Sep 2015

THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY 

PO BOX 106 954, AUCKLAND CITY 1143 

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

September 2015 

A WINNER 

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1,2 

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References: 1. Data on fi le, Bausch & Lomb Inc. 2. Scheuer C.A, Fridman K.M, Barniak V.L, Burke S.E, Venkatesh S: Retention of conditioning agent hyaluronan on hydrogel contact lenses. Contact Lens Anterior Eye. (2010). 3. Frescura M, Berry M, Corfi eld A, Carrington S, Easty D. Evidence of hyaluronan in human 

tears and secretions of conjunctival cultures. Biochem Soc Trans 1994;22:228S. 4. Lerner L, Schwartz D, Hwang D, Howes E, Stern R. Hyaluronan and CD44 in the human cornea and limbal conjunctiva: letter to the editor. Exp Eye Res 1998;67:481-4. 5. Adler’s Physiology of the Eye, 7th ed. RA Moses and WM 

Hart eds. Mosby: St Louis, 1987. 6. Data on File, Bausch & Lomb Inc.: Results of in vitro study following FDA/ISO Stand Alone Procedure performed with the addition of organic soil to create a more rigorous test condition. Primary criteria for effective disinfection are defi ned as a reduction in the number of bacteria by 

a minimum of 3 logs(99.9%) and a reduction of mold and yeast by a minimum of 1 log (90%) within the recommended disinfection time. All solutions passed FDA/ISO primary stand-alone standard testing without organic soil. Results depict mean log reduction measured after manufacturers’ recommended disinfecting 

time (soak only). Biotrue®, Clear Care (AO Sept Plus), RevitaLens OcuTec, OPTI-FREE PureMoist and OPTI-FREE RepleniSH results from separate in vitro studies performed following identical test procedures. 

7. Barniak V, Burke S, and Venkatesh S: Comparison evaluation of multi-purpose solutions in the stabilization of tear lysozyme. Contact Lens Anterior Eye. (2010), doi:10.1016/j.clae.2010.06.011. 

© 2013 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affi liates. Other product names /brand names are trademarks of their respective owners. 

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

2 NEW ZEALAND OPTICS September 2015

Time to move over....... 

It’s time to say goodbye 

to my role as editor and 

publisher of New Zealand 

Optics. When I was 

first involved in purchasing 

the magazine from Barbara 

Vague some 34½ years ago 

I would never have guessed 

that I would spend more than 

half my life involved in the 

ophthalmic industry. And what 

a rollercoaster ride it has been! 

I’d like to thank all my 

friends and colleagues in 

ophthalmology, optometry, 

dispensing and the wider 

industry including the 

university and the many 

wholesalers and distributors 

for their trust in me and their 

support over the years. 

For a non-optometrist 

and ophthalmologist I feel 

privileged to have learnt 

so much about your world 

whether it be eye conditions, 

eye disease, eye surgery, 

ophthalmic drugs, the design 

of frames and lenses to name 

just a few. It’s also been a 

privilege to have been involved 

in the technological advances 

which have transformed this 

industry since joining it in the 

early 80s. One thing for sure, 

these changes are going to 

continue to happen and that’s 

what has made my job so 

exciting. 

I’ve had the immense 

pleasure to meet people all 

around the world associated 

with your professions and 

industry. Too many highlights 

to mention individually 

BY MARYANNE DRANSFIELD 

but certainly the Essilor 

educational conferences held in 

Asia would have to be up there, 

as well as the 40th anniversary 

of Silmo in France. 

There have been many 

people who have helped 

us to make the magazine 

the success it is. I’d like to 

single out Alan Saks who has 

relentlessly churned out a 

monthly In Contact column 

for over 20 years; Professor 

Charles McGhee for having 

the insight to develop the Eye 

on Ophthalmology column so 

research and developments 

in ophthalmology got some 

exposure, and for orchestrating 

along with Associate Professor 

Dipika Patel the many people 

who have contributed to this 

over the years; and Dr Sue 

Ormonde whose idea it was 

to develop the regular Focus 

on Research contribution. 

Also thank you to the various 

contributors of Focus on 

Business, a very worthwhile, 

topical column that plays a role 

in shaping your businesses. 

A special mention too for Dr 

Bruce Hadden who kindly 

guided the way so we could 

embrace ophthalmology in the 

magazine. Also a huge thanks 

to my business partner and 

daughter-in-law Anita who has 

worked with me for the past 12 

years. She has played a big part 

in growing the magazine and 

the Optical Information Guide. 

It’s the end of an era for 

my entire family. All three of 

my children have worked in 

The familiar faces of Maryanne and Anita Dransfield at work at 

ODMA|2015 

the business at some stage 

and have gotten to know 

many of you. Now there are 

seven grandchildren who are 

mightily relieved they don’t 

have to become involved in 

sticking labels on bags or 

inserting copies. 

It’s time to explore new 

ventures and take a welldeserved 

break with some 

travel high on the priority list. 

Anita and her family are off for 

a year’s travel overseas later 

this year before their two girls 

start secondary school. 

Anita and I have handed over 

the reins to Lesley Springall, 

a very competent journalist 

whom I am sure will take the 

magazine to the next level. 

Simon Eskow has joined Lesley 

as editor. However, I can assure 

you that it is business as usual 

and we are both continuing 

to work with Lesley over the 

coming months to ensure that 

she is fully settled and gets 

a chance to meet everyone. I 

will also be continuing with 

the publication in a new role 

as editor-at-large, where I will 

continue to represent NZ Optics 

at various industry events 

and help Lesley make sure we 

continue to keep everyone 

informed of what’s going on, 

both here and overseas. 

Whatever the future holds, 

optics will always be close to 

my heart. Sincere best wishes 

to everyone in this stimulating 

and dynamic industry and 

thank you for the opportunity 

of bringing the changing world 

of optics to you for all these 

years and for the fun we have 

had! O 

Rodenstock quashes sale 

rumours and eyes NZ 

Rodenstock, one of 

the world’s biggest 

frames and lens 

manufacturers, is 

not going through any sort of 

official sale process, despite 

persistent rumours to the 

contrary. 

Tim McCann, general manager 

of Rodenstock Australia, 

quashed the rumours in an 

interview with NZ Optics shortly 

after ODMA. Hearsay is par for 

the course for the company 

given it’s owned by UK-based 

international private equity 

company Bridgepoint and a 

number of other financiers. 

Tim McCann 

There are strong rumours that 

there is an interested party, said 

McCann. “But we don’t know who it is at this stage. The one thing 

that is certain and I have an absolute emphatic response on is it’s 

definitely not Essilor or Hoya.” 

Many were speculating about Rodenstock’s potential sale at 

ODMA|2015 this year following an article by Bloomberg Business in 

May, which named rival lens manufacturers Essilor International 

and Hoya Corp among suitors said to be weighing bids for their 

German competitor. Bridgepoint is said to have hired investment 

bank Goldman Sachs Group to look at options for the company 

earlier this year with any sale likely to fetch more than 500 million 

euros ($825 million) for Rodenstock’s shareholders. 

After hosting Rodenstock’s international senior management 

team at ODMA, McCann says the company is in a good strong 

position and is currently looking to expand its presence globally, 

including returning to its once strong position in the New Zealand 

market. “The strength of the company and the strength of the 

brand is obviously growing globally…and certainly the feeling 

is that our brand is quite well-recognised in New Zealand and is 

viewed favourably so it would make sense to do something with 

that and that’s what we’re hoping to do.” 

McCann was in New Zealand prior to ODMA, canvassing “some 

key opinion leaders” about what it would take to be successful 

again in New Zealand. He says the company’s currently weighing 

up its options. “There’s nothing definite about how we do it, but 

we’re certainly interested. We want to make sure that the quality 

of the brand and the reputation of the company is maintained 

throughout, so it won’t be anything that will be fast but when we 

do it, we will do it well.” O 

CORNEAL LENS 

CORPORATION N.Z. LTD 

ideas into practice 


NEW ZEALAND OPTICS 

3

Tauranga practice taps 

Maunganui style 

Standing are Karl Fischer and Susan Sharpes, with (seated, from left) Anya 

Fischer, and Sally Gowland, office co-ordinator 

The founders of a 

new Mt Maunganui 

optometry practice 

consciously chose the 

look and location of their new 

venture based on more than 40 

years combined experience in 

the industry. 

“We have seen all aspects of 

optics: the good, the bad and 

the ugly,” says Karl Fischer, 

who opened Fischer+Fischer 

Optometrists with his wife, 

Anya. “We decided the only 

way forward was to create 

an independent practice with 

a strong message of quality, 

workmanship, attention to 

detail and impeccable customer 

service.” 

The Fischers favoured a 60s, 

modernist aesthetic in the 

design of their practice and 

in their choice of middle to 

high-end frame lines. They say 

Mt Maunganui was a natural 

location for their style. 

“It is an up and coming area 

with a strong designer and 

art vibe, with well-travelled, 

discerning Kiwis in search of the 

EYE DOCTORS 

FINAL GRAND ROUND FOR 2015 

Dr Andrew Riley 

FRANZCO 

Dr Penny McAllum 

FRANZCO 

better things in life,” says Karl. 

The couple enlisted Stufkens 

and Chambers architects 

to create a “quirky but 

approachable” interior and 

spent months of research 

designing the space. 

“We spent a lot of time with 

our architect explaining the 

flow of our work and the 

patient’s journey. We wanted 

the feeling of space and air 

to permeate the practice. The 

rooms are generous in size, the 

corridors are wide enough to 

manoeuvre a wheelchair, and 

the doorways are broad.” 

The interior combines natural 

materials with polished 

concrete and steel, in a bluegreen 

palette with brown and 

grey highlights. 

Karl says they were elated by 

the end result, but getting there 

wasn’t easy. “The whole process 

can be at times very stressful. 

Always have a plan B, C and 

D… and then relax.” 

The practice opened in June 

with a staff of four, including 

the Fischers. O 

Dr Mark Donaldson 

FRANZCO 

Dr Shuan Dai 

FRANZCO 

Ophthalmologist wins 

entrepreneurial award 

Christchurch-based 

ophthalmologist Dr 

Rebecca Stack stood 

out among 130 entries 

in a competition recognising 

working mothers as successful 

entrepreneurs. 

Dr Stack won the Best 

Product or Service business 

category and was named 2015 

Supreme Mumtrepreneur of 

the Year winner at an event on 

July 22 hosted by Loyalty New 

Zealand, sponsor of the annual 

competition. 

The award recognised Dr 

Stack’s key role in establishing 

the Christchurch Eye Surgery, 

a purpose-built facility that 

opened in June 2014 and now Dr Rebecca Stack 

carries out 75 per cent of 

ophthalmic procedures in the 

Canterbury region. 

Dr Stack says Christchurch Eye Surgery was launched to fill a 

gap in the market for a dedicated facility. “Patients for eye surgery 

are not unwell and do not need to be in a hospital. We wanted to 

create a centre of excellence with the best of technology, the best 

trained staff and by doing so design a patient experience that 

would be as pleasant and non-medical as possible.” 

The surgery has received several awards in its own right and 

now includes two surgical theatres and state-of-the-art air 

management and patient monitoring and tracking. 

“The patient feedback has been overwhelmingly positive,” Dr 

Stack says. “The time spent on design means we have created an 

efficient and technologically superior facility to anything else in 

Christchurch.” 

The practice employs a staff of around 20 with nine 

ophthalmologists, including Drs James Borthwick, Ian Dallison, 

Sean Every, David Kent, Malcolm McKellar, Jo-Anne Pon, John 

Rawstron and Allan Simpson. 

Dr Stack, who earned an MBChB (distinction) and MMedSC from 

Otago, juggles her time among Christchurch Eye Surgery, Southern 

Eye Specialists and Canterbury Charity Hospital and teaches 

medical students and optometrists. She also a regular conference 

speaker, wife and mother of two. 

“While it is a challenge fitting in family time I do try and keep 

one day a week free from work commitments, especially while 

my children are young,” she says, while admitting that she often 

ends up taking work home and spending evenings and weekends 

attached to her laptop after the children have gone to bed. 

“I am lucky enough to have a tremendously supportive husband. 

He is a farmer and has a little more flexibility than me so often 

joins in school activities with the children.” 

As Supreme winner and category winner, Dr Stack has received 

40,000 Fly Buys from Loyalty New Zealand. O 

New campaign for Crizal Transitions 

Crizal Transitions 

has launched a new 

campaign offering 

optometrists and their 

customers the chance to win 

weekly prizes to the value of 

$500 for every purchase of Crizal 

Transitions lenses during the 

campaign period. 

The integrated campaign 

features stunning Canadian 

actress Laurence Leboeuf 

wearing Transitions Graphite 

Green lenses inspired by the 

iconic U.S. Navy pilot eyeglasses 

from the 1950s. 

“Transitions Graphite Green 

perfectly complements many 

frame styles and colours. From 

classic to cutting-edge style, 

customers can transform any 

pair of regular eyeglasses into 

a striking look all their own,” 

said Essilor, manufacturer of 

Crizal Transition lenses, in a 

statement. 

Also available in grey and 

brown and with the added 

benefits of Essilor’s Crizal UV, 

glare and scratch protection, 

Crizal Transitions adapt 

spontaneously to changing 

light conditions, with a fast 

activation in the sun in less than 

60 seconds. 

The new campaign will 

run from September 14th to 

November 27th. O 

Actress Laurence Leboeuf promotes Transitions Graphite Green lenses 

in new campaign 

We look forward to seeing you. 

28th October - Novotel, by Ascot Hospital 

No registration fee . CME points available 

Visit our website for more details 

or phone us on (09) 520 9689 

to register. 

Ascot Hospital (09) 520 9689 - Botany Junction (09) 277 6787 

www.eyedoctors.co.nz 

September is Save Our 

Sight month 

NZAO’s 

annual 

Save Our 

Sight 

campaign returns in 

September showing 

there is more to 

optometry than a 

new pair of glasses. 

The campaign 

is designed to 

reinforce the value 

of eye exams and to 

propagate positive action for eye health among the general public. 

This year’s campaign includes a refreshed Comprehensive 

Eye Exam pamphlet, which will be distributed via MediBoard 

receptacles at 800 GP practices throughout the country. 

The NZAO is also printing a special Save Our Sight issue of its GP 

Quarterly newsletter, which will be distributed to an additional 

4500 GPs, placing a number of advertisements in magazines and 

resurrecting its 2014 TV commercial which will show on air, TVNZ 

on Demand, Stuff and Trade Me. 

Save Our Sight month launched in 2002 with the general aim of 

improving eye health by encouraging people to get regular exams 

by optometrists, to show the connection between eye health 

and general health, and to broaden the perception of eye exams 

beyond its popular association with getting glasses whatever your 

age. More information is available at www.saveoursight.co.nz. 

NZAO conference update 

The NZAO says its 85th annual conference will feature a diverse 

range speakers and quality CPD content. The conference will be 

held at the Scenic Hotel Southern Cross in Dunedin from October 9 

to October 11. 

Optometrists can register from now, online, to the conference 

opening day. The NZAO says the total number of CPD hours to 

be offered has not been finalised, but the organisation expects 

to provide 13 hours in total. To register and to view the full 

programme, visit www.nzao.co.nz/nzao-conferences. O 

ADONZ 2015 

promises stellar 

lineup 

Dispensing opticians have until the afternoon 

of October 1 to register for this year’s ADONZ 

conference, which is hotting up to be quite an 

event. 

The conference features a solid lineup of workshop 

presentations, with the opportunity to earn up to 14 CPD 

points. Plus attendees will need to don their gladrags 

for a ‘Roaring ‘20s’ gala evening, celebrating the 20th 

anniversary of the ADONZ education service, Opti-Blocks. 

ADONZ 2015 runs from October 9 to October 11 at 

the Novotel Tainui in Hamilton. Speakers include wellknown 

optics lecturer, researcher and author Dr David 

Wilson and OTEN optics learning coordinator Steve Daras, 

both Australia-based; Elaine Grisdale, an education and 

marketing coordinator from the Association of British 

Dispensing Opticians will be giving three workshops 

covering the psychology of communicating with patients, 

smarter dispensing for presbyopes and daring to be 

different with bespoke eyewear. Other speakers include 

Dr Srechko ‘Stretch’ Kontelj, legal director for Asia Pacific 

with Specsavers and Clinical Professor at Deakin University 

School of Medicine; Stephen Caunter, ANZ business 

training manager; Rodney Stedall from Paterson Burn 

Optometrists; and Dr Stephen Guest from the Hamilton Eye 

Clinic, who will be talking about ‘Bugs in the Eye: ocular 

infections you should know about’. 

In addition to 13 CPD points available across ethical, 

cultural and technical requirements, a limited number of 

attendees can earn an extra CPD point for sitting in one of 

two sessions on Vertex Distance, though seating for this is 

limited. 

For more information, to see the full programme or to 

register online, go to http://conference.adonz.co.nz/. O 


PROMISES, 

PROMISES… 

(THE SECRET OF A SUCCESSFUL PARTNERSHIP) 

Why so many optical professionals have become Specsavers Partners 

Almost seven years ago we opened the first of our 50+ New Zealand stores, 

which are owned and operated by local optical professionals. Typically, y, a 

Specsavers store is a joint venture partnership between an Optometry Partner 

and a Dispensing Partner: they own all of the profits of their business and all 

the saleable equity too, giving them an asset to build for retirement or when 

it’s time to sell. As the third ‘partner’ Specsavers owns none of the profit or the 

saleable equity but provides a depth of support services in exchange 

for franchise fees. 

Why so much traction? 

Going into business for yourself is a big decision – and we have spent 30 years 

crafting our franchise partnership offer and support package to ensure that, 

once made, the decision hides no surprises for our Store Partners. We’ve found 

that our straightforward answers to a range of big questions – and the promises 

we are happy to make and be held to - are a major factor in the partnership p 

decision-making process… 

5 big questions Specsavers Others 

Can you promise that all your stores 

are available for franchise – and that 

you have no goal to retain a stable of 

company-owned stores? 

Can I become a store owning 

Partner without having to go to the 

bank for finance? 

? 

? 

Will you guarantee me a market rate 

Salary for the life of my franchise? ? 

Can you promise you’ll never reduce 

your marketing budget? 

(it’s 6.5% of sales at Specsavers) 

Will you take on all my accounting, 

back-office, payroll, accounts 

payable and tax compliance work as 

part of the fees you charge your joint 

venture Store Partners? 

? 

? 

Now let’s answer your questions… 

Go to 

spectrum-blog.com 

for all the current 

opportunities! 

