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April 2018

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THE MAGAZINE FOR NEW ZEALAND’S OPHTHALMIC COMMUNITY

PO BOX 106 954, AUCKLAND CITY 1143

APRIL 2018

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

SHAMIR OPENS NEW

GLAZING & CUSTOMER SERVICE

FACILITY IN AUCKLAND!

1st Floor, Entrance B, 31-35 Carbine Rd

Mt Wellington, Auckland 1060

Phone 0800 SHAMIR

New Zealand Account Manager

Francois Cronje 021 449 819

www.shamir.co.nz


2018 • Voted by New Zealanders • 2018

TRANSFORMING

EYE HEALTH

THE ULTIMATE OPHTHALMIC COLLABORATION

At Specsavers we are focussed on providing the highest

levels of optometry and dispensing care in all our New

Zealand and Australian stores.

Our equipment and technology strategies, our close working relationships

with ophthalmology and various eye disease stakeholders alongside our

major investments into dispensing qualifications all contribute to a singular

purpose – to transform the eye health of New Zealanders and Australians.

So, if you’re concerned at the 50 per cent undiagnosed glaucoma cohort

and the under-indexing of diabetic retinopathy screenings; if you’re worried

that available in-store technology isn’t being used on every patient due to

extra fees and charges; and if you’re alarmed at the under-investment in

professional dispensing programs and technology – then we urge you to

talk to us about how you can make a genuine impact at Specsavers.

We’re on a clear mission to transform eye health in New Zealand and

Australia – and we’d like you to join us on that mission.

To ask about optometry and dispensing roles right across the country at all levels, contact Chris Rickard on 027 579 5499

or chris.rickard@specsavers.com, alternatively visit spectrum-anz.com for all the opportunities.

Reader’s

Digest

Quality Service

Award

2018 • Voted by Australians • 2018

Reader’s

Digest

Quality Service

Award

AITD

Voted by New Zealanders

Reader’s Digest

Quality Service

Award

2017

Best Customer

Service in AU

Optometry

2018

Best Customer

Service in NZ

Optometry

Best Talent

Development

Program

2017

Best Talent

Development

Program

2017

Best Customer

Service in NZ

Optometry

2017

Millward Brown

Research

No.1 for eye tests

2016

Excellence in

Marketing

Award

2016

Retail

Store Design

Award

2016

Retail

Employer

of the Year

2015

2018 Transforming eye health

2 NEW ZEALAND OPTICS April 2018


Oculo rolls out in NZ

Oculo says it will now be rolling out its cloud-based secure

messaging and clinical communication software, designed

to better connect optometrists and ophthalmologists, in

New Zealand over the next few of months.

The launch will be kicked-off through Oculo’s agreement with

Specsavers, which has signed a multi-year commitment to use

Oculo on both sides of the Tasman. But Oculo is keen to sign up

as many optometrists and ophthalmologists to its technology as

possible to enable consistency in the quantity and quality of data

shared.

Oculo’s software provides a secure, online system for

optometrists to identify ophthalmologists with particular

specialities and to safely share clinical records, including patient

data, photos and scans for referrals. The system was the brainchild

of Professor Jonathan Crowston, managing director of the Centre

for Eye Research Australia (CERA), and Peter Larsen, director of CERA

and Specsavers optometry director. It was spun out from CERA as a

standalone company in 2015.

The Australian roll-out began in April 2016 and it’s now employed

by more than 1,700 optometrists and 440 ophthalmologists,

managing over 200,000 patients across Australia. An agreement

with Glaucoma Australia last year also allows eye care professionals

to refer patients directly to the charity for help and support.

“Oculo is a fundamental component of our ability to measure

clinical activity and outcomes,” said Larsen. “Through Oculo, we

can access data on detection, referral and diagnosis rates to further

improve clinical standards and contribute to transforming eye

health in Australia and New Zealand. For example, Specsavers-wide

Oculo screen shot

Oculo data will

provide us with

the evidencebase

to show

how we are

closing the gap

on undiagnosed

glaucoma in

Australia and

New Zealand.

