Oct 2015

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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 />


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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 />

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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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What a month<br />

and RANZCO to come<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 />


contact MSO on (09) 849 3415<br />

www.europeaneyewear.com.au<br />

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 />


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 />


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 />


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 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 />


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 />


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 />


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 />


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 />


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 />


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 />


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 />


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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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 />



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 />


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 />


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 />



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 />


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 />


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 />


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 />


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 />


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 />





ideas into practice<br />

<strong>Oct</strong>ober <strong>2015</strong><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 />



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 />


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 />


• 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 />


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 />



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 />



ideas into practice<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 />




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 />


13<br />

<strong>Oct</strong>ober <strong>2015</strong>.indd 13<br />

9/18/<strong>2015</strong> 6:43:42 AM


<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 />


Optos’ core devices produce ultrawidefield,<br />

high-resolution digital<br />

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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 />

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to colour, autofluorescence and fluorescein angiography. Taking<br />

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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 />


optomap optomap af optomap fa optomap icg<br />



Optos has the only imaging technology that produces ultra-widefield images of 200°<br />

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See more, discover more, and treat more effectively<br />

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optos.com<br />

<strong>Oct</strong>ober <strong>2015</strong><br />


15<br />

<strong>Oct</strong>ober <strong>2015</strong>.indd 15<br />

9/18/<strong>2015</strong> 6:43:45 AM


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 is a New Zealand and Australian owned, fully<br />

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We are committed to providing quality products and excellent<br />

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INSTRUMENTS, ACCUTOME, FISO, TOMEY plus many more.<br />

At RANZCO <strong>2015</strong> we will have a great range of equipment on<br />

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ZEISS<br />

RANZCO this year will give clinicians the<br />

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technologies from ZEISS.<br />

With its recent clearance from the US Food and<br />

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AngioPlex OCT Angiography on the CIRRUS HD-<br />

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AngioPlex OCT Angiography takes just seconds<br />

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new Humphrey Field Analyzer 3 (HFA3), the SL220<br />

tower-style slit lamp and the new software for<br />

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ZEISS will be represented by the surgical team<br />

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Hylo-Fresh (sodium hyaluronate 0.1% w/v,<br />

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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 />

9/18/<strong>2015</strong> 6:43:46 AM

TECNIS<br />

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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 />


17<br />

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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 />


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

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UltraSert <br />


Advancing<br />


<strong>Oct</strong>ober <strong>2015</strong><br />


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Alcon NZ Optics UltraSert-ORA single page 420x297_099-15_4 outlines.indd 1<br />

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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 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 />




Optical biometry can be that good!<br />

The OA-2000 integrates topography, axial length, lens<br />

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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 />

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20 NEW ZEALAND OPTICS <strong>Oct</strong>ober <strong>2015</strong><br />

<strong>Oct</strong>ober <strong>2015</strong>.indd 20<br />

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The moment you benefit from the latest medical technology.<br />

ZEISS Innovations: Trusted and Proven.<br />

Visit<br />

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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 />

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Scan here to receive<br />

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www.zeiss.com.au/ranzco<strong>2015</strong><br />

<strong>Oct</strong>ober <strong>2015</strong><br />


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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 />


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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<strong>Oct</strong>ober <strong>2015</strong><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 />


L<br />

R<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 />


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 />


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 />


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 />


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 />


* 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 />


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 />


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 />




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 />


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 />


27<br />

<strong>Oct</strong>ober <strong>2015</strong>.indd 27<br />

9/18/<strong>2015</strong> 6:43:59 AM


TEL:(09) 486-2070 MOB:(0274) 798-798<br />

Email: tony.maddocks@xtra.co.nz<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 />


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 />


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 />


Zeiss Lensmeter (old), Maddox unit, Bernell aperture rule, Javal Schiotz<br />

keratometer. Email mollymat@xtra.co.nz<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 />


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 />


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 />


Bharat Raniga. Call 021424253 or Email: bharatraniga@yahoo.com<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 />


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 />

<strong>Oct</strong>ober <strong>2015</strong>.indd 28<br />

9/18/<strong>2015</strong> 6:43:59 AM

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