Our Partner Recruitment team is always on hand to 

answer questions from aspiring franchise partners – you may be 

thinking about store ownership options and we would like to take you 

through the kind of business opportunity that Specsavers presents, 

from leadership development to sales and profits. We’re an open 

book and we’re ready to talk. 

Simply contact Raj Sundarjee on 0800 773 077 or 

raj.sundarjee@specsavers.com to get the 

conversation started. 

NZ Franchise 

System of 

the Year 

2014 

Retail 

Innovator 

of the Year 

2014 

Multichannel 

Retailer 

of the Year 

2014 

Roy Morgan 

Research 

No. 1 for eye tests 

2014 

FCA International 

Franchisor 

of the 

Year 

2014 

FCA Social 

Responsibility 

Award 

2014 

FCA Established 

Franchisor 

of the Year 

20 

13 

FCA Excellence 

in Marketing 

Award Winner 

2013 

Australian 

Retailer 

of the 

Year 

2013 

Australian 

Retail 

Employer 

of the Year 

2013 

Asia 

-Pacific Best 

Retail Training 

Organisation 

2013 

September embe 

2015 

NEW ZEALAND AND OPTICS 

5

Focus 

on Business 

Aspiring to greatness 

BY JUANITA NEVILLE-TE RITO* 

I 

recently had an interesting discussion with a crowd 

of 150 people about why retail in New Zealand is so 

poor. This conversation took place right after I had 

expressed my adulation for a craft experiencing a 

renaissance. 

Internationally, retail is in a period of renaissance, but 

if my weekend shopping experience is anything to go by, 

New Zealand’s customer service alone may be enough 

to kill any hope of following in our overseas friends’ 

footsteps. For instance, when a cashier asks you, “Do you 

have our Health 2000 loyalty card?” and you say, “No I 

don’t”, and they say, “Ok, then that will be $59.95”, your 

only response has to be, “Huh?” 

Many from within and outside of retail have claimed 

that this fine industry is dying. On its last leg. “Who is 

going to go shopping when the window to the world is at 

everyone’s fingertips?” 

But the cynics are being proven wrong. The only thing 

they had right was that mediocre retail would die—that 

trend continues. However, e-commerce has created a 

catalyst for change and a retail renaissance has emerged. 

In that light, I was delighted to read on the blog of one 

of my favourite retail gurus, Jon Bird, a post based on 

his visit to the recent Cannes Lions International Festival 

of Creativity, an annual event that this time around 

recognised retail as part of its overall creative love fest. If 

Jon’s observations are anything to go by, retailers globally 

are aspiring to greatness, and delivering with verve. As 

Bird notes in his post (http://www.newretailblog.com/ 

retail-roars-at-the-cannes-lions/), a final awards night 

recognised five retail/marketing spaces as Lions winners 

for harnessing the power of retail in a fresh new way. 

Here’s what Jon Bird wrote: 1. The Gun Shop: created 

for the States United To Prevent Gun Violence in the 

US. The concept was to establish a pop-up store selling 

guns (both in real-life and online). Once a customer 

had engaged with the sales assistant, the true horrific 

story behind each weapon was revealed. This case is 

all about affecting shopper behaviour (and ultimately 

consumer behaviour), but by de-motivating, rather 

than motivating, a purchase. I thought it was brilliant. 

2. Monty’s Christmas: created for UK department store 

chain, John Lewis. The annual Christmas commercial 

for John Lewis is eagerly awaited by the British public. 

Last holiday season, ‘Monty the Penguin’ was the 

central character, and he was featured brilliantly, all the 

way from the heart-warming TV ad to a plush toy for 

sale on the department store shelf. This is a superbly 

integrated and original Christmas campaign that had 

both a strong cultural and sales effect. 3. Rabbit Race: 

created for Media Markt, Germany’s biggest electronics 

retailer. How do you get away from the traditional Easter 

retail symbols of eggs and cuddly rabbits? By turning 

those rabbits into red-hot racers and staging a bigger 

live television event than the semi-finals of the soccer 

World Cup. This is a great promotional spin on a seasonal 

retail campaign, which raised traffic to stores by more 

than 18 per cent. 4. Make-Up Genius: created for L’Oreal 

Paris. Digital both instore and out of store is now an 

integral part of shopper marketing. This application 

allowed customers to accurately try on L’Oreal makeup 

in a “digital mirror” (their smartphone screens), 

in order to increase trial and generate sales. 5. Emoji 

Ordering: created for Domino’s. The idea here is to enable 

customers to order from Domino’s via Twitter by simply 

using a pizza emoji. Whether it was a legitimate hit 

with customers or not, I am a big fan of how innovative 

Domino’s has become over the last few years with 

ordering via mobile. 

To read more about the Cannes winner, and to watch 

videos, see my full blog post called Aspiring to Greatness 

on http://www.retailgeek.co.nz/. 

*An Aussie by birth and Kiwi at 

heart, Juanita is CEO and founder of 

retail specialist Hotfoot, a smarter, 

nontraditional advertising and 

communications agency which 

helps transform and build NZ retail 

businesses. Juanita’s insights and 

expertise from the wonderful world that is retail have 

been drawn not just from a twenty year career in the 

industry but also from her personal passion for shopping, 

to which she applies the same high levels of energy, 

leadership and intelligence as she does to business. 

You can follow Juanita on Pinterest (pinterest.com/ 

hotfootnz/) or Twitter (twitter.com/JuanitaNeville) or 

through her website www.retailgeek.co.nz. 

Paragon Care to 

acquire DFV 

Melbourne-based Paragon Care has agreed to buy 

three private companies, including optometry and 

ophthalmology distributor Designs For Vision (DFV). 

Paragon, a medical products and services provider, 

filed documents with the Australian Stock Exchange (ASX) in 

mid-August announcing it would raise A$44 million ($49 million) 

for the acquisitions, valuing the DFV purchase at A$25.5 million 

($28.4 million). Paragon expects to finalise the acquisitions by 

the end of September. 

The purchase of DFV is intended to “expand Paragon’s 

customer base by providing access to the ophthalmic market 

where there will be growth opportunities for some of Paragon’s 

existing products,” according to the ASX-filing. 

Based in New South Wales, DFV provides a catalogue of 

diagnostic equipment, ophthalmic lasers, dry eye treatments, 

and other products to the Australia and New Zealand markets. 

The private company has operated since 1978 and currently 

employs 55 people, including two representatives in NZ. 

“(Paragon) respect what we have created here in DFV and do 

not want to see it changed,” says DFV directors Brad Grills and 

Nikolas Apostolou in a co-authored statement. “The DFV brand 

will remain. We believe in this business and its people and in 

part this is why we decided to transfer the shareholding to a 

stronger balance sheet to build more financial strength into the 

DFV brand and in turn create more opportunities together for 

our people.” 

Grills adds that in NZ Keith Proctor will continue to manage its 

surgical business and Jared Beetham the diagnostic business. O 

Record turnover for 

Specsavers 

Specsavers broke the £2 billion ($4.75 billion) barrier announcing 

a record worldwide group revenue of £2.06 billion ($4.89 billion) 

for the 2014-2015 financial year, a 9.1 per cent increase on 2013- 

2014. 

New Zealand also broke records, exceeding revenues of $100 million 

for the first time, with reported revenue across its 52 Kiwi stores of $106 

million, up 16.5 per cent from $91 million the previous year. Australian 

store numbers increased from 292 to 300, with a reported revenue 

of A$708 million ($791 million), an increase of 12.4 per cent over the 

previous year’s A$630 million despite the company relocating and 

refitting more than 50 stores there in the last financial year. 

In their introduction to Specsavers’ annual review, Specsavers founders 

and owners Dame Mary and Doug Perkins said the 2014-2015 revenue 

was a ‘phenomenal landmark in Specsavers history and a ringing 

endorsement of the partnership model’. 

Charles Hornor, Specsavers’ communications director for Australia and 

New Zealand says the New Zealand revenue increase was ‘significantly’ 

more than expected, with growth particularly driven by stores which 

expanded their number of consulting rooms from one or two to three or 

four in response to demand. “We have been through a big programme of 

opening stores since 2008, and now we’re into a phase of expanding our 

current stores…that’s why average store turnover has grown to around 

$2.1 million per year.” 

Specsavers has helped drive the overall size of the New Zealand 

market since opening here in 2008. The average New Zealander now has 

their eyes tested every two to three years, compared with every five to 

six years a decade ago, says Hornor. 

Record results in New Zealand are expected next year as well, boosted 

by strong early results from Specsavers’ Kids Go Free campaign, 

launched in June. Since the launch the number of kids having their eyes 

tested across Specsavers stores has grown by almost 70 per cent to a 

little over 1,000 eye tests on under 16s each week. 

The company launched 32 years ago and today counts 31 million 

customers worldwide, with 2,300 partners and more than 30,000 people 

working across its 1,767 stores, support offices and supply chain. 

Highlights in Australia and New Zealand for the year include launching 

450 new frame styles, increasing contact lens customers by 50,000, 

increasing sight tests in Australia by 10 per cent and 14.5 per cent in New 

Zealand, and despatching a record 3.7 million orders from its Melbourne 

Glazing Services lab, with only 0.2 per cent returned due to error. 

Specsavers also installed a self-service contact lens ordering system in 

its Australian and New Zealand stores, making it easier for customers 

to order new lenses; and raised A$700,000 ($782,000) for charities 

including the Grandparents Raising Grandchildren Trust in NZ. 

“If someone had said in New Zealand in 2008 that come 2015 

Specsavers New Zealand partners would collectively be turning over 

more than $100 million a year, we’d have said that’s very unlikely, but 

the reason it has happened is because consumers have embraced the 

whole concept of quality and value and that’s produced a revolution in 

the market,” says Hornor. 

Specsavers Gisborne Top Shop 

Specsavers Gisborne was awarded the Overall Regional Supreme Award 

for the Central North Island, in the annual Retail NZ Top Shop awards. 

Mark Johnston, Retail NZ chief executive, says Specsavers Gisborne 

was selected after three rounds of judging, including two in-store 

assessments. 

Speaking at the awards ceremony, Tania Richards, a dispensing 

optician who runs the store with optometrist Nick Whittingham, says 

customer service was key to the win. While Whittingham says a focus 

on training also contributed. “We’ve evolved into a tight-knit group.” O 

Optrex Actimist coming 

to NZ optometrists 

Ernest Tobia at ODMA|2015 

EYELogic, the exclusive distributor of Optrex ActiMist products 

to optometry practices in Australia received the thumbs up the 

day before ODMA|2015 to commence distributing the popular 

dry eye spray to New Zealand optometrists. 

Following the successful launch of the Optrex ActiMist range in New 

Zealand pharmacies, manufacturer Reckitt Benckiser NZ identified a 

strong desire by optometrists to also stock the product, says Ernest 

Tobia, founder and managing director of EYELogic. 

“RB actively pursued a distributor for Optrex to service the New 

Zealand optometry market, leading to the appointment of EYELogic due 

to their specialised expertise and extensive experience in the optical 

industry.” 

Tobia, an Australian optometrist and current owner of two 

independent practices has more than 20 years experience as an optical 

practitioner and practice owner. He launched EYELogic in Australia in 

May 2014. 

He has now registered EYELogic NZ, so New Zealand optometrists will 

soon have the opportunity to sell Optrex ActiMist, instead of referring 

patients to their local pharmacy, he says. 

“Eighty per cent of dry eye patients suffer from meibomian gland 

dysfunction and Optrex is the leading product that fits that space. It’s a 

liposomal spray, not a drop, so it’s a lot easier for patients to use.” 

Tobia says he’s already spoken to several Kiwi optometrists who were 

keen to stock it and he’ll be contacting them following EYELogic NZ’s 

formal launch next month. “It’s unfortunate New Zealand [optometrists] 

have had to wait a year longer than Australia, but now we’re here, we’re 

excited about it.” O 

Essilor buys US 

optometry services 

provider 

Essilor of America Inc, the American subsidiary of Essilor 

International, agreed to buy Vision Source, a network of 

optometrists with nearly 4,000 members across North 

America. 

Details of the purchase were not made public, but the 

acquisition is said to represent a three-fold return on investment 

for Vision Source’s parent company, Brazos Private Equity, a 

Texas-based firm that has been shedding its healthcare holdings 

this year. 

Vision Source provides glasses, contact lenses, practice 

management tools, marketing assistance and supply chain 

programmes to optometrists in its practitioner-network. 

The announcement came soon after Essilor International 

reported total revenue of 3.408 billion euros ($5.8 billion) for the 

first six months of 2015 through June 30, an increase of 22 per 

cent from 2.780 billion euros ($4.6 billion) reported for the same 

period the year prior. The company said it was on track for 8 per 

cent to 11 per cent growth for the full year. 

Essilor has been on a two-year-long acquisition track in 

America, spending $3.66 billion in total for polarised glasses 

maker Costa Inc; photochromic lens producer Transitions 

Optical; and Coastal Contacts Inc, an online retailer of optical 

products. 

Elsewhere in the Americas, Essilor was a sponsor of the first 

World Congress of Optometry in Medellin, Colombia in mid- 

August. The congress is the first in a series of biennial global 

events to encompass all aspects of optometry in order to 

share research knowledge, explore clinical practice, education 

development and technological innovations and define an 

agenda for the future of accessible vision health care, according 

to a media statement. O 


6 o C 

UV INDEX 2 

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7

SPECIAL FEATURE: DRY EYE 

Driving dry eye developments 

Dry eye is a hot topic in ocular circles 

these days. Where once there was a 

dearth of diagnostic and treatment 

options, there now appears to be a 

plethora of new tools, drops, and recipes all aimed 

at helping patients with dry eye. 

Jennifer Craig, an associate professor with 

the University of Auckland’s Ophthalmology 

Department and vice-chair of the internationally 

renowned Tear Film & Ocular Society’s (TFOS’s) 

second dry eye Workshop (DEWSII), says the 

problem has always been there, but these days 

professionals are able to diagnose it properly and 

thus respond better. 

“Until recently the profession relied very heavily 

on artificial tear drops for affected patients 

irrespective of the cause of the dry eye and clearly 

that doesn’t work for everybody. Recognition of 

the importance of evaporative dry eye, ongoing 

research and industry’s increasing support 

through research and development in this area is 

now providing us with better knowledge, better 

diagnostic techniques and tools, and better 

therapies for dry eye.” 

Greater definition 

BY LESLEY SPRINGALL 

TFOS’s first dry eye workshop (DEWS), published 

eight years ago, was instrumental in bringing 

the problem to the fore by developing a common 

and accepted starting platform from which 

organisations could develop products. 

Out went the old definitions, deemed 

inadequate, and in came a new consensus 

definition: 

Dry eye is a multifactorial disease of the tears 

and ocular surface that results in symptoms 

of discomfort, visual disturbance and tear film 

instability with potential damage to the ocular 

surface. It is accompanied by increased osmolarity 

of the tear film and inflammation of the ocular 

surface. 

The chronic lack of lubrication and moisture 

on the surface of the eye resulting from dry eye 

can result in symptoms ranging from subtle but 

constant irritation to inflammation of the front 

tissues of the eye. Persistent dryness, red eyes, a 

feeling of scratchiness or that something’s in your 

eye or a burning sensation are common symptoms, 

as are watery eyes caused by an over-stimulation 

of the watery component of tears as the eye 

struggles to protect itself. 

Causes and prevalence 

According to the experts, there are two main forms 

of dry eye: aqueous-deficient dry eye, where the 

lacrimal gland fails to produce enough tears; and 

evaporative dry eye, where the tear film evaporates 

too quickly. The most common cause of the latter 

is meibomian gland dysfunction (see separate 

story), which is believed to be involved in about 80 

per cent of all dry eye cases. 

Nailing down the causes of either, however, is 

tricky because, researchers say, there are many 

possibilities. 

Age is a factor. It is estimated that more than 70 

per cent of women and 60 per cent of men aged 

over 60 have dry eye. Women are more prone due 

to hormonal changes, such as menopause. 

But dry eye is also increasing in younger people, 

even children, with many studies citing our 

addiction to screens as an exacerbating factor. 

“It seems to be becoming more prevalent, likely 

influenced by the lifestyles we lead,” says Dr 

Craig. “We know when people are concentrating 

on smartphones or tablets they tend to blink less 

frequently and less well than they should, often 

not closing their eyes fully with each blink.” 

Our lack of blinking is considered such a problem 

that TFOS commissioned a song, Blink Around the 

World, for its international campaign to get people 

to blink more. 

“Blink Around the World is a fun and catchy 

way to remind people to blink their eyes, which 

both exercises and protects this preciously vital 

organ,” said Amy Gallant Sullivan, executive 

director of TFOS, when the campaign launched in 

2013. “The simple act of blinking reduces dry eye 

symptoms by flushing fresh tears over the eye, 

re-moisturising and keeping foreign matter and 

irritants out.” 

Dry eye can be a side effect of medications, 

including antihistamines, antidepressants, some 

blood pressure drugs, Parkinson’s medications, 

and birth control pills. Environmental factors are 

also connected to dry eye. Studies have shown 

Some of the imagery used to launch the TFOS DEWS II 

higher incidence rates in densely populated (ie. 

heavily polluted) cities, dusty or high-altitude 

climates, and among those living with constant air 

conditioning or dry heating systems. 

Other factors cited include contact lens wear; 

eyelid diseases such as blepharitis; systemic 

diseases such as lupus and Sjögren’s (pronounced 

“show-grins”—see separate story); allergens; as an 

after effect of eye surgery; as well as poor diet and 

dehydration (see separate story). 

Treating dry eye 

The list of potential treatments and treatment 

regimes mirrors the list of causes. Dry eye is 

considered to be a chronic and typically progressive 

condition that may not be completely curable, 

though most agree it can and should be managed 

well to relieve symptoms as not treating dry eye 

can lead to damage to the ocular surface. 

A recent study co-authored by Professor Reza 

Dana, professor of ophthalmology at Harvard 

Medical School, also found that not treating dry 

eye could lead to a significant decrease in corneal 

endothelial cell density, lending support to those 

who favour treating the underlying inflammation 

often associated with dry eye to reduce the 

chances of dry eye progression. 

In its mildest form dry eye can be managed with 

eye drops and other lubricants, with some artificial 

tear products addressing specific tear deficiencies, 

such as a lack of sufficient lipids. There are also 

prescription eye drops; warm compresses to help 

melt the thickened oil in the meibomian glands; 

and blepharitis treatments to cleanse the lid 

margins and keep the controversial, microscopic 

and ever-so-common Demodex mite (see separate 

story) under control. 