That sort of

information

has not been

available before

and helps not

just us and our

optometrists, but

also government

and other health

stakeholders.

It adds value

because it allows

us to specify the

Oculo’s Dr Kate Taylor and Specsavers’ Peter Larsen

impact we are

making on patient wellbeing.”

“There is so much innovation in eye care – the technologies

available for diagnosis and management are really exciting,” said

Dr Kate Taylor, Oculo’s CEO. “So more than ever, it’s important

to use technology to enhance clinical communication so that

practitioners can share digital information to increase the quality

and efficiency of patient care.”

Background

Oculo was developed by CERA, a not-for-profit medical research

institute based at the Royal Victorian Eye and Ear Hospital (RVEEH)

in Melbourne, in collaboration with Specsavers, OPSM, and Bupa

Optical. Its aim is to promote the efficiency and quality of clinical

communications to support collaboration to improve eye care; to

“be better than a letter,” said Prof Crowston, chair of Oculo, at the

company’s launch back in 2016. “The team has invested thousands

of hours to develop privacy and data security controls that mean

that correspondence by Oculo is indeed better than a letter, and

so much more. It has intelligent prompts and other features to

enhance the quality of referrals and to create a shared eye e-health

record.”

Oculo’s major shareholders are CERA and an angel investor who

had a life-changing intervention at the RVEEH and wanted to give

back. No other individual or corporate involved in optometry or

The hard end of

eye health

EDITORIAL

This month we are proud to include a handful of dedicated low

vision stories and opinions, including an amusing view from

the dark side (as he calls it) from our wonderful new low vision

columnist, Trevor Plumbly (p6). Some put low vision patients in

the too-hard or too-scary basket. But as these stories show there’s

lots that can be done to help New Zealand’s low vision community

and optometrists, new and experienced, are ideally positioned to

help them lead more fulfilling lives, however bad their vision. One

well-known low vision patient advocate, John Veale, has often been

quoted in NZ Optics’ pages championing this area, saying how

rewarding it is to help people with low vision, especially as their

relatives and friends often choose to become your patients as well.

The major causes of low vision will, of course, be a key topic at this

year’s unmissable RANZCO NZ Branch conference in mid-May, which

once again incorporates parallel meetings for our ophthalmic nurses

and our orthoptists. We’ve got the inside scoop, hot-off-the press,

about this year’s programme and keynotes. Plus, we’ve had a look at

what’s on in Auckland around the same time for all the out-of-towners

visiting. We’ve also got all the happenings from sister conferences

in Australia, past and future, and there’s news about RANZCO’s Eye

Foundation, ORIA and a new worm that’s been found in patients’ eyes

in the little-known Mariana Islands (p10-18).

We also celebrate New Zealands’s hosting of the very well-received

and smoothly organised (well done guys) Retina International world

conference (p21) and the work of our combined School of Optometry

and Vision Science and Department of Ophthalmology’s Summer

students (p20).

Meanwhile Style-Eyes tackles the lighter end of the eye health

spectrum with a look at how pop-up stores could mean extra revenue

and customers for the more entrepreneurial among you, and Chalkeyes

gets his typing in a tizz about the lack of decent, compatible practice

software tools on the market (p26). But then again, Oculo (p3) and

1stGroup (p23) might be able to help!

Enjoy, and please get in touch if you’ve got an issue you want us to

cover or you want to comment on anything in NZ Optics. We always

love to hear from you.

Next month: all the happenings from CCLS

NZ, the Ocular Therapeutics Conference

and Excellence in Ophthalmology

Lesley Springall, editor, NZ Optics

ophthalmology has any stake. ▀

0800 55 20 20

First Sanderson

Scholarship

Less than a year after announcing the

establishment of the Gordon Sanderson

Scholarship, Glaucoma New Zealand (GNZ)

has announced its first awardee – Hilary Goh,

a fifth-year medical student for her summer

research project investigating nailfold capillary

abnormalities in glaucoma.

