June 2017

News
in brief
REVIEW REVEALS DELAYS EXTENT
An external review into the true effect of eye appointment delays
in the Southern DHB found up to 34 patients suffered moderate
to major vision loss over a 15-month period to October last year,
and more than 3,400 patients are still overdue for follow-up care.
The review, conducted by Counties Manukau ophthalmologist Dr
James Stewart and Wellington-based consultant Kate MacIntyre,
recommended preventing blindness should be key when prioritising
patients. Southern DHB said it should have reduced waiting lists to
zero by September (see stories, this page and p3).
EARLY DETECTION OF DR
IBM researchers in Australia have achieved 86% accuracy in
identifying diabetic retinopathy (DR) severity, the highest score to
date. Using deep learning, image analytics and pathology insights,
the new IBM vision technology classified the severity of the disease
as no DR, mild, moderate, severe and proliferative DR. A quick and
more accurate identification of DR severity could help clinicians
better understand disease progression to determine treatment, said
researchers.
HOYA INVESTS IN IOLS
HOYA made a multi-million-dollar investment in LensGen, a
Californian-based company that’s developing Juvene, described as
the world’s first modular, fluid-optic accommodating intraocular
lens (IOL) for the treatment of cataract and presbyopia. The new
Juvene lens copies the eye’s natural ability to change shape and
adjust focus, like the autofocus of a camera, said LensGen.
DAILIES OVERTAKE MONTHLIES
Daily contact lens sales have surpassed monthlies in the US,
accounting for 38.1% of the market compared to 31.5% in January
2016, an increase of 21% on the previous year. US daily lens sales
are now growing faster than any other segment with peaks driven
by new products, despite new CL wearer numbers remaining flat.
EMPLOYEES WANT VISION CARE
A survey by Transitions discovered that 98% of employees believe
that including vision benefits as part of an overall company health
package shows an employer cares about its employees’ wellbeing.
A further 87% said they would be more likely to stay with
a company which offered high quality vision benefits, such as
coverage of premium lens and frame options.
IFE FOR VISION IMPAIRED
Virgin Australia is the first airline in Asia Pacific and the second
in the world to introduce an in-flight entertainment (IFE) userinterface
designed to make content more accessible for visionimpaired
passengers. The new interface has a more simplified
layout, larger icons and voice prompts. Developed by Cokinetic
Systems, the interface is available on VA’s Boeing 777-300ER
aircrafts and, soon, on the Airbus A330 fleet.
READING DISORDERS TEST
RightEye, a US-based eye-tracking technology company, has
launched a new reading disorder test to differentiate eye
movement issues from other reading disorders to allow earlier
and more appropriate intervention, it said. The test uses different,
age-appropriate stories to identify and compare metrics to assess
oculomotor abilities when reading, including words per minute,
fixations, saccades and regressions.
RETINA CELLS REDUCE JET LAG?
An Edinburgh University study published in the Journal of
Physiology, has uncovered a new group of cells in the retina that
send signals directly to the region of the brain that regulates our
daily (circadian) rhythms. Professor Mike Ludwig said the finding
could open new therapeutic possibilities for restoring biological
clocks in people suffering from jet lag or working night-shifts.
TOOTH SAVES EYESIGHT
A blind man had his eyesight restored by Sydney surgeons who
sewed his tooth into his eyeball. The procedure, reported in the
Sydney Daily Telegraph, involved planting a tiny lens inside the
tooth to reflect light onto the back of the eye. By using the patient’s
own tooth, the patient’s body doesn’t reject the implant. The osteoodonto-keratoprosthesis
operation was performed at Sydney Eye
Hospital, completely restoring the sight of the 72-year-old patient
who had lost his vision through the herpes virus.
NEW DR MOLECULE IDENTIFIED
Researchers at the Bascom Palmer Eye Institute at the University of
Miami have identified a new molecule responsible for the formation
of abnormal blood vessels in the eyes of diabetic mice. Published in
The Journal of Experimental Medicine, study lead author Professor
Wei Li, said inhibiting this molecule may lead to the prevention of
similarly aberrant blood vessels forming and damaging the vision of
diabetics and premature infants through diabetic retinopathy and
ROP, the most common cause of vision loss in children.
WIN $1000 WITH YOUNGER
Younger Optics Australia and New Zealand is celebrating its 60+
years of independence with an eyecare professional competition
to win a $1,000 Visa Gift Card. To enter, simply state why you
recommend Younger Optics lenses to patients in 25 words or less at
www.youngeroptics.com.au before 30 June.
Prioritising priorities
As the public becomes increasingly alarmed by stories about patients going blind as they wait for treatment,
a group has been busy beavering away behind the scenes to fine tune the Clinical Priority Assessment Criteria
(CPAC)* for surgical eye care, including a relevant Impact on Life questionnaire. Leading the development is
Auckland-based ophthalmologist Dr Dean Corbett, chair of the CPAC steering group for ophthalmology. Here
Dr Corbett outlines why this is being done and where it’s currently at.
BY DR DEAN CORBETT
In any circumstances where resources are limited and demand is
high, there is a need for rationing. This applies to food and water
in refugee camps or medical supplies in a time of need.
We are faced with this problem right now in ophthalmology in New
Zealand. In fact, we’re facing it across all our elective surgical services,
whether for hip replacements, coronary bypasses, bariatric surgery, as
well as any form of surgical eye care. No longer is there just a demand
that outstrips supply for operations such as cataract surgery. We now
face an ever-increasing elderly population and expanding treatment
options, such as intravitreal anti-VEGF’s for macular degeneration,
that is resulting in a large mismatch of resources compared with
demand.