Diet can also make a difference with a lack 

of vitamin A and essential fatty acids and 

dehydration often cited as a cause or exacerbation 

of dry eye (see separate story). 

For the aqueous deficient form of dry eye, some 

practitioners advocate punctal occlusion, where 

a small plug, either temporary or permanent, is 

inserted into one or more puncta in the eyes to 

slow tear drainage. Punctal plugs are preferred 

over intracanalicular plugs by some, due to 

the lower risk of infection and—in those with 

confirmed benefits from punctal occlusion— 

punctal cautery can be a superior long term option 

(see separate story). 

The future 

Our knowledge, diagnostic tools and treatment 

practices are getting better, says Dr Craig, but 

there’s still a long way to go. “We’re learning all the 

time. We have to remain open to understanding 

the different ways that dry eye can be caused and 

other complicating factors.” But the industry’s 

increased focus on meibomian gland dysfunction 

and its role in evaporative dry eye is certainly 

helping far more people with dry eye than ever 

before, as is improved understanding of lid hygiene 

and the importance of blinking. 

We will undoubtedly also learn more following 

publication of the DEWS II outcomes, but given 

that the workshop was only officially launched in 

March 2015, it’s still very early days, she says. 

DEWSII’s sub-committees have been set up and 

are currently compiling the outlines of what they 

propose to include in their reports, which are due 

to have their preliminary readings at the next TFOS 

conference in Montpellier, France in September 

next year. O 

Dry Eye & Allergy 

Centre of Excellence 

123 Remuera Rd, Remuera 

0800 393 527 

info@eyeinstitute.co.nz 

Dry eye research at New Zealand’s Ocular 

Surface Laboratory 

Located within the Department of 

Ophthalmology at the University of 

Auckland, the Ocular Surface Laboratory 

(OSL), led by Associate Professor Jennifer 

Craig, provides an environment for 

clinical and basic science researchers to 

collaborate to improve understanding of the 

mechanisms underlying the development 

and propagation of ocular surface disease, 

particularly dry eye disease, and to develop 

and test new therapies for managing this 

prevalent and debilitating condition. 

We asked Dr Craig to outline some of the 

research projects underway at the OSL at 

present. 

BY JENNIFER CRAIG 

At the OSL, we continue to explore the efficacy of 

a number of therapies for both aqueous deficient 

dry eye and evaporative dry eye. Current projects 

include: 

• Recent BOptom honours and summer student 

projects confirmed that a microwavable 

seed-filled warm compress (MGDRx EyeBag) 

has greater predictability and heat transfer 

capabilities than a portable heating mask 

(Eyegiene). Published earlier this year, the 

results show that despite these differences, 

both devices demonstrated clinical benefits for 

individuals with mild MGD. 

• Native Manuka honey, with its intrinsic 

antibacterial and anti-inflammatory 

properties, has also been under scrutiny 

for its potential as a therapeutic agent for 

patients with lid disease. From an idea first 

proposed by optometrist Grant Watters, 

the OSL has worked in collaboration with 

senior lecturer and BOTU Director Dr Ilva 

Rupenthal; microbiologist Dr Simon Swift; and 

Manuka Health NZ to create a Manuka honey 

formulation designed for daily overnight 

topical application to the eyelids. Development 

and preclinical testing began several years ago 

and the clinical tolerability trial has recently 

been completed in healthy individuals, with 

the assistance of Auckland optometrist Chee 

Loh and trainee ophthalmologist Dr Leah Te 

Weehi. 

The next stage of the process involves testing 

the efficacy of the product in clinically 

significant blepharitis. A call will be made 

to clinicians in the Auckland area in coming 

months for patients who may wish to 

participate in this three month trial. This work 

will be coordinated by postdoctoral research 

fellow Dr Isabella Cheung, while evaluation of 

inflammatory markers is being undertaken by 

Auckland optometrist Varny Ganesalingam, 

currently working towards a MHSc on the topic 

of ocular surface inflammation. 

• Successful publication of Amy Chen’s NZAOsponsored 

summer studentship conducting a 

pilot study on the efficacy of IPL has led to a 

new international industry collaboration. The 

future project forms the basis of Ally Xue’s PhD 

studies, where she is delving deeper into the 

mechanisms of action of IPL (see associated 

story) 

• The group at the OSL has also been working 

in collaboration with Oculeve, a US company 

recently acquired by Allergan. Participation 

as one of the sites in Oculeve’s international 

multicentre trial last year created the 

opportunity for further collaboration with the 

team in the area of nasal neurostimulation, 

using a device which has been designed to 

help address aqueous deficiency. 

• Learning more about ocular demodecosis 

and seeking better tolerated and efficacious 

treatments for Demodex infestation has been 

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PROUDLY NEW ZEALAND OWNED 



9


Meibomian gland dysfunction and contact lenses: our challenge 

BY GRANT WATTERS* 

Awareness of meibomian gland 

dysfunction (MGD)—and its role in 

ocular surface discomfort and contact 

lens intolerance—has been raised by 

the Tear Film and Ocular Surface Society (TFOS) 

workshop. Working towards understanding 

the mechanisms contributing to MGD and the 

implications of MGD on ocular surface health, the 

TFOS came up with a definition of MGD: 

MGD is a chronic, diffuse abnormality of the 

meibomian glands, commonly characterised by 

terminal duct obstruction and/or qualitative/ 

quantitative changes in the glandular secretion. It 

may result in alteration of the tear film, symptoms 

of eye irritation, clinically apparent inflammation, 

and ocular surface disease. 

Because it is well established that all types of 

contact lenses (CL) can disrupt the lipid layer of 

the tears, it stands to reason that any MGD will 

exacerbate the situation, and cause an increase in 

evaporative dry eye and contact lens intolerance. 

Add to this the “hostile” environment of airconditioned 

offices, heating in cars and at home, 

and a lowered blink rate during long hours of 

computer work and you end up with a surprising 

number of patients struggling, especially with 

the added “double whammy” of impending 

presbyopia. 

These “Peter Pan Presbyopes” want solutions. 

Their eyes are drying out, causing blurred vision, 

and their near focus is also deteriorating. CL 

technologies for presbyopia can still be limiting, 

especially as we absolutely require wettable CL 

materials with good stable optics. A bridge too far? 

To provide some sort of a solution in our practice, 

we have become more assertive in offering 

in-house MGD therapy. We recommend the 

purchase of an eye wheat bag to replace the use of 

facecloths at home for more sustained heat release 

and for longer heat exposure periods of four to five 

minutes. We perform regular in-house expression 

programmes: first with eye wheat bags to warm 

up the MG’s; then, a golf club spud for lid margin 

debridement of any keratin over the MG’s; and 

finally with MG expression using mastrota paddle 

tweezers. We are also considering buying an E>EYE 

IPL machine, which has shown great promise (see 

separate story). The problem is that MGD, like 

blepharitis, can be chronic and recurrent—two 

ominous words—and patients are time-poor and 

even lazy when it comes to doing their own home 

therapy. Usually when things are going better, 

patients tend to stop doing their home treatments 

and then of course things take a turn for the 

worse. Educating them is therefore key so they 

know how to get back on track. 

In-house MGD therapy actually achieves two 

things: you motivate the patient into keeping it up 

and you give them a “head start” for their home 

sessions; plus it allows you to diagnose far more 

accurately the degree or grade of blockage. Are 

the ducts completely plugged? Or, if expressible, 

what is the texture and colour like? Is it cloudy or 

creamy like tooth-paste or fairly clear? Does the 

patient show improvement with time? Are the lid 

margins looking less red and inflamed? Is there any 

improvement in corneal staining? I tell patients 

that one session in-house is the equivalent of 

them doing it for about two weeks at home to help 

motivate them. 

If after a month of weekly in-house and home 

sessions there is little or no improvement, I write 

to the patient’s GP to ask for additional oral 

doxycycline or azithromycin supply, explaining 

why. Most GP’s will send out a script without 

insisting on a consultation and the mucolytic 

effect of tetracyclines can often soften up the 

blockages, improving treatment outcomes. 

With a bit of effort and teamwork from us and 

the (motivated) patient, we can usually make good 

progress. Keeping them on an on-going home 

maintenance programme of eye wheat bag warm 

compresses and digital massage for 2-3 sessions a 

week also seems to help avoid regression. 

Finally, there are two other groups of CL 

wearers who have to have a good stable tear film: 

orthokeratology (OK) wearers and keratoconics. 

The hydraulic engineering the tear film must 

achieve in OK lens wearers is massively affected 

by marginally dry eyes. While a lot of keratoconics 

have little choice other than to tolerate CLs for at 

least 16 hours a day in all sorts of crazy conditions. 

I have had to “pre-treat” OK children for MGD 

before proceeding, as it’s much easier to do first 

than having to backtrack! It is also not unusual 

for OK kids and keratoconics to have rosacea 

Factors and associations thought to 

adversely affect MG performance 

• Lid hyperkeratinisation 

• Age 

• Androgen deficiency with menopause 

• Contact lens wear 

• Asian ethnicity 

• Rosacea 

• Sjögren’s syndrome 

• Blepharitis 

• Atopy 

• Demodex folliculorum 

• Antihistamines 

• Antidepressants 

which has been overlooked. Also do a little bit of 

investigative work to see if any of your teenage OK 

wearers are on Roaccutane? Plus, MGD is known to 

be more prevalent in the Asian population. 

In general we need to be more attentive to 

MGD therapy to help our CL patients maintain 

asymptomatic wear for reasonable periods. Our 

patients certainly enjoy their in-house “day spa” 

sessions and get on board with some positive 

education, after all “a problem shared is a problem 

halved!” O 

* Grant Watters is a qualified TPA optometrist and co-owner 

of Mortimer Hirst in Auckland. He specialises in keratoconus, 

DRY EYE TREATMENT 

E>Eye gets the thumbs up in latest NZ patient 

research 

More than 80 per cent of patients who received 

E>Eye intense pulsed light (IPL) treatments 

at Merivale Optical in Christchurch reported 

their dry eye symptoms had improved, while 

95.7 per cent said they would recommend the 

treatment to others. 

The results come as part of a survey of E>Eye 

patients at Merivale treated over a 10-month 

period. Of the 86 respondents, 74.4 per cent 

were over 60 years old, 23.3 per cent were 

between 20 and 40 years old and 2.3 per 

cent were between 20 and 40. The research 

was conducted by John Veale, optometrist 

at Merivale and New Zealand distributor for 

France Medical’s E>Eye machine. 

The E>Eye machine has been specifically 

designed for treating dry eye due to 

meibomian gland dysfunction (MGD). The 

device works by producing a calibrated series 

of IPL. These light pulses are precisely set at a 

specific energy and frequency to stimulate the 

meibomian glands and help them to recover 

their function. 

Other results from Merivale’s research 

include 98.5 per cent saying the treatment 

was “no problem” or “okay”, and 55 per cent 

reporting they no longer needed to use eye 

drops following treatment. 

A double-blind, placebo-controlled clinical 

trial of 28 patients with MGD by Associate 

Professor Jennifer Craig from the Ocular 

Normal meibomian glands 

Ortho-K (orthokeratology), complex contact lens fitting and 

management and contact lens troubleshooting. He’s also a 

lecturer and researcher with the Departments of Optometry and 

Vision Science and Ophthalmology, University of Auckland. 

REFERENCES: 

• Craig JP, Chen Y-H, Turnbull PRK. Prospective trial of 

intense pulsed light for the treatment of meibomian gland 

dysfunction. Invest Ophthal Vis Sci 2015; 56(3):1965-1970. 

• Nichols KK et al. The International Workshop on Meibomian 

Gland Dysfunction: Executive Summary. Invest Ophthal Vis Sci 

2011; 52(4):1922-1929. 

• Pult H, Riede-Pult BH, Nichols JJ. Relation Between Upper and 

Lower Lids’ Meibomian Gland Morphology, Tear Film, and Dry 

Eye. Optom Vis Sci 2012; 89(3):310-315. 

• Kunnen C, Nichols JJ. Meibomian Gland Dysfunction: An 

Update. CL Spectrum 2015; 30:22-27. 

• Efron N. Contact Lens Complications (3rd.Ed) 2012 Elsevier. 

Surface Laboratory in Auckland University’s 

Department of Ophthalmology found 82 per 

cent of patients showed improvement after 

three treatments with the E>Eye device of at 

least one lipid layer grade on day one with 

86 per cent noting reduced symptoms by day 

45. There was also significant improvement 

in non-invasive tear breakup time (NIBUT) vs 

controls*. 

For more information on the E>Eye visit: 

www.dryeyetreatment.co.nz. O 

*Source: Craig, Jennifer P., Yen-Heng Chen, and Philip RK 

Turnbull. “Prospective trial of intense pulsed light for the 

treatment of meibomian gland dysfunction.” Investigative 

ophthalmology & visual science 56, no. 3 (2015): 1965-1970. 

Current price 

available until 

October 1 

For more information visit our website 

www.dryeyesyndrome.co.nz 

or email us info@dryeyetreatment.co.nz 

Achieving 

great results 

throughout 

NZ 

I started using E►Eye in January 2014. It quickly became evident that patients 

were extremely happy with the results. In particular, the patients with obvious 

rosacea were describing huge improvements in their ocular comfort and an 

improvement in their conjunctival injection. For a condition that previously had 

limited therapeutic options, IPL is an exciting and highly eff ective new treatment 

modality for patients with dry eye from MGD. 

Dr Brendan Cronin, Ophthalmologist 

I invested in E►Eye with peace of mind as I would have got my money back 

in the fi rst three months if it was not successful. 

Not only my dry eye patients were happy with their IPL treatments but they 

also recommended their friends and relatives to get treated too and this has 

become a very profi table service for my business. In fact, in less than four 

months, I had already got the return on my investment! 

There is no other optometry equipment on the market with such a quick 

return and it defi nitely makes my practice stand out from the crowd. E►Eye is 

defi nitely the best piece of equipment that I have invested in. 

It is attracting on average three to fi ve new customers per week and these 

customers are now coming to buy our frames and have their eyes examined. 

John Veale, Optometrist 

My eyes felt great after three treatments and continue to improve in regards 

to tolerance of air conditioning and computer use, especially after a long day. 

Thank you for being so kind and allowing me to have the treatment. My eyes felt 

so much better I was fi nally encouraged to apply for a job and was successful. 

Sofia, dry eye sufferer from Sydney 

IPL research call for patients 

BY ALLY XUE* 

Artificial tears, warm compresses, manual 

expression, lid scrubs - the majority of 

current treatments for meibomian gland 

dysfunction (MGD) are deemed largely 

palliative, providing at best transient relief from 

dry eye symptoms. Both clinicians and affected 

patients frequently describe MGD therapies as 

disappointing and continually seek alternative 

management options. One alternative which has 

emerged in recent years is intense pulsed light (IPL) 

therapy, conventionally applied to reduce facial 

melasma, but within the last decade recognised 

to have positive ocular effects in MGD. Following 

the arrival of the E>Eye IPL device (France Medical) 

in New Zealand in 2013, Associate Professor 

Jennifer Craig and her team at the Ocular Surface 

Lab (OSL) conducted a Prospective Trial of Intense 

Pulsed Light for the Treatment of Meibomian Gland 

Dysfunction. Results from this randomised, doublemasked, 

placebo-controlled study (published 

in IOVS this year) demonstrated significant 

improvements in tear film quality and patient 

symptoms. Effects were cumulative, prompting 

Dr Craig and I to design a second IPL trial on 

a larger participant group, and over a longer 

treatment period. In addition to assessing efficacy, 

we will explore a range of potential therapeutic 

mechanisms involved in IPL therapy. We hope 

to better understand the applicability of IPL in 

different patient sub-groups in order to improve 

prognostic value and enable further therapeutic 

refinements. We will be offering IPL treatment to 

patients interested in participating in the research 

project in exchange for a few hours of their time. 

Recruitment of suitable dry eye patients with 

symptomatic MGD is due to begin shortly, with 

plans to commence the IPL study later this year. 

Practitioners are invited to mention the study to 

patients they think might be suitable. O 

*Ally Xue is a PhD student with the OSL. Practitioners and 

patients interested in the study can contact Ally at 

a.xue@auckland.ac.nz to obtain more information about the 

study. 


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The Dry Eye Relief Mask, D.E.R.M., contains Silica beads which naturally 

attract moisture from the air and release it when microwaved. Heating the 

mask for 20 seconds will provide soothing moist-heat relief for 4-6 minutes. 

Applying a moistened cotton liner to the mask prior to heating will extend 

the treatment to 7-9 minutes. 

D.E.R.M.. is hypoallergenic and can also be used to create cold therapies 

for allergy relief. 

The Tranquileyes system incorporates two re-usable 

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proven to effectively improve tear quality by providing 

the intensity and duration of heat required while 

hydrating the sensitive eyelid and surrounding skin. 

Tranquileyes allows patients to create soothing 

moist-heat compresses, ranging in temperature from 

101–110°F/38.33-43.33°C and lasting up to 25 minutes. 

May also be used for cold therapies. 

 

 

Meibomium Gland Expression Paddle 

Long Term Temporary Canalicular 

Inserts. Effective 60 – 180 days 

The most advanced silicone 

punctum plug available 

InflammaDry is a rapid, immunoassay test for 

the detection of elevated levels of the MMP-9 

protein in human tears, to aid in the diagnosis 

of dry eye, in conjunction with other 

methods of clinical evaluation. 

This test is intended for professional 

use at point-of-care sites. 

0800 338 800 

www.designsforvision.co.nz 



11 

DV765-0715


Diagnosing and treating dry eye disease in a specialist setting 

BY THE DRY EYE & ALLERGY SPECIALISTS AT EYE INSTITUTE* 

Diagnosis and management of dry 

eye disease (DED) has improved in 

recent years because of advances in 

understanding the underlying causes. 

Tests and equipment once considered research 

tools have found their way into specialist dry eye 

clinics here and overseas. 

There is no single test that is sufficiently sensitive 

or specific to diagnose dry eye. An accurate diagnosis 

of the causes of a particular patient’s DED needs to 

be derived from investigating several aspects of the 

health and integrity of the ocular surface. 

HISTORY AND SYMPTOMS 

The usual history-taking process includes asking 

about environmental and occupational factors, as 

well as noting any allergies or medications that 

may relate to dry eyes. 