Goh, who undertook her research project within

the Department of Ophthalmology at the University

of Auckland, is one of the top medical students at

the University, said Professor Helen Danesh-Meyer,

chair of GNZ. “She is razor sharp, dedicated and

great with patients. She was a natural fit for the

project as it was very demanding.”

Goh’s project explored whether nailfold capillary

health can be used as a biomarker for glaucoma

progression, based on the hypothesis that glaucoma

involves vascular dysautoregulation, explained Prof

Danesh-Meyer, who was also Goh’s supervisor for

the project. “There is some evidence to support

this from Harvard which demonstrates there is

a difference between the nailfold capillary of

glaucoma patients compared to controls. Hilary’s

project is an extension of this work to see if it

correlates with glaucoma severity and progression.”

Presenting her work at the Auckland Summer

Student Symposium in March (p21), Goh concluded

that primary open angle glaucoma (POAG)

patients did indeed have nailfold capillary (NFC)

abnormalities and abnormal NFC is associated with

increased risk of POAG and more severe visual field

loss. However, more studies were needed as was an

improved capillary grading system, she said.

Prof Danesh-Meyer said GNZ decided to

award the first scholarship this year as they had

received a number of pledges and donations

since announcing the new scholarship in August

last year. The scholarship was set up in honour of

the much-admired Associate Professor Gordon

Sanderson, a founding trustee of GNZ, who died

earlier in the year.

“Gordon was very passionate about GNZ and the

prevention of blindness from glaucoma. He was

Hilary Goh, recipient of the inaugural Gordon Sanderson Scholarship

from Glaucoma New Zealand

a huge advocate for students and relished seeing

students involved in research,” said Prof Danesh-

Meyer. “I know from personal experience that

Gordon always helped provide opportunities to

students to be involved in eye research. I was one

of these students. GNZ is committed to ensuring

his passion for students and research is continued

through this scholarship.”

GNZ will be advertising for applications for

the 2019 scholarship from June this year. The

scholarship is available to medical and optometry

students, ophthalmologists or optometrists

undertaking research or teaching experience in

glaucoma from the Universities of Auckland, Otago

or Sydney as these institutions had close ties with

A/Prof Sanderson.

To find out more or to contribute to the Gordon

Sanderson Scholarship fund, please visit www.

glaucoma.org.nz. ▀

To read more about the 2017-2018 Summer

student projects, please turn to p21.

www.re.vision.nz

Dr Trevor Gray

April 2018 NEW ZEALAND OPTICS

3


News

in brief

CLS WITH BUILT-IN TELESCOPE

An international collaboration of

scientists has created a contact

lens (CL) which can shift between

magnified and normal vision. The

lens, which increases peripheral

vision three-fold, is safer and

cheaper than surgery and will allow people with sight loss to read

text better and see faces, said Dr Eric Tremblay, a Swiss Federal

Institute of Technology designer. The lenses have tiny telescopes

built into the centre which work like binoculars and are activated by

specially-adapted glasses that recognise winks, but ignore blinks.

The new lens could be available for sale in two years.

VITAMIN B3 FOR GLAUCOMA?

Researchers from the Centre for Eye Research Australia (CERA)

have started a six-month clinical trial to see if high-dose vitamin

B3 (nicotinamide) can support existing therapies for glaucoma by

protecting nerve cells from dying. The ability to recover from an

eye injury diminishes with age, so CERA’s looking for treatments

to boost recovery, said study lead Professor Jonathan Crowston. “If

you can improve optic nerve recovery after an injury then we can

reduce the risk of glaucoma progressing.”

ARTIFICIAL PHOTORECEPTORS RESTORE SIGHT

A Fudan University team in

China has developed artificial

photoreceptors to replace

diseased and no longer

functioning rod and cone cells

within the retina. A study on

laboratory mice, published

in Nature Communications,

showed the artificial photoreceptors, made from gold and titanium

oxide nanowire arrays, could successfully convert light into

electrical signals.