This has led to the realisation that we need to allocate our efforts in
a way that is most effective. By ‘effective’ the Ministry of Health and
its advisors mean that outcomes must be measured and quantified
and, most importantly, analysed in a way that makes sense. Hence
the science behind PROs (patient-reported outcomes) and PROMs
(patient-reported outcome measures) has exploded.
Previously, elective surgical intervention has been delivered by a “Dr
knows best” approach with few metrics employed to judge how well
the intervention has been received. But now, work across multiple
specialties in the different Clinical Priority Assessment Criteria (CPAC)
workshops, including ophthalmology, has allowed us to look more
objectively at outcomes and agree parameters with input from
both surgeon and patient to generate priority weightings. These
priority weightings are unique to each specialty. In ophthalmology,
they have been developed by a multidisciplinary team comprising
ophthalmologists, optometrists, GPs, lay people, patients,
biostatisticians, bioethicists, physicians and politicians. Thus, all
CPAC have a balance between clinical weighting and patient-derived
Impact on Life (IoL) scores.
Much time and effort has been spent on the Impact on Life (IoL) or
patient-derived scoring tool. For this to be most useful, the concept
of a generalised questionnaire that can be used across all elective
interventions has been developed. It is anticipated that as time
passes, patients will become more and more familiar with this tool
and understand that it is their way of adding input to the planning
and treatment of their condition.
The IoL tool has undergone many modifications since it was first
introduced for cataract surgery in 2005, and then subsequently in
plastic and reconstructive surgery in 2008. In its current form it has,
however, been shown to be representative of a patient’s view of how
their condition is affecting their life. It has had input from experts
in questionnaire development and has been validated by a group of
actual patients and been shown to be robust in its usage.
In the ophthalmic care model, the CPAC are designed to assess
and appropriately prioritise patients wanting to access cataract care
across our health system. The ophthalmology criteria (including
the IoL tool) have also now been reviewed as appropriate for the
entire elective ophthalmic care spectrum, so can be viewed as a true
“whole-of-ophthalmology” tool, but will not be fully accepted until
the pilot programme by two district health boards (DHBs) has been
completed this year.
The ultimate vision for the CPAC tool is that patients will be
www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand
prioritised far more
efficiently both across
the country and within
their own communities so
valuable DHB resources
can be used to deliver
interventions rather
than having to deal with
assessments as well.
In time to come, we will
also have a much better
understanding of what we
are achieving as we will be
able to compare IoL scores
pre- and post-intervention.
In a perfect world, we could
then apply this data to a
generic measure of disease
Dr Dean Corbett, chair of the CPAC steering committee
burden model, such as
QALY (quality-adjusted life-year), which includes both the quality and
quantity of life lived, to gain more meaningful information about
cost utility. This could then guide allocation funding toward the most
beneficial interventions.
*Also known as Clinical Prioritisation System (CPS) tools
CPAC and optometry
The new Clinical Priority Assessment Criteria (CPAC) for surgical
eye care is having a positive effect across the eye care spectrum,
says Kiwi optometrist Claire
McDonald.
“Previously there was the
option to listen to the presenting
symptoms, record VAs, note lens
opacities and refer on. You could
be sympathetic to comments like
‘the taxes mum has paid, she
shouldn’t have to wait’, and make
a comment about long queues
in the public health system. But
now we can have a fuller role in
helping our patients access the
care they need.”
Claire McDonald
The IoL questionnaire gives
insight into the real difficulties
patients have due to their vision, says McDonald. “The surprising
cases are those non-drivers with 6/12 to 6/15 acuity who
really are not at all bothered by their reduced vision. Or the 6/9
binocular acuity person struggling with glare.
“Using the CPAC tool with the IoL questionnaire gives us a real
indicator on how our patient’s case will be prioritised. Often
these are our long-standing patients so these insights can guide
our efforts to help people manage their vision and cement our
patient relationships.” ▀
World Retina Congress in NZ
The University of Auckland will host the 20th International World
Retina Congress from 7 to 11 February 2018. The Congress is
designed to share and advance international knowledge in
retinal health.
“Being part of the Retina International World Congress is an
experience in optimism and inspiration and we hope to deliver a
unique event, bringing together some of the world’s foremost retinal
scientists and clinicians along with the global leaders in patient
advocacy and peer support,” said the local organising committee.
The 2018 Congress is aimed at patients and their families, clinicians,
rehabilitation professionals, students and anyone with an interest
in retinal disorders. It will include a number of short scientific
presentations, expert discussion panels, treatment approach sessions
and social events.
“Our aim is to create the best educational environment possible
(with) the most acclaimed experts in biomedical research, clinical
practice, rehabilitation best practice in blindness and effective
peer support methodologies and treatment advocacy,” said the
committee.
Session themes include: gene therapies, bionic vision, stem
cell treatment, low vision strategies, patient-focused forums and
clinician-focused education. An outline of the programme and more
information can be found at www.retina2018newzealand.com ▀
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NZ Optics magazine is the industry publication for New Zealand’s ophthalmic community. It is published monthly, 11 times a year, by New Zealand Optics 2015 Ltd. Copyright is held by
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4 NEW ZEALAND OPTICS June 2017