Normal history-taking can be enhanced by 

using special questionnaires designed to detect 

clinically significant DED and to grade the severity 

of symptoms. Using validated and repeatable 

questionnaires also helps eliminate variability 

between visits and examiners. McMonnies is a good 

screening tool and guide to what questions to ask 

a patient about their dry eyes. The Ocular Surface 

Disease Index is suited to monitoring change over 

time, and SPEED evaluates both the frequency and 

severity of symptoms in just eight questions. 

After a careful history check, it is good clinical 

practice to continue with the least invasive tests 

first. Assessments of tear quality should be 

performed before anything is added to the tear 

film or the tear flow is stimulated by bright lights 

or eyelid manipulations. It is important to measure 

each eye separately, as differences between them 

can help in the diagnosis. 

Common symptoms of dry eye disease 

• Dry, gritty, sore eyes 

• Tired or heavy eyes 

• Foreign body sensation ‘feels like sand in 

my eyes’ 

• Stinging 

• Burning—often associated with ocular 

surface or lid margin inflammation 

• Itching—this is more often associated 

with allergic eye problems, but due to 

languages differences a person may use 

this term for symptoms related to dryness 

• Smeared or blurry vision that improves 

with blinking 

• Light sensitivity, for example sore and 

watery eyes in bright sunlight 

• Red eyes 

• Not able to wear contact lenses as long as 

in the past 

• Intermittent paradoxical watering of 

the eyes (for example, in dry windy 

conditions)—this is reflex tearing in 

reponse to an irritated cornea, which 

can happen if the eyes are dry. This is a 

more common cause of watery eyes than 

blocked tear drainage. 

CLINICAL ASSESSMENT 

A simple but important part of the examination 

is to observe the patient’s blinking, noting if it 

is complete or partial, and the length of time 

between blinks. This should be assessed before the 

patient is aware they are being examined to avoid 

conscious alterations to the blink pattern. 

Analysis of the tear film lipid layer is based upon 

the observation of colour interference effects in zones 

of specular reflection at the air-lipid layer boundary. 

Thin lipid layers (Eye 

story). 

IN SUMMARY 

Once the clinical information has been gathered 

in a standardised way, a decision on the optimal 

treatment plan can follow. This will vary from 

patient to patient depending on the identified 

contributing factors and the relative contributions 

to the dry eye state from aqueous deficiency or 

excessive evaporation. O 

* The Eye Institute in Auckland is a provider of eye surgery and 

ophthalmic care, employing a team of 10 ophthalmologists and 

50 dedicated staff. 

Dry eye research at New Zealand’s Ocular Surface Laboratory 

CONTINUED FROM P8 

Donations welcome for the Ocular Surface 

Research Fund 

Running in parallel with the Ocular Surface 

Laboratory is the Ocular Surface Clinic, where a 

limited number of patients (distinct from research 

participants) are reviewed and treated for their 

ocular surface conditions. The clinic is supported by 

donations from patients and others to the Ocular 

Surface Research Fund, managed by the School 

of Medicine Foundation. All donations go directly 

towards staffing the research facility and funding 

activities such as upgrading and purchasing 

equipment and funding smaller research projects 

such as those conducted by Honours and summer 

students. Further information about the Ocular 

Surface Research Fund and options for donation 

can be found at 

www.givingtoauckland.org.nz/osr. O 


Get to the main 

cause of dry, 

irritated eyes* 

4UP TO 

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Optrex ActiMist – clinically proven to work 

How does Optrex ActiMist work? 

ActiMist liposomes 

Natural lipids 

Optrex ActiMist contains 

liposomes (tiny bubbles fi lled with 

moisture) that migrate across the 

surface of the eyelid and collect 

at the edges of the eye. 

These liposomes mix with natural 

lipids on the eyelid. 

When the eyes are open the new 

lipid mixture spreads over the 

whole tear fi lm, and helps fi ll the 

gaps to restore the damaged 

lipid layer. 

Hygienic. Can be used 

by multiple people 

Lasts 6 months 

after opening 

Won’t smudge 

make-up 

Convenient and 

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Order stock for your practice today 

FREE CALL 0800 EYELOGIC (0800 393 564) 

www.optrex.co.nz optrex@eyelogic.com.au 

Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. †When wearing make-up, it is recommended to apply from 20cm. *Due to disturbed lipid layer of the tear fi lm. References: 

1. Lee S et al. Klin Monatsbl Augenheilkd 2004; 221:1–12. 2. Khaireddin R, Schmidt KG. Klin Monatsbl Augenheilkd. 2010; 227: 128-134. 3. Pult H et al. Contact Lens Anterior Eye 2012, 35:203-207. September Reckitt Benckiser, 2015 NEW Auckland. ZEALAND TAPS DA1541 OPTICS 

13


AFT PHARMACEUTICALS 

EYELOGIC 

OIC 

The systematic 

approach to eye 

lubrication 

HYLO-FRESH and 

HYLO-FORTE eye drops 

provide a systematic 

approach for dry eye 

treatment through 

a revolutionary 

multi-dose device. 

The patented COMOD 

(COntinuous MOno 

Dose) application 

system protects the 

sodium hyaluronate solution from contaminated ambient air, 

and ensures the precisely measured delivery of at least 300 

completely sterile drops without the use of preservatives. 

This ingenious airless system provides long-term stability 

for up to 6 months after opening, and with at least 150 

treatments (both eyes) it provides at least five times more 

treatments per pack than single-use preservative-free eye 

drops currently available in New Zealand.* 

The HYLO range is also phosphate-free which is important 

for patients suffering pronounced damage to the corneal 

surface. The use of phosphate-containing eye preparations 

can result in corneal calcification as a result of the 

precipitation of calcium phosphate in patients suffering 

extensive corneal damage, and can be avoided through the 

use of the phosphate-free HYLO range. 

HYLO-FRESH eye drops (sodium hyaluronate 0.1% w/v, 

10mL) offer long-lasting lubrication for dry eyes of moderate 

or medium severity, and are fully funded under Special 

Authority criteria (see the Pharmaceutical Schedule for 

details). 

The increased sodium hyaluronate concentration in 

HYLO-FORTE eye drops (sodium hyaluronate 0.2% w/v, 

10mL) results in a higher viscosity solution for long-lasting, 

intensive and soothing relief of severe or chronic dry eye. 

Both products are also suitable for use following surgery, and 

can be used with all contact lenses. 

For enquiries about HYLO-FRESH and HYLO-FORTE eye drops 

contact Corneal Lens Corporation. O 

*Based on the largest available pack size of single use 

preservative-free eye drops available in New Zealand as at 

July 1, 2015. 

OPTREX 

ACTIMIST 

Dry eye is 

described 

as aqueousdeficient 

or 

evaporative 

dry eye, the 

latter being 

the most 

common type 

(78%). 1 The 

Lipid layer of 

the tears plays 

an important 

role in inhibiting tear film evaporation. 2 

Optrex ActiMist is applied to the closed eyelids via a spray and 

supplements phospholipid-liposomes to the lid margin, where the 

phospholipids mix with present lipid reservoir from the meibomian 

glands. A certain part of the lipid reservoir spreads over the film and 

forms the tear film lipid layer. Improving symptoms, visual acuity, 

lipid layer thickness, tear film stability, eyelid margin inflammation, 

tear production and lid parallel conjunctival folds. 3,4 

The liposomal spray Optrex ActiMist is a tear film supplement 

containing phosphatidylcholine deriving from highly purified soylecithin. 

The major phospholipid, phosphatidylcholine is delivered 

in a stable form of liposome to the closed eyelid. From there, they 

migrate with blinking across the eyelid margins to combine with 

the tear film. 

Compliance is always the biggest bug bear of any practitioner 

dispensing a solution for the treatment of evaporative dry eye. 

Patients just don’t like putting in their drops. Optrex ActiMist 

provides a spray solution that makes the delivery of their dry eye 

preparation simple and easy thus improving patient compliance 

and addressing your patient’s dry eye symptoms. For further clinical 

information please contact our office at 

admin@eyelogic.com.au. O 

1. Heilgenhaus A,Koch JM,Kruse FE, Schwatz C,WaubkeTN. Diagnosis and differentiation of 

dry eye disorders. Der Ophthalmologe 1995:92 (1):6-11 

2. Mishima S,Maurice DM. The oily layer of the tear film and evaporation from the corneal 

surface. Experimental Eye Research 1961;1:39-45 

3. Craig JP, Purslow C Murphy PJ,Wolffsohn JS. Effect of a liposomal spray on the pre-ocular 

tear film. Contact Lens and Anterior Eye 2010;32 (2)83-7. 

4. Dausch D, Lee S Dausch S Kim JC, Schwert G, Michelson W. Comparative study of treatment 

of the dry eye syndrome due to disturbances of the tear film lipid layer with lipid containing 

tear substitutes. Klinische Monatsblatter furAugenheilkunde 2006;223(12):974-83 

OIC introduces Avenova to NZ 

Avenova, a new daily lid and lash 

cleanser that’s garnering a lot of 

attention in the United States, 

will be available in New Zealand 

from the end of September. 

The product, made by 

biopharmaceutical company 

NovaBay, is the only one 

to contain Neutrox, a pure, 

proprietary, stable formulation of 

hypochlorous acid (0.01 per cent) 

in saline. Hypochlorous acid is a naturally occurring 

substance produced by white blood cells to fight 

microbial invaders and has a very low toxicity—1000 

times lower than Betadine, according to NovaBay. 

In a recent study, Dr Arthur Epstein, director of clinical 

research and head of Phoenix Eye Care’s Dry Eye Center 

of Arizona, compared six leading lid and lash cleansers 

with Avenova. He found Avenova was the only one to 

neutralize the bacterial enzyme lipase—a major cause 

of blepharitis and meibomian gland dysfunction. 

In vitro studies of Avenova have shown the product 

is effective against most microorganisms commonly 

found on eyelids and eyelashes, including Demodex. It 

has an antimicrobial time-kill of less than a minute. 

The new product will be available from the 

Ophthalmic Instrument Company (OIC) from the end 

of September. Managing director Tim Way says he’s 

delighted to add Avenova to OIC’s growing list of 

premium Dry Eye products. “Dry Eye is a very common 

patient complaint, so it’s great to be able to offer them 

this exciting new product. Avenova has the potential 

to make a huge difference to a dry eye sufferers’ quality 

of life.” 

OIC’s other Dry Eye products include the Polaris, a 

slit lamp accessory made by Italian company CSO for 

advanced tear film analysis; the RPS InflammaDry 

Detector, the first and only rapid point-of-care test 

to detect MMP-9 (an inflammatory marker that is 

elevated in the tears of patients with dry eye disease); 

and the Medmont E300 USB Corneal Topographer, 

which has just had a comprehensive tear film package 

released free of charge for existing Medmont Studio 

Version 6 users. O 

NEW 

VISION FX 

S U P P O R T S 

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For a FREE practitioner sample* 

please call 0800 147 325 

or email ceo@realvitamins.co.nz 

*Limited stock: first come, first served 

Assessment and diagnosis of Sjögren’s syndrome 

A 

useful concept in 

dry eye disease 

management is to 

consider the parts that 

maintain the ocular surface as 

one unit. 

This “Lacrimal Functional Unit” 

consists of the ocular surface 

(cornea, conjunctiva, accessory 

lacrimal glands, and meibomian 

glands), the main lacrimal 

gland, and the interconnecting 

innervation and chemical 

signals between them. If any 

portion of this functional unit or 

communication is compromised, 

then the ocular surface can be 

damaged. Some diseases affect 

one part of this unit more than 

others. 

Sjögren’s syndrome (SS) is a 

chronic autoimmune problem 

that affects the function of the 

exocrine glands, including the 

lacrimal and salivary glands. 

The effect on these glands 

is characterised by focal, 

mononuclear cell infiltrates that 

surround the ducts and replace 

the secretory units. SS is usually 

categorised as either primary 

(presents by itself) or secondary, 

if it appears in association with 

other well-defined connective 

tissue autoimmune diseases. 

As you would expect from a 

chronic incurable condition, 

SS can lead to significantly 

degraded quality of life. As well 

as causing the grittiness and 

discomfort of dry eyes it also 

impacts on the quality of vision 

and can cause significant long 

term damage to the mouth. 

The pathogenesis of SS is 

still not fully understood, 

but is thought to involve a 

BY THE DRY EYE & ALLERGY SPECIALISTS AT EYE INSTITUTE* 

combination of genetic and 

exogenous factors. Studies have 

postulated that infection with 

Epstein-Barr, Coxsackie B, or 

cytomegalovirus, amongst other 

viruses, could be a trigger. SS 

is also known to have a higher 

prevalence in women and in 

some families. 

Many cases of SS are detected 

by a patient’s eye care provider, 

which perhaps comes as no 

surprise given that Henrik 

Sjögren (1899–1986), a Swedish 

ophthalmologist, was the first 

to identify a group of affected 

women and to connect the triad 

of keratoconjunctivitis sicca, 

xerostomia and polyarthritis. 

DIAGNOSIS 

When a GP or medical 

practitioner suspects SS, 

they should ask about 

dry eye symptoms. 

Similarly optometrists and 

ophthalmologists need to ask 

dry eye patients about any 

oral symptom, such as dry 

mouth, swollen salivary glands, 

or the need for liquids to aid 

swallowing. 

To confirm the diagnosis, 

objective criteria are needed, 

including tear and saliva flow, 

autoantibody status (including 

SS-A), and minor salivary gland 

histology. 

Because SS may be just one 

contributing factor to the dry 

eye status, all of the normal 

ocular investigations for dry 

eye should be performed. 

Meibomian gland dysfunction 

is not uncommon in Sjögren’s 

syndrome. Even if the diagnosis 

is aqueous deficiency secondary 

to Sjögren’s, a complete 

understanding of that patient’s 

Lacrimal Functional Unit helps 

us find ways to improve overall 

tear quality. 

Other special investigations 

and tests are usually coordinated 

by a rheumatologist. 

Radiographic examination of 

the salivary glands involves the 

injection of a small amount 

of contrast medium into the 

salivary duct of a single gland, 

followed by X-rays—called a 

sialogram. A biopsy of a salivary 

gland can be examined for 

lymphocytic infiltration and 

acinar loss, and the presence of 

autoantibodies can also be used 

as a diagnostic tool. 

TREATMENTS FOR 

DRY EYE IN SJÖGREN’S 

SYNDROME 

There are some specific 

considerations when treating 

dry eye for Sjögren’s patients. 

Inflammation of the ocular 

surface is a key feature of all dry 

eye disease, but especially so 

in severe SS, so judicious use of 

topical, non-preserved steroids 

is helpful. 

Secretagogues are a class 

of drugs that increase mucin 

secretion, improve tear film 

stability, and decrease ocular 

surface inflammation. Two 

examples of these are oral 

pilocarpine and cevimeline. Both 

stimulate secretion of lacrimal 

gland fluid (tears) and saliva, but 

have side effects of excessive 

sweating and cramps. More 

recently, topical secretagogues 

such as diquafosol have been 

developed, although these 

are currently commercially 

available only in Japan. Topical 

application reduces the 

occurrence of the side effects 

commonly associated with oral 

secretagogues. 

Autologous serum drops have 

been shown to be useful for 

patients with severe aqueous 

deficiency. They contain several 

key components of the tear 

film such as epidermal growth 

factor, vitamin A, and lysozyme. 

The use of autologous serum 

overseas is often limited by 

the challenges of frequent 

drawing of blood, preservation 

of sterility, and appropriate 

facilities willing to prepare 

them. We are fortunate here 

that the NZ Blood Service will 

make these drops from the 

patient’s plasma and supply 

them at no charge. O 

* The Eye Institute in Auckland is a 

provider of eye surgery and ophthalmic 

care, employing a team of 10 

ophthalmologists and 50 dedicated staff. 

REFERENCES: 

• Clinical Guidelines for Management 

of Dry Eye Associated with Sjögren 

Disease, THE OCULAR SURFACE / 

APRIL 2015, VOL. 13 NO. 2 / www. 

theocularsurface.com 

• Terry G Coursey, Cintia S de 

PaivaClinical: Managing Sjögren’s 

Syndrome and non-Sjögren Syndrome 

dry eye with anti-inflammatory 

therapy, Ophthalmology 2014:8 

1447–1458, 

• http://www.ncbi.nlm.nih.gov/pmc/ 

articles/PMC4128848/pdf/opth-8-1447. 

pdf 

• Michael Voulgarelis & Athanasios G. 

Tzioufa: Pathogenetic mechanisms 

in the initiation and perpetuation of 

Sjögren’s syndrome. 

• Nature Reviews Rheumatology 6, 529- 

537 (September 2010) |doi:10.1038/ 

nrrheum.2010.118, http://www.nature. 

com/nrrheum/journal/v6/n9/abs/ 

nrrheum.2010.118.html 


Avenova for daily lid and lash hygiene 

NEW 

Avenova with Neutrox 

Gentle, refreshing and soothing for 

everyday eyelid and eyelash cleansing 

Ideal as part of any lid hygiene 

regimen for: 

- Dry Eye 

- Blepharitis (including Demodex) 

- Contact lens wear 

- Ocular surgery and procedures 

Because what we do every day matters 

The E300 Advantage 

• Largest coverage of any 

placido ring topographer, 

limbus to limbus 

• The GOLD standard for 

fitting specialty lenses 

• Exceptional accuracy with a 

standard deviation of 2 µm 

• Comprehensive new tear film 

package, understand and 

analyse tear film break-up 

The RPS InflammaDry Detector is the first 

and only rapid, point-of-care test to detect 

for MMP-9, an inflammatory marker that has 

consistently been shown to be elevated in the 

tears of patients with Dry Eye disease 

Distributed by: 

phone: 09 443 0072 

email: September info@oic.co.nz 

2015 NEW ZEALAND OPTICS 

15


DESIGNS FOR VISION 

Designs For Vision has a 

comprehensive range of 

diagnostic and therapeutic 

products for dry eye. The 

Oculus Keratograph 5M 

provides complete dry eye 

assessment with multiple 

scan modes and tear film 

analysis functionality, in 

addition to topography and 

advanced external imaging; 

and InflammaDry is a fast, 

affordable immunoassay test 

for the detection of dry eye 

indicators in human tears. 

Innovative treatment options 

include the Blephasteam 

moist-heat therapy system for 

the relief of Meibomian Gland 

Dysfunction and associated 

REAL VITAMINS 

A powerful new formula to 

support and preserve vision 

Eye-health research has 

linked proper nutrition to 

decreased risk of age-related 

macular degeneration. New 

Zealand company Sanderson 

have developed a convenient 

new one-a-day capsule 

called Vision FX in their 

Practitioner Series range, that 

combines effective levels of 

key nutrients identified in 

research like AREDS I & II as 

having positive benefits for 

eye health. 