COLLABORATION HELPS GLAUCOMA CARE

A collaborative clinic at the University of New South Wales Centre

for Eye Health, where optometrists and ophthalmologists work sideby-side,

is providing beneficial for glaucoma patients. A study of the

clinic’s first 18 months showed patients waited 43 days on average

for an appointment; most (51%) were diagnosed with glaucoma; 41%

had suspected glaucoma requiring monitoring; 2% had a different

optical neuropathy; and 6% had no eye disease. The new model

of care has great potential for helping to assess new, non-urgent

outpatient referrals, said study co-author Dr Michael Hennessy.

START-UP MAKES VISION CARE MORE ACCESSIBLE

A Massachusetts Institute of Technology

(MIT) spinout, PlenOptika has developed a

highly accurate, portable autorefractor called

QuickSee. Costing about a third of the price of

traditional autorefractors, the device is ideal

for developing countries and hard to reach areas, said the company.

After six years in development, eight product iterations and clinical

studies involving 1,500 patients across five countries, The QuickSee

has just been released in India.

ESSILOR-LUX MERGER GIVEN THE GO AHEAD

The proposed merger of international eyecare heavyweights, Essilor

and Luxottica, is all but a done deal after being unconditionally

cleared by both the European and US Federal Trade Commissions.

In other news, Essilor reported solid 2017 earnings with good

overall performance in its lenses and optical instruments divisions,

reflecting strong online sales and US growth, offsetting lower

sales in other areas, notably Australia and Brazil.

HAITI OPENS OPTOMETRY SCHOOL

Supported by the Brien Holden Vision Institute (BHVI), the first

School of Optometry has opened in Haiti, welcoming 17 new

students, selected from 144 applicants, onto its Bachelor of Vision

Sciences programme. Five years in the making, the new school,

which is part of the Faculty of Medicine at l’Universite d’Etat d’Haiti

in Port au Prince, will be of huge benefit to the 70% of Haitians who

currently have little or no access to eye care, said Dr Luigi Bilotto,

BHVI’s director of global human resource development.

O-SHOW 2018 – FILLING UP FAST

The take up of exhibitor space at this year’s boutique style O-Show

in Melbourne, from 14-15 July, has been extraordinary, with just

10 booths left to fill, said Finola Carey, ODMA CEO, adding she’s

delighted, but not surprised by the response. ‘’Certainly, the fact

that the O-Show is owned and organised by ODMA for the benefit

of the industry, has been warmly received.”

RETINA SCANS AND AI TO DETECT HEART DISEASE

The necrotic photoreceptor layer in the blind

retina is replaced by an Au–TiO2 NW array

Scientists from Google and its health-tech subsidiary Verily

are assessing a person’s risk of heart disease using computer

learning and retina scans. Using deep learning algorithms,

trained on retina data from 284,335 patients, combined with

knowledge about the patient’s age, blood pressure and smoking

habits, Google’s software successfully predicted 70% of future

cardiovascular events, such as a heart attack or stroke, that would

occur within five years of the retinal exam.

Regarding the retina

BY ELLA EWENS

The first of the two-repeated autumn seminar evenings by

Retina Specialists was held on 6 March in the leafy Auckland

suburb of Parnell. Attending optometrists were greeted by the

Retina Specialists team, wine and canapés.

The all-female speaking line-up for the evening included Retina

Specialists’ Dr Rachel Barnes, Associate Professor Andrea Vincent, Dr

Dianne Sharp and Dr Narme Deva.

A pictorial FAF journey

A/Prof Vincent kicked off the evening with a pictorial journey through

fundus autofluorescence (FAF) in clinical practice, showing us “pretty

pictures” depicting the presentation of various retinal dystrophies

and disorders. FAF is a non-invasive technique, which highlights

lipofuscin (the main fluroflore in the retinal pigment epithelium). FAF

may detect abnormalities beyond the clinical exam and is useful in

classifying various retinal dystrophies and disorders, she said.

