking permanent position(s) in Auckland<br />
LinkedIn, 027 225 7112, traceyjonesoptometrist@gmail.com<br />
28 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />
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