Vision FX is especially 

notable for its high levels 

of Lutein and Zeaxanthin. 

The super antioxidant Alpha 

Lipoic Acid has been included 

to support against glaucoma 

• Anti-Bacterial Action 

• Anti-Inflammatory Action 

• Antiseptic Management 

• No Stinging 

• Long-Term Dry Eye Relief 

• Immediate Comfort and Lubrication 

• No Evidence of Allergic Reaction 

• Can be Recapped and Safely Used 

within 24 hours 

• Unit Dose Tip is Safest for Accidental 

Cornea Touch 

Distributed by: 

diseases. While a selection 

of punctum plugs from 

Eagle Vision and Mastrota 

meibomian expression paddle 

are available for clinical use. 

For ongoing patient use, 

Designs For Vision provides 

the Tranquileyes and D.E.R.M. 

moist-heat systems from 

EyeEco. These products offer 

safe, effective home treatment 

for those requiring application 

of regular warm or cold 

therapy. 

Optimel Antibacterial 

Manuka Eye Drops is now 

available in two strength 

formulations and is suitable 

for the treatment of chronic 

dry eye and blepharitis. 

and cataracts. Flaxseed oil 

has been included for its 

dual benefits, as a source 

of omega 3 as well as being 

beneficial for dry eyes. This 

comprehensive formulation 

means patients no longer 

need to take several different 

supplements. 

Each Vision FX capsule 

contains: 

* Flaxseed Oil 500mg 

* Vitamin A 1000iu 

* Vitamin C 150mg 

* Vitamin D3 1000iu 

* Lutein 20mg 

* Zeaxanthin 10mg 

* Alpha Lipoic Acid 10mg 

* Natural Vitamin E 200iu 

* Zinc 15mg 

* Copper 1mg 

Sanderson Vision 

T: 0800 954536 

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NO ANTIBIOTICS 

NO PRESERVATIVES 

Oculocin Propo is a natural based dry 

eye drop that also treats conjunctivitis with 

no known side effects 

KEY INGREDIENTS: 

Propolis 

Aloe Vera 

Chamomilla 

The medical grade 

antibacterial Manuka honey 

is clinically proven to stabilise 

and improve the ocular surface 

health of dry eye patients. O 

FX is available from 

pharmacies, health shops 

and health practitioners. 

Ophthalmologists, 

optometrists and DOs are 

invited to request a free 

sample by emailing 

ceo@realvitamins.co.nz. O 

IMPORTANT ACTIVE AGENTS: 

• Phenols 

Antimicrobial properties 

TM 

NEW! 

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approved - no 

prescription 

required 

• Aloins and emodins 

Has Analgesic (painkiller) and powerful virucidal and 

antibacterial properties 

• Alfa-bisabolol and it’s oxides. Azulens* 

Anti-inflammatory, anti-irritant and antimicrobial properties 

DOSAGE: 

1 - 2 Drops in each eye as required or as 

recommended by your eyecare professional 

ANTI-VIRAL AND ANTI-BACTERIAL 

PROPERTIES 

*UAB ORIGMED is using high activity extract normally double in 

values compared to standard 

pharmacopeia values. For 

example, propolis water extracts that is normally used, 

holds 0.5% phenols and Oculocin -1-1.5%. Because of 

natural origin chemical components which are important 

in product activity are more than 50 active Ingredients 

To punctal plug or not: when 

surgery is the answer 

BY BRIAN SLOAN* 

The tear film on the front of the eye is a 

balance between tear production and 

tear drainage, so when tear production is 

limited it makes sense to look at limiting 

tear drainage as well. And sometimes this is a good 

idea, but other times it’s not. 

Tears drain through the lacrimal punctae at the 

medial (inside) end of the upper and lower eyelid. 

From there, very narrow passages called the upper 

and lower lacrimal canaliculae drain towards the 

nose, joining into a common canaliculus which 

empties into the lacrimal sac. This then drains 

through the nasolacrimal duct into the nose. 

Narrowing or blockage of the lacrimal drainage 

system is common, especially as we get older. 

The most common site of narrowing or blockage 

is where the nasolacrimal duct enters the nose. 

Blockage at this point causes stasis of tears in the 

lacrimal sac and, like anywhere else in the body, 

stasis usually leads to infection, so people with 

blocked tear ducts often have either a chronic low 

grade infection (lacrimal mucocoele) or a more 

severe infection called acute dacryocystitis. Either 

way, the tear film will often be loaded with more 

bacteria, their toxins and associated inflammatory 

mediators, which tends to make ocular surface 

discomfort worse. This is a form of the so-called 

“toxic tear syndrome” and explains why patients 

with a degree of dry eye may still benefit from 

tear duct bypass surgery (dacryocystorhinostomy 

or DCR) in the presence of nasolacrimal duct 

obstruction (NLDO). 

Creating or exacerbating toxic tear syndrome 

can happen whenever tear drainage is disrupted— 

partly because of stasis/infection within the 

residual drainage system and partly because 

increased evaporative tear loss increases 

concentrations of electrolytes and proteins in the 

precorneal tear film. These effects will be least if 

tear drainage is blocked at the lacrimal punctae, 

which is convenient, but when the punctae are 

blocked, and how, needs to be very carefully 

considered when deciding on which treatment to 

adopt. 

First and foremost we need to be sure that 

the patient has a genuine deficiency of aqueous 

tear production as the cause for their “dry 

eye” symptoms, rather than a disorder of tear 

film stability. Aqueous tear deficiency is quite 

uncommon, while secondary causes of tear film 

dysfunction are very common. Punctal occlusion 

will often improve symptoms in the former, but 

may make things much worse in the latter group, 

with inappropriate punctal occlusion potentially 

giving the patient symptoms of tear overflow 

(epiphora). Clinical assessment of aqueous tear 

production is notoriously variable, so multiple 

assessments of Schirmer’s test or Phenol Red 

Thread Test are helpful in establishing the 

diagnosis. 

Even in patients with proven tear production 

deficiency, there may be secondary factors actively 

destabilising the tear film, such as Meibomian 

gland dysfunction, lid margin inflammation etc. 

These problems need to be aggressively managed 

before punctal occlusion is considered. 

Lastly, the technique used for punctal occlusion 

needs to be determined—punctal plugs or 

surgical. “Punctal plugs” come in a huge variety of 

designs and materials, but can be considered as 

either temporary (dissolving) or permanent; and 

can be sited either at the punctum or within the 

canaliculae. 

CLC 

Oculocin Propo is a new product to the NZ 

and Australian markets targeting two key 

areas: chronic conjunctivitis and periodic 

inflammation; and dry eye. 

It’s a sterile, natural pharmaceutical grade 

extracts-based eye drop, which contains no 

preservatives. Other key points are: 

• Contains glycerin, propolis, aloe vera and 

chamomile extracts; is rich in phenols, 

aloins, amodins, alfa-bisabolols and its 

oxides and azulenes; 

• Composition is dedicated for proper 

lubrication, antibacterial, antiviral, 

antifungal, pain relief, immune boost and 

faster healing effects; 

• Works like a soft, wide-range antibiotic and 

NSAID together covering lubrication, easy 

The lacrimal drainage system 

Temporary plugs are most often intracanalicular 

and, depending on the material, will last one to 

four weeks. These plugs are enormously useful in 

determining the possible benefit from permanent 

punctal occlusion and assessing the risk of the 

patient developing epiphora. 

Permanent intracanalicular plugs should be 

avoided as they can migrate and cause infections 

and fistulae in the canaliculae or lacrimal sac. 

Permanent punctal plugs are also very useful in 

determining the effect of punctal occlusion for a 

given patient and have the added benefit of the 

plug being clearly visible and so easily removable. 

Used long term, however, they also can be 

associated with irritation of the punctum and the 

ocular surface and accumulation of biofilm on the 

plug itself. 

Surgery for punctal occlusion can be very simple 

(punctal cautery) or complex (conjunctival flaps 

used to reversibly cover the punctae). Given that 

most people with poor tear production have a 

very low chance of recovery, permanent punctal 

occlusion by cautery is most commonly employed. 

MANAGEMENT 

Patients with moderate/severe dry eye 

symptoms are best managed cooperatively by 

their optometrist and ophthalmologist. Careful 

documentation of examination findings will help 

secure the diagnosis (or more commonly, multiple 

diagnoses), allowing for aggressive management 

of all exacerbating factors. 

For a patient with significant symptoms 

and signs despite maximal tolerated medical 

management, test occlusion of one or both 

superior punctae can be performed with 

temporary or permanent punctal plugs. If this 

shows benefit without epiphora, permanent 

occlusion of the superior punctae by cautery 

should be performed, and medical management 

continued as required. 

For the rare patient still having significant 

symptoms and signs, temporary occlusion of 

the inferior punctae can be trialled, followed by 

punctal cautery as indicated. O 

* Dr Brian Sloan is based at the Milford 

Eye Clinic, consults at Milford’s 

Warkworth Branch once a fortnight 

and works half-time at Greenlane 

Clinical Centre. He consults in all areas 

of general and acute ophthalmology 

and specialises in oculoplastic surgery, 

which includes surgery for skin cancers 

and watery eyes. 

pain and spasmolytic relief properties; 

• Can be used long term with no potential 

side effects or other harm, providing 

symptomatic relief together with light 

antibacterial and anti-inflammatory 

action; 

• Can be used in the period after antibiotic 

or anti-inflammatory treatment when 

prolonged use of chemical drugs could put 

the patient at risk; 

• Can be used inconjunction with antibiotic 

or anti-inflammatory treatment (drop time 

may differ) for better effect and irritation 

relief; and 

• Due to its antibacterial properties it is a 

effective product for long term dry eye 

antiseptic management. O 



New study sheds light on Demodex 

role in rosacea 

The clinical implications of Demodex mites 

in rosacea was discussed at the recent 

annual meeting of the American Academy 

of Dermatology. 

According to a press release issued by the 

National Rosacea Society, which sponsored the 

discussion together with Galderma Laboratories, 

while Demodex are found on the skin of all 

humans, they frequently occur in greater numbers 

in those with rosacea. 

“Researchers have more recently discovered 

that while Demodex folliculorum and D. brevis 

live in the hair follicles and sebaceous glands of 

the facial skin, D. folliculorum is also found in the 

meibomian glands of ocular rosacea patients,” 

said Dr Frank Powell, consultant dermatologist 

at Mater Misericordiae Hospital in Dublin and 

former president of the European Academy of 

Dermatology and Venereology. “In the mites’ brief 

life span of 14 days, they live and reproduce in 

the pilosebaceous units, subsisting on sebum and 

cellular contents, and emerge from the follicles 

primarily at night.” 

The significance of the relationship between 

Demodex and rosacea has long been controversial, 

said Dr Diane Thiboutot, professor of dermatology 

and vice-chair for Research at Penn State 

University and a consultant to Galderma. “These 

parameters may have been superseded by more 

recent findings, and a recent review of 48 articles 

in the Archives of Dermatology concluded that the 

degree of Demodex infestation, as opposed to its 

simple presence, is an important factor in rosacea.” 

She pointed out that rosacea and demodicosis 

are currently the only diseases widely associated 

with increased Demodex mites, although recent 

evidence suggests there may be others. Dr Powell 

noted that increased Demodex numbers causing 

inflammation may be present in those whose 

immune systems are compromised, including 

individuals with malignancy, leukemia, HIV 

infection or pregnancy. Interestingly, he said, 

individuals who had significant acne when 

younger have often been observed to have rosacea 

later, supporting a possible genetic component 

Nourishing dry eye away 


Mitigating the effects of mild dry eye 

disease (DED) can be as simple as 

staying hydrated. 

We constantly lose water through 

urine and sweat. Of the water we lose, studies 

show 20 per cent is replaced by the food we eat 

and 80% by the fluids we drink, which is why 

Health authorities around the world say we should 

be drinking about 2 litres of water a day, or roughly 

eight medium-sized glasses of water. Others say 

we should be sipping water constantly, even when 

we’re not thirsty. 

In America 75 per cent of the population is 

believed to be at least mildly dehydrated, but 

even a small deficit can exacerbate symptoms 

associated with DED. The problem is made 

worse by our love of coffee, tea, alcohol and fizzy 

drinks - all diuretics that can lead to us becoming 

dehydrated more quickly. 

Plus we don’t just lose water in sweat and urine, 

but essential minerals such as sodium, potassium 

and magnesium, that enable cells to maintain 

their shape and to function properly, generating 

energy, contracting muscles and everything else 

they do. 

This has implications for the tear film because 

studies show it is essential for nourishing as well 

as lubricating the eye, with each of the three 

different layers—mucin, aqueous and lipid - 

playing a vital part in keeping our eyes healthy. 

Each layer is fuelled by varying concentrations of 

vitamins and minerals to ensure it does its job 

correctly. 

According to NTPtalk, a forum for nutritional 

therapists in the US, the mucin layer requires 

vitamin A; the lacrimal gland requires zinc, 

magnesium, Vitamin C, B6 and niacin; and the 

oily layer needs essential fatty acids—omega 3s, 

ZINC POTASSIUM VITAMIN A OMEGA 3 OMEGA 6 MAGNESIUM 

Shellfish White beans Carrots Flaxseed oil Vegetable oils Dark leafy greens 

Meat 

Dark leafy Sweet potato Seeds Nuts (walnuts) Nuts 

greens 

Wheat germ Baked 

Dark leafy Oily fish Seeds Seeds 

potato(skin on) greens 

Spinach Bananas Squash Tofu Meat Fish 

Pumpkin seeds Mushrooms Lettuce Edamame Milk 

Beans 

beans 

Nuts (cashews) Avocados Melon Walnuts Eggs Whole grains 

Cocoa Fish Dried apricots Squash Cheese Avocados 

Beans Yoghurt Tuna Olive oil Cereals Bananas 

Mushrooms Dried apricots Tropical fruit Brussel 

sprouts 

Foods rich in essential minerals and vitamins for good eye health 

Patient with rosacea and ocular rosacea 

in patients with skin that reacts to either 

Propionibacterium acnes or Demodex. 

Dr Linda Stein Gold, director of dermatology 

clinical research at Henry Ford Hospital, noted that 

microbic organisms that live on Demodex mites 

may also be involved, as a recent study found an 

unexpected diversity of such microorganisms, 

including a total of 92 species, 36 of which were 

never before recorded on humans. 

The roundtable participants agreed that 

further studies should be conducted to improve 

understanding of the presence of Demodex and 

its potential actions and interactions with other 

pathogenic factors in rosacea, as well as to provide 

knowledge for uniquely targeted therapy in clinical 

practice. 

Ocular rosacea 

Ocular rosacea is inflammation that causes 

redness, burning and itching of the eyes. It often 

develops in people who have rosacea, a chronic 

skin condition that affects the face. Sometimes 

ocular, or eye, rosacea is the first sign patients may 

later develop the facial type. 

Ocular rosacea primarily affects adults between 

30 and 50 years old and appears to develop in 

people who tend to blush and flush easily. O 

Drinking water—the simplest but most essential way 

to help keep dry eye at bay 

Evening 

primrose oil 

Dried fruit 

Demodex does or Demodex don’t 


There was an audible gasp in the audience 

as the mightily-magnified Demodex 

mite appeared on the screen, stubby legs 

waggling, long fat body wriggling. 

The initial shock, followed by some nervous 

laughing, brought a smile to Australian 

optometrist and director of Innovative Eye Care 

Lachlan Scott-Hoy, who was busily demonstrating 

microblepharoexfoliation using RySurg’s BlephEx 

to a large audience at one of ODMA’s Spotlight 

sessions this year. 

Sold in New Zealand by OptiMed, BlephEx, with 

an bit of extra help from some added tea tree 

oil – Scott-Hoy actually adds extra tea tree oil to 

Blephadex (the new at home and in practice lid 

cleanser sold in tandem with BlephEx) to increase 

its potency - not only cleans up the lids of patients 

with blepharitis, one of the most common causes 

of dry eye, it also kills the two species of Demodex 

mite (see box below) that are believed at best to be 

an aggravator of blepharitis and at worst to be a 

major cause of dry eye disease. 

Scott-Hoy, who said he believes Demodex is a 

major cause of blepharitis and dry eye, told his 

audience how he bought a microscope on eBay 

so he could see the prevalence of Demodex on his 

patients’ lids for himself. He was soon a convert 

and decided to deal with the beasties once and 

for all. The live Demodex pictures (transmitted 

straight from microscope to screen) also really help 

enormously with patient compliance, he laughed. 

Jennifer Craig, an associate professor with 

the University of Auckland’s Ophthalmology 

Department, declares a similar level of interest 

in Demodex and the potential role the mites 

play in the pathophysiology of lid disease and 

dry eye. Evaluation of epilated eyelashes under 

a microscope, from patients suspected of 

About Demodex 

Demodex mites are microscopic arachnids 

(relatives of spiders and ticks) that live in 

and on the skin of mammals—including 

humans. On humans they are most 

common on facial skin, such as the external 

ear canals, eyelashes, sides of the nose, 

cheeks and forehead. 

Generally the mites live out a benign 

coexistence with their hosts, but they 

are known to cause mange amongst 

animals and skin ailments like rosacea and 

blepharitis in humans. 

Humans host two species on their faces: 

Demodex folliculorum, which have the 

longer body, vary from about 0.3mm to 

0.4mm long, affect hair follicles, like the 

eyelashes, and feed on skin cells; and 

Demodex brevis, which tend to be about 

0.15mm to 0.2 mm long, inhabit the oil 

glands connected to follicles and feed on 

gland cells. 

The mites tend to be most active at night 

and escape deep into their follicles in bright 

light. 

Sardines: good for combating dry eye 

commonly found in fish oil, algae and flax seed oil, 

and omega 6, which comes from vegetable oils, 

cereals, eggs, poultry and supplements such as 

evening primrose oil (see table). Zinc is believed 

to be particularly important as the highest 

concentration of zinc in the entire body is in the 

cornea, while a lack of potassium is linked to both 

dehydration and DED. 

Adding nutrients to the diet isn’t straight 

forward, however. 

Take gamma-linolenic acid (GLA) for example, an 

omega 6 fatty acid shown to reduce lacrimal gland 

inflammation, says Jagrut Lallu of Visque Rose 

Optometrists in Hamilton. Or Docosahexaenoic 

demodecosis, is a regular occurrence in the Ocular 

Surface Clinic and, while patients are offered 

the latest evidence-based treatments, research 

exploring novel therapies is under way, in parallel, 

within the Ocular Surface Laboratory (see OSL 

story). 