In albinism, where the retina is not metabolically affected, the

FAF appears normal. However, in choroideremia (an X-linked retinal

condition affecting males) widefield Optos images show patchy

changes with scalloped edges where the retina is ‘metabolically

dead’. In X-linked retinitis pigmentosa there is a so-called water-shed

zone seen between the good and bad metabolic areas of the retina.

In PDE6B retinitis pigmentosa, FAF is very useful – visual results are

closely correlated to FAF, so generally visual fields are not necessary

and don’t give any extra information, A/Prof Vincent explained.

Among other fascinating pearls, Vincent also revealed what she

calls the ‘moustache sign’ of the adRP rhodopsin mutation – an

inferior central rim of hyperfluorescence – and showed FAF images

of eight siblings with different presentations of ABCA4 retinal

dystrophies, where the whole retina may be affected.

AMD new treatments?

Dr Barnes spoke about the new treatment options for age-related

macular degeneration (AMD). She begun her presentation by

outlining the goals of the different treatments for both dry and wet

AMD, and enthusiastically explained what else waits in the wings in

the long journey to market.

The first drug she discussed, Roche’s lampalizumab, an antigenbinding

fragment of a humanised, monoclonal antibody directed

against complement factor D (CFD), had showed promising initial results

in early trials with a 20% reduction in geographic atrophy. The phase III

results, however, showed no benefit at all. Nano-second laser may also

have an application in early dry AMD, with pilot studies indicating a

reduction in drusen. Phase III results are expected later this year.

Looking at possible treatments for wet AMD, Barnes reminded us

gravely that there is no permanent cure for this devastating disease

and that real-world results often fall short of drug trials due to under

treatment. A new pigment-derived growth factor, which it was hoped

would work to reduce fibrosis and help mature vessels to regress,

looked hopeful early on but was ineffective in phase III trials. Roche,

however is still in the game, with its drug, also based on angiopoitein

(a proangiogenic cytokine involved in neovascular AMD), and is

persevering with the expensive trials required.

A new formulation of ranibizumab (Lucentis: a recombinant

humanized IgG1 monoclonal antibody fragment that binds to and

inhibits vascular endothelial growth factor A) delivered by a port

system is also an exciting possibility with more results planned soon,

said Dr Barnes. Gene therapies using new viral vectors are also being

trialled. While many trials seem to show early promise and then fall

at the final hurdle, brolucizumab is in Phase III trials and results are

looking very positive. With its small molecule size allowing higher

potency in the eye, results are showing significant reduction in retinal

thickness and better performance than aflibercept (Eylea), she said.

Lastly Dr Barnes discussed the new imaging technique, OCT-A

that offers a quick, non-invasive 3D method to image the retinal

vasculature. It is particularly useful for showing the structure

of choroidal neovascularisation and for visualising occult

neovascularisation not visible by any other means, she said.

MD and the ageing eye

Dr Sharp presented a practical presentation on MD in the ageing

eye. The high metabolic demand of the macular area of the retina

makes it particularly susceptible to oxidative damage, she said.

With more than 10% of babies born today destined to become

centenarians, MD is more relevant today than ever.

A recent model-of-care, commissioned by the government,

highlighted the national low understanding of the disease and areas

requiring improvement, such as speed to treatment. This model set out

the importance of prompt care and said the time from first diagnosis

to first treatment should be no more than one week. The Beckman

classification can be used to identify different stages of AMD and help

to predict the risk of progression at each stage, she said.

“Small fine drusen (or druplets as they are sometimes called) are

not MD and it is wrong to call them this. Soft drusen combined with

pigment changes are high risk. Give the patient an Amsler Grid test

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand

Drs Narme Deva, Dianne Sharp and Rachel Barnes

Stuart Campbell and Richard Chinn

and monitor them closely.” Those with choroidal neovascularisation

can particularly be helped by getting them treatment fast, she added.

Dr Sharp also shared some data from UK records over a 12-month

period, showing that the starting vision level is of great importance.

Optometrists present were also interested in discussing RANZCO’s

revised referral pathway for MD. “Too often a patient stops attending

appointments after anti-VEGF treatments because their vision

is good, only to have problems reoccur,” said Dr Sharp, providing

examples of the sequelae of neovascular MD. Patients must be

educated that this is a chronic disease that requires long-term

management, she stressed.

DR, risks and treatment

Dr Deva tackled diabetic retinopathy, a main cause of the blindness in

working-age people. One third of diabetics will have retinopathy and

for a third of those it will threaten their vision. To reduce risk during

the early stages, optometrists must ask about how well patients are

controlling their blood sugar levels, she said, citing data that intensive

therapy, reduced the risk of developing retinopathy by 76%. A good

understanding of the disease and encouraging patients to form good,

healthy-eating and monitoring habits is key in these early stages.

The second question that optometrists should ask is, “how is

your blood pressure?” said Dr Deva. The Wisconsin epidemiologic

study of diabetic retinopathy showed that lowering blood pressure

can half the risk of retinopathy. The third question centres around

cholesterol levels, and while this is not as well-supported by clinical

data as blood sugar levels, good cholesterol control can reduce the

progression of retinopathy, she said.

Dr Deva then summarised the treatments for diabetic retinopathy

and associated macular oedema focusing on lasers and anti-VEGF

injections. Widefield imaging is helping us monitor treatments over

time, she said. Keeping to the technological theme, Dr Deva also

discussed the growing interest in artificial intelligence and the rise

of studies using machines that can perform deep learning (see NZ

Optics March 2018 issue, p14), “that is, showing a machine data and

have it teach itself how to analyse it,” may well at some point in the

future replace optometrists and ophthalmologists, analysing many

data points, from diagnosis and classification to risk assessment, in

mere minutes, and suggesting appropriate treatment plans.

Concluding remarks

Sandhya Mathew and Surekha Parag

Hilary Rayner, Retina Specialists practice manager, said the evening

was a great success. “It was wonderful to see so many people at our

event and we are looking forward to meeting our next group in a

couple of weeks. Everyone is busy these days so we really try to make

the education meetings we hold interesting and useful and we really

appreciate the effort that people make to come along.” ▀

Retina Specialists’ Spring seminar evenings will be held on the 4 and

18 September.

For general enquiries or classifieds please email info@nzoptics.co.nz

For editorial, please contact Lesley Springall at lesley@nzoptics.co.nz or +64 27 445 3543

For all advertising/marketing enquiries, please contact Susanne Bradley at susanne@nzoptics.co.nz or +64 27 545 4357 in the first instance, or Lesley Springall at lesley@nzoptics.co.nz

To submit artwork, or to query a graphic, please email susanne@nzoptics.co.nz

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

NZ Optics 2015 Ltd. As well as the magazine and the website, NZ Optics publishes the annual New Zealand Optical Information Guide (OIG), a comprehensive listing guide that profiles the

products and services of the industry. NZ Optics is an independent publication and has no affiliation with any organisations. The views expressed in this publication are not necessarily

those of NZ Optics 2015 Ltd or the editorial team.

4 NEW ZEALAND OPTICS April 2018


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NEW ZEALAND OPTICS

5


Low Vision Day: a real eye-opener

BY SUSANNE BRADLEY

How do you tell someone they’re losing

their sight? What can you do to really

help a low vision patient? How do you

explain the often-complex web of support and

technology available? These, and many other

important questions were the focus of the School

of Optometry and Vision Science (SOVS) Low Vision

Day on 1 March.

The day included lectures, workshops and a panel

discussion where students had the opportunity to

talk directly with low vision patients and ask them

questions about their lives and the help they had

or hadn’t received.

Nick Lee, New Zealand Optometry Student

Society (NZOSS) president, said it was the first

time many students had had an opportunity

to be exposed to true low vision patients. The

day provided a safe and encouraging learning

environment and the students he spoke to really

appreciated the opportunity to talk openly to

patients who had low vision and were comfortable

with and open about their condition, he said.