In-office lid margin optimisation combined with 

detailed lid hygiene instruction is an integral 

part of Dr Craig’s management philosophy. As 

an advocate of the “ocular hygienist” (playing a 

comparable role to dentistry’s “dental hygienist”), 

being proactive in treating individuals affected by 

Demodex is no different, but she says she feels it’s 

important to weigh the recent hype and wave of 

mass hysteria against the reality that almost all 

adult patients, especially older patients, exhibit 

demodecosis, yet there are vast numbers who are 

asymptomatic. 

Dr Craig says she can report some excellent 

outcomes from treating individuals exhibiting 

lid disease associated with significant Demodex 

infestation, but says she’s careful to explain 

to patients the goal is to reduce the level of 

infestation rather than eradicate the mites 

altogether, as that would be virtually impossible. 

“If you have blepharitis or other lid disease or 

dry eye then treating Demodex is important. But 

what we don’t know for certain yet is whether 

Demodex is one of the actual causes of meibomian 

gland dysfunction or whether it just makes things 

worse.” O 

Lachlan Scott-Hoy demonstrating the BelphEx at 

ODMA|2015 

Demodex folliculorum 

acid (DHA), which affects retinal cell signalling 

mechanisms involved in phototransduction. 

And eicosapentaenoic acid (EPA), a substrate of 

DHA, which has been linked to abnormal retinal 

neovascularisation, vascular permeability, and 

inflammation. 

The vast amount of research in this area shows a 

healthy and effective diet must contain a balance 

of these omega 3 and omega 6 fatty acids. Too 

much omega 6—typically found in animal fats 

and vegetable oils, heavily used in fast food—can 

have an inflammatory effect, as not all omega 

6s are created equal. On the one hand GLA 

reduces inflammation, but linoleic acid (LA) and 

arachidonic acid (AA) promote it. Yet even GLA 

isn’t good if taken on its own: it only acts in an 

inflammatory manner if converted to dihomoy-linolenic 

acid (DGLA), which requires other 

nutrients, such as magnesium, zinc, and vitamins 

C, B3 and B6 to happen. 

A balanced diet is best for treating dry eye, says 

Lallu. “In general if you treat dry eye systemically, 

then you can help alleviate a lot of the symptoms.” 

But every patient is different, he warns, and some 

nutrients can interfere with a patient’s medication. 

For example, omega 3 supplements can affect the 

action of a number of blood thinning drugs. “So 

you have to know about the interactions before 

you go, ‘here, this is great’.” O 



17

Focus on 

Eye Research 

The latest topics in eye research reviewed by 

Save Sight Society ophthalmologists 

Oculoplastics 

REVIEWED BY KATHLEEYA STANG-VELDHOUSE* 

RISK FACTORS FOR DEVELOPING THYROID-ASSOCIATED 

OPHTHALMOPATHY AMONG INDIVIDUALS WITH 

GRAVES’ DISEASE 

Stein JD et al. JAMA Ophthalmol. 2015;133(3):290-296. 

This longitudinal cohort study evaluated health care claims data of 

8404 individuals who were newly diagnosed with Graves’ disease 

(GD). Examination of variations in exposure to medications and 

treatment modalities was performed in an attempt to identify 

modifiable risk factors predisposing patients to thyroid associated 

ophthalmopathy (TAO). 8.8% of patients developed TAO during the 

10-year follow-up period. Compared with radioactive iodine therapy 

alone, surgical thyroidectomy (alone or in combination with medical 

therapy) was associated with a 74% decreased hazard for TAO. 

Additionally, the use of a statin for 60 days in the preceding year was 

associated with a 40% decreased hazard. 

COMMENT: Dysthyroidism and smoking have been long associated 

with an increased risk of developing TAO. In 2014, Khong JJ et al. 

identified selenium deficiency as a possible risk factor for thyroid 

eye disease (TED). This study helps to identify possible preventive 

measures and establishes a need for prospective studies evaluating 

the effect of statin therapy and surgical thyroidectomy on patients 

with GD. 

THE BLICK MNEMONIC FOR CLINICAL–ANATOMICAL 

ASSESSMENT OF PATIENTS WITH EPIPHORA 

Tse DT et al. Ophthal Plast Reconstr Surg. 2014;30(6):450-458. 

Following a review of the literature from 1957-2014, the oculofacial 

plastic surgery team at Bascom Palmer Eye Institute have introduced 

the BLICK mnemonic to highlight less commonly considered 

causes of epiphora. The paper provides an overview of the lacrimal 

distribution system and blink cycle, and discusses under-recognised 

but important abnormalities that may lead to watering. BLICK stands 

for the following: 

Blink dynamics: a quick review of various conditions that alter the 

blink cycle are discussed, including facial nerve palsy, ichthyosis, and 

botulinum toxin. 

Lid malposition: abnormalities are classified as issues concerning 

anterior lamellar elasticity, apposition of the eyelid to the globe, or 

problems with canthal anchoring. 

Imbrication: the authors emphasise the significance of “a lax 

upper eyelid [that] overrides the lower eyelid during closure”. The 

contribution to epiphora is argued to be two-fold: chronic irritation 

of the upper palpebral conjunctiva triggers a foreign body sensation, 

resulting in reflex tearing; a poor eyelid-tear film apposition leads to 

suboptimal lacrimal distribution. 

Conjunctivochalasis: redundant bulbar conjunctiva may lead 

to poor tear distribution, while the finding of a megalocaruncle 

represents mechanical blockage of lacrimal outflow channels. 

Kissing puncta: punctal apposition in primary gaze and throughout 

the blink cycle can lead to disturbances in this pressure-sensitive 

system, preventing appropriate lacrimal drainage. 

COMMENT: This major review helps to remind clinicians of the 

complexities of tear film distribution and drainage. Further 

consideration of the more subtle findings on physical exam can help 

to elucidate the causes of epiphora in the challenging patient, as well 

as to point out which treatment options are more likely to succeed. 

EARLY RESULTS OF SURGICAL MANAGEMENT OF 

CONJUNCTIVAL DERMOLIPOMA: PARTIAL EXCISION AND 

FREE CONJUNCTIVAL AUTOGRAFT 

Choi YJ, et al. Br J Ophthalmol 2015;99:1031–1036. 

This study is a retrospective analysis of 13 patients treated for 

conjunctival dermolipomas, which are congenital choristomas 

(collections of normal cells/tissue in an abnormal location). Early 

surgical outcomes are reported for these patients undergoing 

partial resection of the mass. They report acceptable cosmetic 

results with no significant complications (ie. diplopia, ptosis, or 

keratoconjunctivitis sicca) in any of the subjects. The authors 

attribute these results to the introduction of a free conjunctival graft 

harvested from the contralateral eye. 

COMMENT: Dermolipomas most commonly present as unilateral, 

subconjunctival light pink to yellow lesions noted in the lateral 

aspect of the palpebral fissure. Growth is common in the first two 

decades of life, and while they may involve the lateral rectus muscle 

insertion dermolipomas rarely extend into deeper orbit. Historically, 

surgical resection is discouraged due to the risks of complications 

as listed above. The technique described in this paper, which takes a 

page from the evolution of the pterygiectomy procedure, may make 

surgical excision for patients with symptomatic dermolipomas a 

safer and more reliable option. 

ABOUT THE AUTHOR 

* Dr Kathleeya Stang-Veldhouse is an 

ophthalmologist who works at the Eye Clinic at 

Greenlane Clinical Centre. She is board-certified 

with the American Board of Ophthalmology and 

completed her fellowship in oculoplastics, lacrimal, 

and orbital surgery at the University of Auckland. 

Cataract and refractive 

surgeons will head to sunny 

Noosa in Queensland for the 

2015 AUSCRS conference from 

October 7 to October 10. 

The conference will take place at 

the Peppers Noosa Conference Centre, 

under the theme The Nexus. It has 

attracted well-known speakers in the 

field of refractive surgery, including 

two from Europe and two from the US. 

Dr David Kent, a New Zealand 

representative on the AUSCRS 

committee, says there are compelling 

reasons for cataract and refractive 

surgeons from here to attend the 

conference. “It is our local Australian 

and New Zealand cataract and 

refractive surgery meeting and it is a 

good way to meet and discuss cataract 

and refractive surgery topics with other 

Australasian ophthalmologists with 

similar interests.” 

Although there is a refractive surgery 

component at this meeting, most will 

be on modern cataract surgery, he says. 

“Another attractive component is the 

Vision Eye backs Chinese buyer 

Australian ophthalmic care 

provider Vision Eye Institute 

(VEI) has endorsed an A$1.10- 

a-share takeover offer by 

Shanghai-listed Jangho Group, effectively 

knocking rival Pulse Health’s bid into 

touch. 

Pulse, a small, Australian private hospital 

manager, which has a 15.9 per cent stake 

in VEI, made a hostile takeover bid for VEI 

in July. But the 85c a share, full scrip offer 

MDNZ wins friends 

with Professional 

Friend programme 

Macular Degeneration New Zealand (MDNZ) 

has had a very positive response from 

optometrists and ophthalmologists to its new 

Professional Friend programme. 

The programme includes free access to information for 

distribution to patients, a highlighted listing in the MDNZ 

web-directory and a quarterly newsletter. 

“We are working more closely with optometrists and 

ophthalmologists than ever before, while our key message 

of ‘early detection saves sight’ sends the public to the 

professional practices to get their eyes checked,” says 

MDNZ general manager Phillippa Pitcher. 

Pitcher says more professionals are turning up to MDNZ 

seminars and the strengthening connections are creating a 

unified message to get the public to take action to preserve 

their sight. 

The MDNZ website currently lists 23 Friend programme 

members from Invercargill to Whangarei, and Pitcher says 

more are planning to sign on soon. Check out the MDNZ 

website www.mdnz.org.nz for more information. Early bird 

signatories will be listed in the next Viewpoint newsletter. 

There is still an opportunity to be listed as MDNZ is 

committed to publishing the first 20 Ophthalmologists and 

the first 100 Optometrists who enlist. O 

event is being held at a holiday resort 

so it is more relaxing.” 

Dr Kent says he looks forward to 

hearing presentations by Dr Bob Cionni 

and Dr Eric Donnenfeld, who are two 

of the most renowned international 

speakers in their field. 

Dr Cionni, medical director for 

The Eye Institute of Utah, performs 

more than 2,500 operations a year, 

specialising in cataract surgery, lens 

implants, refractive surgeries such 

as LASIK and PRK, and refractive lens 

exchange. In addition to advanced 

technology IOLs, he utilises the LenSx 

femtosecond laser and ORA system 

with VerifEye. 

Dr Donnenfeld has been performing 

refractive surgery in the United States 

since 1989 and was one of the first 

surgeons in the world to do laser 

vision correction. He was involved 

with the initial studies that led to the 

approval of the excimer laser and is an 

experienced corneal surgeon who has 

performed more than 2,500 corneal 

transplant procedures. 

was swiftly rejected by VEI’s directors. 

Jangho, a Chinese construction material 

company, cemented its interest by 

acquiring Australian healthcare company 

Primary Healthcare’s 19 per cent in VEI 

stake last month. 

In explaining its decision to back 

Jangho’s cash offer, VEI’s directors in 

a statement said the bid “highlights 

the strategic value of our business, in 

particular its day surgery clinics, the 

Also speaking will be Dr Roberto 

Belluci, director of ophthalmology 

at the Hospital of Verona, Italy, and 

Dr Gilles Lesieur, a former intern of 

the Toulouse Hospital, France who 

graduated in IUD refractive surgery and 

phacoemulsification and is currently 

a scientific advisor to Bausch + Lomb 

and PhysIOL laboratories. Recognising 

the important roles support staff 

play in a practice, AUSCRS 2015 

also includes a practice managers/ 

administration staff programme and a 

technical staff programme. 

The event is well supported by 

industry partners with Bausch + 

Lomb and Alcon as key sponsors, while 

exhibitors include Ellex Medical, BOC 

Ophthalmic Instruments, Lumenis, 

Medibroker, Designs for Vision, 

AcuFocus, OptiMed, Medical I.T. Best 

Practice Software, Spectrum Surgical, 

AMO Australia, IQ Medical, Bausch 

+ Lomb, Insight Surgical, Device 

Technologies, Alcon and ZEISS. For 

more details, visit 

www.auscrs2015.org.au. O 

program of strategic initiatives being 

undertaken and Vision’s strong prospects 

for future growth.” O 

A BIG (Beat Invisible 

Glaucoma) thank you 

from Glaucoma NZ 

Glaucoma NZ extends a big thank you to all those 

who supported the 2015 July Annual Awareness 

Appeal. 

It has been extremely encouraging to have so 

many regular participants willing to help out once again 

and also some new faces and places joining in. 

Optometrists and ophthalmologists responded by taking 

donation boxes to display at their practices, as well as 

some making a donation from eye and/or glaucoma 

examinations undertaken during July. The support 

nationwide of pharmacies and ASB Bank also made a 

significant difference, and this year we also welcomed a 

great number of new corporates and businesses joining in. 

A large amount of media exposure was generated and 

we were also grateful for the added support of GNZ’s 

ambassador Sir Richard Hadlee and his wife Lady Dianne 

who appeared in NZ Woman’s Weekly to support the cause. 

GNZ’s 0800 line was busy with enquiries from the 

public wanting to know more about glaucoma and early 

detection. Many of these people were subsequently advised 

to visit their local optometrist for an eye examination. 

The Appeal overall has been a great success, lifting the 

awareness of glaucoma and boosting funds. 

Again, Glaucoma NZ appreciates all your efforts during 

the 2015 July Annual Awareness Appeal and your 

continued support throughout the year working towards 

eliminating blindness from glaucoma. O 


World class eye centre opens 

in Solomons 

Fred Hollows Foundation staff from left: Lucy Dryden, Konio Szetu, Celia Parry, John Szetu, Andrew Bell, Marleen 

Nelisse and Craig Fisher 

The Hon Prime Minister Manasseh 

Sogavare of the Solomon Islands opened 

the region’s first Regional Eye Centre in 

the country’s capital, Honiara. 

The Centre provides free eye care to all citizens 

and doubles as a training hub for visiting eye 

care professionals. 

Officially launched on July 22, the Centre 

represents a partnership between the Solomon 

Islands, the New Zealand government and 

The Fred Hollows Foundation NZ. The site was 

designed by award winning New Zealand firm 

Bossley Architects and built by local contractors. 

The Centre’s lead ophthalmologist, Dr Claude 

Posala, says he is thrilled to see the facility 

launch after all the extensive consultation and 

planning. 

“The Centre’s design and construction is 

incredibly high quality. Ninety-four per cent of 

the Centre’s power comes from solar energy 

and the building materials will last 50 years. I’m 

proud to say we have the most advanced eye 

care facility in the Pacific.” 

Dr Posala says the Centre will help prevent 

avoidable blindness in the country. “In Solomon 

Islands, as in the wider Pacific region, four out 

of five people who are blind don’t need to be— 

their condition is preventable or treatable.” 

Twenty-one Solomon Island eye nurses and 

four eye doctors have so far graduated from The 

Foundation’s Pacific Eye Institute in Fiji. 

“The Solomon Island government has shown 

great commitment to building the country’s eye 

health systems. Their graduates are amongst the 

best and brightest in the Pacific, and now they 

have a facility befitting of their specialist skills,” 

says Andrew Bell, executive director for The Fred 

Hollows Foundation. 

Eye care professionals from the region can 

gain further specialist knowledge at the 

Centre, which will also run mobile clinics in 

neighbouring Pacific nations. 

In its first year alone, the Centre will double 

the number of sight-saving surgeries performed 

in the Solomon Islands. The New Zealand 

Government has invested more than $4.1 million 

in the facility, with additional funding coming 

from the World Diabetes Foundation, the Queen 

Elizabeth Diamond Jubilee Trust and The Fred 

Hollows Foundation NZ. O 

OBITUARY 

Sydney-based optics giant, Brien Holden 

Internationally renowned optics researcher 

and philanthropist Professor Brien Holden 

died on July 27, aged 73, sending ripples 

from his home in Sydney throughout the 

world of optics and beyond. 

Holden was a teacher, researcher and 

humanist, who held a lifelong interest in 

bringing healthcare to developing nations, a 

passion that resulted in the organisation that 

now bears his name, the Brien Holden Vision 

Institute (BHVI), for which he served as CEO 

until his death. 

“I have huge respect for what Brien achieved 

in his lifetime,” says Paul Rose, a Hamiltonbased 

Optometrist and contact lens developer 

who flew to Sydney for Holden’s funeral. “My 

association with Brien goes back many years 

now and I remember well our first encounter 

back in the early 70s. He will be a difficult man 

to replace.” 

Holden was known for his pioneering work 

in soft contact lenses, beginning in the early 

1970s at the School of Optometry of the 

University of New South Wales where he was 

a lecturer. There he led a team of postgraduate 

students in determining what was needed 

in contact lenses to maintain eye health. 

Their work drew wide interest, prompting the 

group to move beyond the original goal of 

understanding the effects of contact lenses 

on the cornea to all aspects of contact lenses 

from lens design, material properties and 

performance to the effects of a wide range of 

ocular devices, procedures and contact lens 

solutions on the eye. 

Holden is credited in the co-development 

of the silicone hydrogel contact lens which 

makes up more than half of all contacts used 

worldwide. 

He was awarded an Order of Australia Medal 

in 1997 for his work in eye health and vision 

science. 

BHVI today is a non-profit organisation that 

has established hundreds of eye care sites 

around the globe, provided optometric services 

to more than two million people and trained 

nearly 50,000 eye care personnel. 

Optometry Ball 

University of Auckland optometry 

students enjoyed a night out at 

Alexandra Park for the annual 

Optometry Student Ball. The August 6 

event saw students, staff, and significant others 

Professor Brien Holden 

“Brien’s efforts and achievements have 

been recognised, applauded and adopted 

worldwide,” says BHVI Chair Brian Layland. 

“All who have worked with him will have fond 

memories to cherish; all will miss him. His 

legacy will encourage all to strive to achieve 

the goals he had set.” 

Holden is survived by wife Yvonne, three 

children, and four grandchildren. 