“Previously, it felt like there was a certain negative

stigma surrounding low vision patients, but

everyone who volunteered their time was just

happy to be helped and helped our learning too.”

Samantha Simkin from the Blind and Low

Vision Education Network NZ (BLENNZ), started

the day with a talk about BLENNZ’s role helping

low vision and blind children access education.

Low Vision Day team Claire MacDonald, Sam Simkin, Michelle O’Hanlon, Shireen Ali and Katy Webber

Ophthalmologists, optometrists and teachers can

refer to BLENNZ. As there are different levels of

support available, it’s important to refer even in

cases when the child is perhaps not fulfilling all

the criteria, said Simkin.

Katy Webber, a counsellor with the Blind

Foundation (BF), talked next about how BF can

support adults and children alike, with different

practical and emotional aspects of their life, to

work towards a more independent and fulfilled

life. Webber said the perception that BF is only for

adults is wrong, BF and BLENNZ work together

with the age group 0-21, but where BLENNZ’s

focus is on education, BF focuses on supporting

the individual in their daily life. So, it’s important

to always make two referrals, one for BLENNZ and

one for BF, she said.

Low vision patients Trevor Plumbly (see Blind

ignorance, this page), Susan Grimsdell, Camille Guy

and Michael Lloyd made up the much-anticipated

panel for the day’s discussion session. From

sharing their life stories and answering the many

questions put to them by the audience, it was clear

life with low vision isn’t all bad, but it certainly has

its challenges. “It doesn’t stop me from doing the

things I want to do, I just need to find another way

to do them,” explained Lloyd.

The discussion covered everything from good

and bad optometry visits, with most saying ‘telling

it, how it is’ was the preferred way to receive and

deliver bad news, to how public spaces could

be improved to better support our low vision

community.

The three afternoon

workshops were practical,

providing insights into

adaptive technology, how

to best communicate with

patients with low vision and

how to use electronic devices

designed to assist patients

with low vision, orientation

and mobility. The latter

included role-play testing

techniques for correctly

performing sighted-guide

assistance.

The day ended with a

WELCOME TO OUR NEWEST DIRECTOR

Dr Logan Robinson,

MB ChB, PG Dip Ophth BS (Distinction),

FRANZCO

An experienced cataract surgeon

with an enthusiasm for vitreoretinal

surgery, Logan, completed a medical

degree in 2003 at the University of Otago

and completed a Postgraduate Diploma

in Ophthalmic Basic Sciences (with

distinction) in 2008.

Continuing his professional development

via a fellowship in vitreoretinal surgery

at Wellington Hospital, Logan then moved to the UK, completing a second

vitreoretinal surgery fellowship at the Manchester Royal Eye Hospital.

Returning to Christchurch in 2015, Logan took up a position as a consultant

ophthalmologist at Christchurch Hospital and subsequently joined us at SES.

Away from work Logan enjoys spending time with his young family and is an

avid sports fan, enjoying mountain biking, golf and fishing.

From everyone at SES, ‘Welcome aboard Logan’.

128 Kilmore Street, Christchurch, New Zealand

PO Box 21023, Edgeware, Christchurch 8143

t: +64 3355 6397 f: +64 3 355 6156

e: info@southerneye.co.nz www.southerneye.co.nz

refraction clinic, offering

students an opportunity

to perform a low vision

refraction test. Student

Andrew Kim said this part

of the day was one of his

highlights and a valuable

experience. Melissa Zhu

said it was one of the most

rewarding and challenging

practical learning sessions

she’d experienced.

“As students, we mostly

encounter patients with

no pathology or patients

who have pathology but

are sufficiently sighted

enough to come to our

clinics. The duty of telling someone they will lose

their driving and independence was a topic on a

lecture slide I had once thought was far, far away.

It was easy to avoid. (So) I felt most challenged by

the hard truth that there are simply no cures yet to

restore vision in some patients.