BHVI appoints interim CEO 

The Brien Holden Vision Institute (BHVI) has 

appointed deputy CEO, Professor Kovin Naidoo 

as interim CEO. Naidoo was a co-founder of the 

Clear Vision Optical franchise and has served 

in many elected/voluntary positions including 

Africa Chair of the International Agency for the 

Prevention of Blindness. A Fulbright Scholar, 

Naidoo was awarded a PhD from the University 

of New South Wales, a Doctorate of Optometry 

from the Pennsylvania College of Optometry, 

a Masters in Public Health from Temple 

University and a BSc and BOptom degree from 

University of Durban-Westville. He was African 

Optometrist of the Year in 2002, International 

Optometrist in 2007, and was jointly awarded 

with Holden the Schwab Social Entrepreneur 

Award for Africa 2010. O 

dress up as pirates, with James Li and Rosa 

Sun taking prizes for their outfits. The event 

was sponsored by Specsavers, Eye Institute, 

NZAO, Luxottica, Designs for Vision, Optimed, 

CooperVision and Corneal Lens Corporation. O 

Prime Minister Rt Hon Manasseh Sogavare gets an 

explanation of the centres solar power by David 

Pollard from What Power Crisis? 

The Fred Hollows Foundation NZ Regional Eye Clinic in 

Honiara, Solomon Islands 

Health tracking in a pair of specs 

US-based VSP Global claims to have 

developed the first wearable 

prototype of optical frames integrated 

with health-tracking technologies. 

Project Genesis features sensor technology 

housed within the temple of a pair of Dragon 

Alliance frames, allowing the wearer to track 

steps, calories burned, activity time and distance 

travelled via an app developed in-house, and 

synced via Bluetooth. 

The app and integrated frames were developed 

in secret over 12 months by VSP Global’s inhouse 

laboratory, the SHOP, under the leadership 

of Jay Sales and Leslie Muller. 

“Eyewear has been the most successful piece 

of ‘wearable technology’ for over 700 years,” 

says Muller. “With Genesis, we’re now adding 

additional value into the frame, but doing so in 

a seamless, fully integrated design that creates a 

richer experience for the wearer.” 

SHOP is beta testing the prototype with 

26 VSP Global employees at the company’s 

Californian headquarters. Participants give 

real-time feedback to SHOP engineers and 

designers, allowing for rapid improvements to 

The tracking device is built into the frame’s temple 

the prototype’s initial hardware and software 

designs. 

“Wearable technology is exploding right now, 

some of it could be considered hype, some of it 

could be considered the start of a personalised 

medicine revolution,” says Sales. “The Genesis 

prototype is a first step at providing a deeper 

level of contextualised health data through 

a device a large portion of people are already 

utilising every day.” O 

Back row from left to right: Rahul Kumar and Sayed 

Shuaib; Centre: Annie Wang, Dexter Low, Janet 

Chung, Huimin Dai, Lexia Ahkit and Sean Mahendran. 

Front: Divya Anthraper and Brinda Mamidi 

From Left to Right: Costume prize winner Rosa Sun 

with Alyssa Lie, LeiLei Zhou, Jingyi Xu, and Michelle Ko 

(Standing, left to right) Tyler Duncan, Robert Burnie, Katarina Marcijas, Chad Walker; (middle, seated): Marna 

Classen, Gemima Ji, Menaga Manokoran, Alice Jackson, Sharni Killoran, Kayleigh Aspeling; and (centre, in 

repose) Ken Turner 



19

with 

Prof Charles McGhee 

& A/Prof Dipika Patel 

Series Editors 

Corneal collagen crosslinking update 

A 

B 

BY AKILESH GOKUL, DIPIKA PATEL, CHARLES MCHGEE* 

INTRODUCTION 

In 2003 Wollansek et al. published a nonrandomised 

clinical pilot study detailing the 

procedure for corneal collagen crosslinking 

(CXL) as a means to halt or slow down 

the progression of keratoconus. 1 Known as the 

Dresden protocol, the procedure requires removal 

of the central corneal epithelium, followed by 

application of riboflavin (vitamin B2) solution 

and irradiation with ultra-violet A (UVA) radiation 

(370nm). 

A variety of alterations to the Dresden protocol 

have been proposed, aimed at increasing the 

number of patients that can undergo CXL, in terms 

of time taken to perform the procedure (efficiency) 

and anatomical limitations (corneal thickness 

>400µm at the thinnest point), while maintaining 

safety and efficacy. 

This article provides an update on CXL including; 

variations in procedure and evidence on safety and 

efficacy. 

VARIATIONS IN PROCEDURE 

Accelerated Corneal Collagen Crosslinking 

The main differentiating factor between the 

Dresden and accelerated CXL procedure is the 

intensity of UVA utilised and its duration. The 

Bunsen-Roscoe law of reciprocity states that; if the 

irradiance (total energy received by a surface per 

unit area) remains constant, the photochemical 

effect should be similar. Thus, theoretically, 

increasing the intensity of UVA and reducing 

treatment time to keep irradiance constant should 

yield similar results while improving efficiency. The 

Dresden protocol calls for irradiation with UVA of 

3 mW/cm 2 for 30 minutes, total irradiance of 5.4 

J/cm 2 . 1 Modified protocols using UVA intensities 

of 9 mW/cm 2 for 10 minutes, 2 18 mW/cm 2 for 5 

minutes 2 and 30 mW/cm 2 for 3 minutes 2,3 (total 

irradiances of 5.4 J/cm 2 ) have been investigated. 

Transepithelial Corneal Collagen Crosslinking 

Removal of the central corneal epithelium in 

the Dresden protocol is necessary to allow 

riboflavin to penetrate into the corneal 

stroma and reach concentrations adequate 

for effective crosslinking to occur. However, 

epithelial debridement results in significant 

post-operative pain and carries significant risk 

of complications. Transepithelial CXL minimises 

these risks as the epithelium is not removed. 

However, tight junctions within the epithelium 

limit riboflavin penetration, thus epithelial 

disruption is required. Epithelial disruption can be 

achieved chemically using penetration enhancing 

agents such as benzalkonium chloride (BAK) 

and Ethylenediaminetetraacetic acid (EDTA), 

sometimes in combination. Ionotophoresis 

(application of a low electric gradient to the 

cornea to improve riboflavin penetration) 4 does 

not require epithelial disruption and is reported to 

produce higher levels of riboflavin in the stroma 

compared to other methods of transepithelial CXL. 

However this technique is not commonly used as it 

is more technically challenging. 

MICROSTRUCTURAL CHANGES 

In vivo confocal microscopy has been used 

extensively to investigate the microstructural 

changes that occur following CXL. Following 

Dresden protocol CXL; the central corneal subbasal 

nerve plexus is often completely obliterated 

and a significant decrease in anterior keratocyte 

density (due to apoptosis) is observed at 1-6 

months post-operatively with a return to the 

pre-operative state at 12 months. 3,5 Additionally, 

anterior stromal oedema with hyper-reflective 

cytoplasm and extracellular lacunae in a 

honeycomb-like appearance is observed for up to 3 

months postoperatively (Figure 3). 3,5 The apparent 

demarcation between treated and untreated 

stroma appears as a region where normal 

keratocytes transition into elongated, hyperreflective, 

needle-like structures and then into 

large hyper-reflective stromal bands. 5 Cytotoxic 

effects of CXL on the corneal endothelium is a 

major concern, however, it appears that this does 

not occur as long as a minimum corneal thickness 

of >400µm is adhered to. 3,5 Accelerated CXL with 

irradiances of 18 mW/cm 2 for 5 minutes 6 and 30 

mW/cm 2 for 3 minutes 3,4 are reported to have 

similar microstructural effects as the Dresden 

protocol, though there is some indication that 

the anterior microstructural changes are slightly 

more pronounced. 3,4,6 Generally, none to minimal 

disruption to the corneal microstructure occurs 

when transepithelial CXL is utilised. 4,6,7 

SAFETY AND EFFICACY 

Safety 

CXL carries the risk of a number of complications 

including; infection, sterile or infectious 

infiltrates, transient corneal haze and scarring 

(Figure 2), most of which are due to removal of the 

epithelium. Many of these risks are significantly 

reduced when transepithelial CXL is utilised and 

can be minimised with a strict regimen of topical 

antibiotics and corticosteroids. The Dresden 

protocol has reported rates of sterile infiltrates in 

7.6%, stromal scarring in 2.9% and loss of 2 lines 

of vision or more in 2.9% of cases. 8 Transient postoperative 

corneal haze, which fades with time in 

most cases, is observed in the majority of cases 

(up to 90%) following the Dresden protocol. 8,9 

Infection following CXL is a rare complication, 

a recent large retrospective study revealed an 

infection rate of 0.0017% following the Dresden 

protocol and no infections were reported 

following accelerated and transepithelial CXL. 10 

Efficacy 

Much like measuring progression in keratoconus, 

measuring the efficacy of CXL is challenging. 

The measures of a successful outcome are 

generally based on whether there is progression 

in corneal shape, refraction and visual acuity. 

A recent Cochrane systematic review was 

conducted concerning CXL as a treatment for 

keratoconus, which highlighted the fact that 

there is a shortcoming in the evidence that CXL is 

an effective treatment for slowing or halting the 

progression of keratoconus. 11 There are over 600 

peer-reviewed publications concerning CXL, but 

there are very few well conducted randomised 

controlled trials (RCTs). Only three RCTs were 

included in the final Cochrane analyses, all of 

which adhered to the Dresden protocol. While 

the quality of evidence was graded as very low 

(grade 1 of 4), the observations are similar to the 

majority of investigations concerning the efficacy 

of the Dresden protocol. 

Topography/Tomography 

The Cochrane review revealed that at 12 months, 

the mean maximal keratometry was 1.92D less 

than the preoperative state (Figure 1). 11 There is 

a significant reduction in the risk of progression 

(defined as an increase in maximal keratometry of 

1.5D or more in 12 months following treatment), 

relative risk of 0.12. 11 However, at 36 month 

follow-up and progression defined as an increase 

in maximal keratometry of 2D or more, the 

relative risk is even lower at 0.03. 11 Progression 

has been reported to occur in 4.8% 11 and 7.6% 8 of 

cases, variations in failure rates between studies 

is likely due to different definitions of failure. 

Investigations with UVA intensities of 9 mW/cm 2 

for 10 minutes, 2 18 mW/cm 2 for 5 minutes 2 and 30 

mW/cm 2 for 3 minutes 2,3 compared to the Dresden 

protocol, are promising and reveal flattening of 

the cornea at 12 months in all cases. However, it 

appears that the flattening affect may reduce as 

the intensity of UVA increases. Mean maximum 

keratometry at 12 months was reduced by 1.32D 

(Dresden protocol), 0.67D (9mW/cm 2 ),0.52D (18 

mW/cm 2 ) and 0.18D (30 mW/cm 2 ). 2 Failure rates 

of 3% were noted for the 18 mW/cm 2 and 30 mW/ 

cm 2 groups. 2 

Results following the transepithelial CXL 

protocol with chemical disruption are less 

promising. On average, there was no significant 

increase in maximum keratometry at 12 months, 

however, at 24 months there was a significant 

increase in maximum keratometry. 12 The use of 

ionotophoresis in transepithelial CXL interestingly 

shows considerable reduction in maximum 

keratometry of 2.35D at 12 month follow up. 7 We 

should bear in mind that the aim of CXL is not to 

flatten the cornea but rather to prevent further 

steepening thus a lower flattening effect in itself 

does not constitute failure; however, this may 

carry a greater risk of failure with longer follow 

up. 

Figure 1. Anterior Axial/Sagittal Curvature. A. Pre-operative, maximum keratometry 54.1D. B. 12 months postaccelerated 

CXL (30mW/cm2), exceptional flattening effect, maximum keratometry 51.5D 

A 

Figure 2. Post-accelerated CXL (30mW/cm2) corneal haze. A. 16x magnification B. 25x magnification 

A 

Figure 3. Anterior keratocytes A. Pre-operative. B. 1 month post-op, hyper-reflective cytoplasm and extracellular 

lacunae honeycomb-like appearance 

A 

B 

Refraction/VA 

Treatment with CXL often results in a modest 

improvement in uncorrected (UCVA) and best 

corrected VA (BCVA) as well as spherical equivalent 

refraction (SE). For the Dresden protocol, at 12 

months there is an improvement of approximately 

2 lines in UCVA 11 and BCVA 9 and an improvement of 

0.65D in SE. 11 Unlike the topography/tomography 

B 

B 

Figure 4. 

Demarcation 

line on 

Anterior 

Segment OCT 

A. Shallow 

demarcation 

line B. Deep 

demarcation 

line 

results, the Dresden protocol, 9 mW/cm 2 , 18 

mW/cm 2 and 30 mW/cm 2 intensities, yielded no 

difference in BCVA and SE when post-operative 

improvements in both parameters were compared 

between intensities. 2, 3 Transepithelial CXL with 

chemical disruption resulted in an improvement 

in UCVA and BCVA at 12 months, however, at 

CONTINUED ON P21 


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2020 with most of the growth 

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Although revenues have 

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as generic versions of 

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Factors driving these changes 

include: aging of world 

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markets and the developing 

world; increasing rates of high 

myopia; increased access to 

care in the developing world, 

CONTINUED FROM P20 

24 months UCVA fell below baseline and BCVA 

returned to baseline. 12 Transepithelial CXL with 

ionotophoresis has shown an improvement in 

UCVA, BCVA and refractive astigmatism of 0.13 

LogMAR (1 line), 0.05 LogMAR (0.5 line), and 0.49D, 

respectively at 12 months. 7,9 

AS-OCT 

As previously mentioned, an apparent demarcation 

between treated and untreated corneal stroma 

is observable with IVCM, a similar demarcation 

line is observable on anterior segment optical 

coherence tomography (AS-OCT) (Figure 4). Though 

not definitively established, it is believed the 

demarcation line indicates how deep the crosslinking 

effect has occurred. If this is indeed the 

case, it has not yet been determined if there is 

an ideal or minimum depth of the demarcation 

that would likely result in a successful outcome. 

When the Dresden protocol is utilised, the depth 

of the demarcation is usually around 300µm. 13 

Accelerated CXL modalities reveal a shallower 

demarcation. It appears that with increasing 

intensity, the demarcation line is shallower and 

more variable. With the 18 mW/cm 2 and 30 mW/ 

cm 2 intensities the average depth of demarcation is 

observed at 203µm 2 and 184-201µm, 2,4 respectively. 

Similar to accelerated CXL, the demarcation line is 

shallower following transepithelial CXL, compared 

to the Dresden protocol. In fact 50% of corneas 

treated with transepithelial CXL do not display 

any demarcation line, even when ionotophoresis 

is utilised. 4 Corneas treated with transepithelial 

CXL utilising ionotophoresis demonstrates a 

demarcation line at 212µm on average, when 

present. 4 As previously stated no minimum depth 

of demarcation for CXL to be effective has been 

revealed thus far hence a possible advantage 

of current accelerated and transepithelial CXL 

protocols is that they may be employed safely on 

corneas

Reflections 

Writing this edition involved much 

reminiscing and introspection as it 

marks some significant events. 

Maryanne and Anita Dransfield have sold New 

Zealand Optics to Lesley Springall who takes over 

as Publisher and Editor. 

After acquiring a fledgling NZ Optics in 1981, 

Maryanne moved the magazine production to a 

converted garage at her home in Kohimarama. 

From small beginnings she grew NZ Optics into 

the multimedia publication that it is today and it 

remains the only such publication in New Zealand. 

A colourful and energetic character Maryanne 

has penned millions of words covering the whole 

gamut of eyecare. She’s become part of the 

scene and fabric of New Zealand eye care and 

has helped organise and attended conferences, 

launches, functions and CPD events. She is 

justifiably proud of their efforts in helping to lift 

the profile of organisations like the NZ National 

Eyebank, MDNZ and Glaucoma NZ and supported 

fundraising efforts and events. Maryanne is 

pleased that the magazine has helped foster ties 

between optometrists and ophthalmologists 

and has enjoyed the challenge of embracing 

ophthalmology and learning fantastic things 

about eye disease and treatment. 

Most things have been dutifully recorded in word 

and in the thousands of photographs that serve 

as a documented record of the evolution of the 

professions. Fun times were enjoyed at many great 

events. 

At the start publishing was literally cut and 

paste with scissors and runny glue something 

NEW 

I too experienced in the mid ‘70s. Maryanne 

relates the evolution of publishing as follows: “I 

started by typing stories on an IBM typewriter, 

then Commodore computer and finally 286 & 

386 computers. We’d then take the stories into 

Parnell where they were typeset and printed out in 

galleys. I used to start laying up at 4pm and end at 

4am. I’d sleep three hours and then head back to 

the typesetters for corrections, headings, change 

of font size and have bromides made of photos. 

All layup was by hand; wax the galleys and paste 

them into place, juggling copy to fit, cutting out 

whole paragraphs… 

This went on for two to three days. It was a huge 

undertaking. How technology has changed things. 

I think it was around the late ‘80s that I was able to 

give a floppy disk of stories to someone who then 

laid them up into PageMaker. This changed my life 

as well as everyone in publishing. I’m pleased I had 

this experience as I knew what point sizes would 

suit and which fonts were best to use.” 

I first approached Maryanne in late 1994 offering 

my services, which resulted in my first column 

appearing in early 1995. This is well covered in my 

recent twentieth-anniversary edition. 

NZ Optics has also been a family affair with 

Maryanne’s son Kyle working with Maryanne 

during the 1990’s, taking NZ Optics online during 

this time. 

Anita, Maryanne’s daughter-in-law then 

joined up full time and has been a co-owner 

of the magazine for the past twelve years. Her 

contribution has also been immense, doing much 

of the layout and production, reporting on and 

attending numerous events. 

NZ Optics is always an attractive publication, 

with solid editorial content. Anita has also helped 

Built on the ACUVUE ® MOIST Platform 

the #1 best-selling daily disposable brand around the globe 1 

Her Vision Will Change. 

Her Experience Won’t. 

arrange many conferences, shared her personal 

experiences with Ortho-K and LASIK and been a 

key part of the online presence. 

We’ll miss their familiar faces at future events! 

I’ll never forget an incident when I presented the 

2009 BCLA Pioneers Lecture at the Royal Society of 

Medicine in London. I was standing in the foyer at 

the tea break only to catch a glimpse of Anita out 

of the corner of my eye. I couldn’t believe that the 

two of them had travelled all the way to London to 

surprise me with their attendance and coverage of 

this milestone event in the December 2009 edition. 

Full credit to the Dransfield’s! 

It’s been a pleasure working with you for the 

past twenty years with many great memories and 

sharing fantastic meals in Queenstown, Omaha 

and Auckland. 

Rest assured NZ Optics is now in the capable 

hands of Lesley Springall who has much experience 

at the pointy end of NZ journalism, writing, PR 

and marketing. Lesley has written for The Herald, 

NZ Business, and Unlimited and covered a broad 

range of industries along the way. A stint in the UK, 

with high finance and venture capital adds to her 

extensive biography, I am sure she will continue 

the fine traditions of NZ Optics while continuing 

its evolutionary journey onwards and upwards. 

We wish Lesley much luck in her new venture and 

I look forward to working with her. 

Great Mentors 

July marked the passing of two friends and legends 

in contact lenses. 

Trevor John Duncan RNZAF 326872 8 April 1932 

– 12 July 2015, passed away after a brief illness. 

Trevor was one of the founder members of the 

CCLS and was active on council for over three 

decades. He served as secretary/treasurer 1984- 

1986 and as President 1991-1992. He was made a 

life member of the CCLS in 1993 as recognition for 

his sterling contribution to contact lenses and the 

society. 

He again served as secretary/treasurer from 1999 

to 2008, which coincided with my time on council 

and term as president. It was during this time that 

I got to know Trevor well as a fellow councillor 

and friend. In this period we got the CCLS online 

and moved the administration to computer and 

email. I was impressed with how Trevor took on 

this challenge and it did not take him long to 

master email, Word, electronic accounting and 

maintenance of the online membership database. 

Having Trevor on council was fantastic as he had 

a great sense of humour, was always calm and 

rational and was a real gentleman. He was also 

always au fait with the rules, the history and the 

correct procedures for elections and AGMs. We 

achieved many positive things during this time 

including the name change from the NZSCLP to 

the CCLS and steps needed to keep the society 

relevant in the ever-evolving world of contact 

lenses and CPD, while warding off threats to the 

profession. We arranged numerous conferences 

in this time, when most of the work was done by 

council; as opposed to the current situation where 

professional conference organisers do much of the 

work. This required a massive input of time and 

effort, many meetings and countless emails. It is 

credit to Trevor that some of these conferences 

were rated as the ‘best conferences ever’ by 

attending delegates. 

Trevor had a sterling career in practice in 

Hamilton as a general optometrist and contact 

lens specialist and provided excellent care to tens 

of thousands of appreciative patients over the 

decades. 

There are many people who recall with pleasure 

and fond memories the many dive trips that he 

organised in NZ and the Pacific Islands. I’ve heard 

stories of legendary fishing trips, where copious 

quantities of beer were consumed. 

Trevor is also remembered as the author of 

the notoriously politically incorrect newsletters 

that he regularly sent out to CCLS members. 

Apart from keeping the membership up to date 

with the goings-on of the society, these always 

included some humour. We kept in touch by 

email until shortly before his passing. I always 

enjoyed receiving his jokes and at times raunchy 

communications. He also sent these to his dear 

friend, ophthalmologist David Sabiston, another 

early CCLS member, former president and life 

member of the society. Trevor was instrumental in 

corralling David into writing the amazing history 

of the CCLS and one in which Trevor (and David’s) 

names feature dozens of times. You can read the 

history via this link. Search for ‘Duncan’ to gain an 

insight into his staunch contribution. 

It was friendships like the one between David 

and Trevor that helped foster the unique and 

amazing relationship between optometry and 

ophthalmology in the CCLS that continues to 

thrive. 

Trevor is survived by his wonderful wife, 

Noeleen. They were married for fifty-nine years. 

She supported him greatly and he took great care 

of her in latter years, when macula degeneration 

made every day life challenging. 

He will be fondly remembered by friends, 

patients, colleagues and around two-dozen 

children, grandchildren and great-grandchildren. 

RIP old friend. 

Last but not least, the sudden passing of the 

legendary and larger-than-life, Brien Anthony 

Holden OAM, 06.01.1942 - 27.07.2015 was a shock 

to everyone in the eye care world. One could write 

pages in tribute to Brien but this is well covered in 

numerous places on the web so I will not repeat it 

here. It is strangely coincidental that Optometry 

and Vision Science featured his enlightening 2014 

Prentice Award Speech in the July 2015 edition. 

I have known Brien since the late 1970s. He 

was an amazing character and in my view the 

gold standard of presenters, who I have striven to 

emulate. He was one of my prime motivators, who 

set me on the path to doing what I do in terms or 

presenting and writing. 

Some of the highlights of my speaking career 

have been presenting with Brien on the same 

stage and our debate at the 2010 BCLA was 

memorable. I loved his brash Aussie style. Of 

course he had his detractors and he offended 

a good few people. Brien is however one of the 

most internationally respected people in the eye 

care world. His amazing contribution to research, 

founding of the CCLRU - which though its variuos 

iterations has garnered an astounding $1.3 billion 

in funding over the past five decades - is part of his 

legacy. Among many things, this in turn lead to the 

co-development of the now ubiquitous siliconehydrogel 

contact lenses. Today these account for 

the majority of soft contact lens fittings. 

What is arguably more important going forward 

is his staunch and unfailing endeavor to erradicate 

preventable blindness among those less fortunate. 

He had strong moral convictions and humanitarian 

beliefs. In time I believe that his vision will see 

to it that millions of people will have their sight 

restored. His commitment to Global Vision was 

immense and I was honoured to cover it in an 

article for the Optician journal. 

I believe his dedication to myopia control will be 

significant, as it’s already proving to be. 

There are many other projects he was involved 

in. The perfection and commercialisation of 

the restoration of accomodation project, postpresbyopia 

and in cataract surgery, could become a 

multi-billion dollar industry in its own right. 

I have many wonferful memories of Brien. I 

recall with fondness the many interactions we 

had at conferences around the globe. Beer-fuelled 

sessions in hotel rooms, with interesting people, 

were the venue for many significant discussions. 

These often went on until sunrise. We’d have a 

quick power nap, dust ourseleves off and be back 

on the podium presenting, with few any the wiser 

as to the shennanigans of the night before. 

RIP mate. There will never be another like you. 

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ACUVUE® and 1-DAY ACUVUE® MOIST are trademarks of Johnson & Johnson Vision Care Companies. © Johnson & Johnson Vision Care Companies 2015 10314426-A April 2015 

Change of ownership in Marton 

A 

long 

established optometry 

practice in Marton, northwest of 

Palmerston North, has changed 

hands. 

David Newman Optometrist has been 

sold to Ross Tayler and renamed the Vision 

Experience Optometrist. It will remain in its 

central Marton main street location. 

Newman sold the practice to retire from 

optics after a 35-year career, but will 

continue to pursue his parallel career in 

music. 

Tayler graduated from the University 

of Auckland in 1994 and has worked 

in various practices in the lower North 

Island. He has been a member of the ODOB 

board since 2014 and serves on several 

committees. O 


AAOMC conference 

sees heaviest 

attendance 

BY JAGRUT LALLU, VISIQUE ROSE OPTOMETRISTS 

Over 500 people 

attended the 

Vision by 

Design 2015 

annual meeting of the 

American Academy of 

Orthokeratology & Myopia 

Control (AAOMC), the 

highest attendance in its 

history. 

The assembly doubled 

as the fourth meeting of 

the International Academy 

of Orthokeratology (IAO), 

with over 40 countries 

from the IAO’s five regional 

associations represented. 

The IAO at the meeting 

launched its sixth region 

covering southeast Asia, 

India, and Africa initiated. 

The AAOMC meeting 

featured presentations 

on inwardly focused lens 

design, pharmaceutical 

and multifocal 

lens interventions, 

ergonomic and binocular 

modifications, and 

unique treatment options 

employed in China. Other 

panel sessions covered 

troubleshooting Ortho-K, 

scleral lens designs, 

practice management, and 

Ortho-K practice in other 

countries. 

Vision By Design also 

launched the first Ortho-K 

Mentoring event, in which 

new AAOMC members 

were paired with veterans 

to act as mentors through 

the event. Over half the 

attendees were firsttimers. 

The Orthokeratology 

Society of Oceania section 

of the IAO will hold its 

next international meeting 

in October 2016 on the 

Gold Coast. For more 

information about the 

Oceania society, visit 

www.osa.net.au or email 

jlallu@visique.co.nz. O 

Scent of Sunnies 

Luxury eyewear brand Oliver Peoples has partnered with 

Ben Gorham’s Stockholm-based fragrance house, Byredo, 

to explore the intersection of sight and scent. 

The collaboration was inspired by synesthesia, a 

phenomenon in which stimulation of one sense involuntarily 

produces an association with a different sense. 

The collaboration involves Byredo’s master perfumer perceiving 

the sights of Los Angeles through different coloured lenses, and 

translating them into various smells, producing a multi-faceted 

fragrance. The result is an original Oliver Peoples frame through 

which the colour of the lenses correlate with the aroma of the 

custom-blended fragrance by Byredo. O 

Banner year 

for Australian 

optometry 

researcher 

It’s been a banner year 

for Queensland-based 

Professor Nathan Efron. 

Efron is the recipient 

of the 2015 H Barry Collin 

Research Medal, awarded 

by Optometry Australia and 

considered the premier prize 

for optometry researchers 

across the ditch. 

Efron will deliver a medal 

address when he receives the 

medal at Optometry Australia’s 

Southern Regional Conference 

in Melbourne next March. He is 

the ninth researcher to receive 

the medal, a list that includes 

the late Professor Brien Holden, 

who won the award in 1988. 

Efron has received other 

accolades this year, recognising 

his ongoing contribution 

to eye health. He was 

named Companion in the 

General Division of the 

Order of Australia, for 

clinical optometry work 

in vision correction and 

corneal physiology, and as 

an academic, researcher 

and author. The award is 

bestowed by the Queen of 

England. 

Efron also received the 

Kenneth W Bell Medal 

from the Cornea and 

Contact Lens Society of 

Australia for extensive 

commitment and research 

achievements in the field 

of contact lenses and the 

anterior segment. O 

Professor Nathan Efron 

A limited edition sunglass and fragrance blend from Byredo and Oliver 

Peoples 

NEW APPOINTMENT 

Guy Whittaker appointed 

VP, global marketing for 

CooperVision 

Guy Whittaker has been 

appointed vice president, global 

marketing for CooperVision, 

with responsibility for 

advancing the company’s master and 

product brands, marketing its range of 

contacts lens products and services, and 

strengthening the company’s reputation 

worldwide with customers. 

A former practising optometrist, Whittaker has held 

management roles with CooperVision since 1998. Most 

recently he was general manager, Australia/New Zealand 

and Southeast Asia, and Vice President, Strategy, Asia- 

Pacific. O 

YOU WON’T SEE A MORE COMPREHENSIVE 

1-2 

RANGE OF SURFACE PROTECTION. 

Soothe, rehydrate and protect sore, dry eyes. 

ALWAYS READ THE LABEL. USE ONLY AS DIRECTED. IF SYMPTOMS PERSIST OR YOU EXPERIENCE SIDE EFFECTS, SEE YOUR HEALTHCARE PROFESSIONAL. KEEP OUT OF REACH OF CHILDREN. 

Reference: 1. Davitt WF, Bloomenstein M, Christensen M, et al. Efficacy in patients with dry eye after treatment with a new lubricant eye drop formulation. J Ocul Pharmacol Ther. 2010;26(4): 

347–353. 2. Christensen MT. Corneal staining reductions observed after treatment with Systane Lubricant Eye Drops. Adv Ther. 2008 Nov;25(11):1191–9. doi: 10.1007/s12325-008-0112-0. 

Alcon Laboratories (Australia) Pty Ltd. 10/25 Frenchs Forest Road East, Frenchs Forest NSW 2086. Distributed by Pharmaco (NZ) Ltd in New Zealand, 4 Fisher Crescent, Mt. Wellington, Auckland. 

Ph 0800 101 106. POPH.15106. NP4. A21507352611. TAPS.PP6917. 



23

SPECIALIST SHOPFITTERS & DESIGNERS TO THE OPTOMETRIC PROFESSION 

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

Email: tony.maddocks@xtra.co.nz 

LOCUM OPTOMETRIST AVAILABLE 

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

TRAINEE DISPENSING OPTICIAN 

We are looking for a motivated, friendly, enthusiastic team player 

to join our Tauranga family practice. This is an immediate start 

as an optical receptionist while training to qualify as a future DO. 

This is a full time position Monday-Friday; occasional Saturday 

morning cover may be required. 

Further information email: kmiller@visique.co.nz. 

TRACEY JONES OPTOMETRIST 

Seeking permanent position(s) in Auckland 

LinkedIn, 027 225 7112, traceyjonesoptometrist@gmail.com 

RARE OPPORTUNITY 

We have a lifestyle practice serving a semi-rural community 

for sale not far from central Auckland. Ideally suited for an 

optometrist wanting to work for themselves and have all the 

flexibility that goes with being an owner operator. Could also be 

ideal business opportunity for a mum wanting to return from 

maternity leave providing the flexibility that is needed. Double 

digit earnings with potential for further growth earnings. 

If you think this sounds like you, please apply in the strictest 

confidence c/- NZ Optics, info@nzoptics.co.nz Code PFSS1. 

LOCUM OPTOMETRIST - AUCKLAND & NZ 

Thomas Cheong. 021 210 8098 or cheong.thomas@gmail.com 

WANT YOUR OWN PRACTICE? 

Owner/optometrist Jan Thompson is selling her West Auckland 

practice, Westgate Optometrists. Those interested in taking over 

an independent practice that has been established in its current 

location for over a decade is welcome to send a confidential 

enquiry to westopt@ihug.co.nz or stu@opticsnz.co.nz. 

DO YOU SEE YOURSELF MAKING A DIFFERENCE? 

Does the challenge of working at the coalface excite you? 

You’ll want to go out of our way to find solutions for our 

wonderful clients? You will have great lens and dispensing 

skills, good technical aptitude, and enjoy sharing knowledge 

to coach others. Of course, you’ll understand technology and 

the importance of all the systems that make things happen. 

Combined with great communication skills, and showing care and 

attention to detail you could be just the person we’re looking for. 

Our team in South Auckland is made up of dedicated and highly 

motivated optometrists and support staff. Fun and friendly 

interactions are our specialty. You’ll enjoy the opportunity to be 

part of our business growth. 

If this sounds like you then call 0220128761 and leave your 

contact details and a short message. 

MAGNIFIERS + MORE 

Dear Colleagues, 

Thanks for sending me your low vision patients. I love 

helping them. 

I have headed offshore to observe low vision clinics and 

learn more about visual rehabilitation, so please keep 

sending those referrals, but let them know I will contact 

them on my return in mid-October. 

Greetings from the other side of the world. 

Naomi Meltzer 

Naomi Meltzer 

BSc, Dip Opt, P-G Dip 

Rehab 

Low Vision Consultant 

Optometrist 

P.O. Box 29021 

Greenwoods Corner 

Auckland 1347 

info@sightloss-services.com 

LOCUM OPTOMETRIST - AUCKLAND 

Mellissa Teh. Call 021 157 1136 or Email: hetassillem@gmail.com. 

OPTICAL ASSISTANT/RECEPTIONIST 

Mt. Albert Optometrists seeks an optical assistant / receptionist 

We are a longstanding small independent practice that 

endeavours to offer old fashioned friendly and personal service 

with a smile. We are seeking someone to work ideally 4 to 5 

weekdays per week. 

If you have a passion for dealing with people, an eye for detail and 

are self motivated we would love to hear from you. No late nights 

or weekends, free onsite parking. 

Experience with Optomate and a passion for finding the ‘perfect 

frame ‘ would be an advantage. 

All inquiries are strictly confidential . Please email expressions of 

interest to Christina at cherrick73@gmail.com. 

With growth continuing, our store teams 

are currently seeking optometrists to fill 

3-month, 6-month or permanent roles 

in the following NZ practice locations: 

• Invercargill 

• Timaru 

• Wellington CBD 

• Gisborne 

• Auckland CBD 

• Whangarei 

• Keri Keri 

• Albany 

We are currently also seeking 

experienced dispensers for a variety 

of our New Zealand stores. 

Alternatively, if you're interested in 

a move to Australia – either short or 

longer term, talk to us for the lowdown 

on possible locations in all states. 

To discuss any of the opportunities 

availalble, please contact 

Yvette Michael on 0800 228 417 or 

yvette.michael@specsavers.com 

NZ AND AUSTRALIAN 

OPPORTUNITIES! 

Family reunion for 

Curtis Vision and CLC 

Christchurch optometrists Curtis Vision has 

established a new location, sharing facilities with 

Corneal Lens Corporation’s laboratory in Wigram, 

Christchurch. 

The two companies sprang from the same family-owned 

business which has deep roots in the Canterbury region. 

Michael Curtis took on the optometry side and his brother 

Graeme runs the well-known Kiwi lens manufacturing 

business. 

“We used to be in the same building in Christchurch, 

but with the earthquake that site wasn’t sustainable so 

the Corneal Lens Corporation built in Wigram,” says Chris 

Clark, a director for Curtis Vision. 

Curtis Vision has three other shops around Christchurch, 

while the Wigram site operates a few days a week as a 

specialty practice focused on contact lenses. 

Clark says the site was a natural fit for Curtis Vision as 

Wigram has little competition, despite rapid development 

due to the reconstruction of Christchurch. It also fills a 

space Corneal Lens Corporation had set aside when it 

built its facility. “Michael is highly regarded in contact lens 

work, and working with complicated scrips, so it’s ideal for 

them to work together,” says Clark. 

Clark did not say when the Wigram site would expand 

beyond its part-time, contact lens work, but he says plans 

for the site include a full spectrum service and training for 

other optometrists. 

Curtis Vision is part of the EyePro network of 

independent optometrists, for which Clark also serves as a 

director. There are 55 optometrists associated with EyePro, 

located around New Zealand. O 

B4 eye exams serve 

most eligible children 

The government announced a record 92 per cent of eligible 

four-year-olds are now receiving a B4 School Check vision 

exam. 

“The B4 School Checks help to give children the best 

start at school by identifying and addressing any potential 

health or developmental problems at an early stage,” said Health 

Minister Jonathan Coleman in a statement. “The checks are also 

supporting families by connecting them to the health and support 

services they need.” 

The B4 School Check is a national programme offered to all 

families with children turning four. It is the final core of the 

Well Child/Tamariki Ora check provided free through a range of 

community health services. It includes hearing, eyesight, height, 

weight, and oral health assessments, as well as comprehensive 

health and development assessment, and costs the government 

about $10 million a year to provide. O

Sep 2015

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