“This led to a sense of collective awkwardness

when we faced our volunteers in the clinic; as if we

have, somehow, failed to do our jobs. However, by

talking to the volunteers both in clinic and in the

panel, I have come to see people living fulfilling

lives with their vision problems. This was the

Blind ignorance

BY TREVOR PLUMBLY*

Sight loss, I discovered, is such a gradual

process that it’s generally detected by others

before the victims themselves.

Certainly, the indications I had came at me,

rather suddenly. I was sitting down, quietly

enjoying a cup of tea, when my wife Pam said:

“we really need to talk”. Now anyone with

any experience of married life or full-time

employment, knows that when someone says

that, good news is not about to follow.

The conversation started innocently enough,

along the lines of, “do you realise how often you’re

bumping into things lately?” I put on, what I hoped

was a pensive, reasonable expression, waiting

for the final verdict and sure enough it arrived.

“You need to get your eyes tested again, but go to

someone a bit more high-tech than old Charlie.”

I thought that was a bit harsh, Charlie had done

my glasses for years and never given me any grief.

Anyway, if there was bad news out there why go

looking for it? I tried the usual, “I’ll think about it”

and “as soon as work eases off a bit”.

Occasionally this ploy works, but not this

time and a couple of days later off I went, feet

dragging, to the high-tech optometrist (HTO).

Mentally debating the difference between an

‘HTO’ and a normal optometrist, I decided it was

probably the size of the bill.

The HTO looked more like a cemetery for posh

spectacle frames than a place to get your sight

fixed. The decor was a floor to ceiling sort of

glaucoma grey which matched the hair colour

of the chirpy, competent looking women behind

the counter. My optometrist was a really pleasant

young Australian woman who shuffled and dealt

the test lenses with all the panache of a Las

Vegas croupier. Whilst I gained confidence from

this dexterity, she obviously wasn’t satisfied. She

followed up the first act by shining a magnifying

torch into my eyes muttering ‘Hmm’.

It’s a personal opinion of course, but a ‘Hmm’

coming from anyone in the medical game has got

to be one of scariest expressions in the English

language. Its only got two meanings; a) “I haven’t

got a clue what’s wrong with you”; or b) “I don’t

want to be the one to tell you.”

We talked about my vision and I mentioned

having problems driving at night. She trumped

this by saying, “I don’t think you should be driving

in daylight either and you definitely need to see a

specialist.” Not really what I wanted to hear.

Seeing a specialist implied that what I had was

beyond her ability, and then there was the cost.

With Charlie, it was in and out with glasses for

around $300 but this little number was looking

like $600 plus, with the specialist in the game, I

was starting to feel like I was involved in some

sort of optical pyramid scheme.

The specialist oozed professional competence.

He sat me in front of an ancient-looking machine,

explained the process, gave me a buzzer and said,

“press this when you see the lights.” After a while

he said, “when you’re ready,” and then, with a

Students testing sighted-guide techniques with their blindfolded partners – Yasmeen Musa, Melissa Zhu,

Tish Peat, Susan Cordery and Amelia Hardcastle

highlight of my day,” explained Zhu.

“The most important message to me was that

we, as practitioners, cannot carry a misguided idea

that low vision’ is a euphemism for the traditional

meaning of ‘blindness’, and therefore an end to a

person’s productivity in society. We must treat the

subject with sensitivity but not taboo, as our role is

to help our patients do the best in life with their own

vision – whether that means spectacles, surgery,

CCTVs or a referral to the Blind Foundation.” ▀

See p21 for more on low vision and the world of

retina.

touch of insistence, “when you see the lights.”

Anxious to please, I finally spotted one and

jabbed the button in triumph. He didn’t cheer,

but I thought I detected a bit of relief in his

expression. From there we moved into the surgery,

which really looked as if it could do the biz: bright

lights, lots of neatly laid-out implements that

looked essential and expensive, with a patient

chair that could have been salvaged from a

space shuttle. He did the old shuffle and deal

with the test lenses, not quite with the flourish

of the optometrist, but more measured, as if he

was catering to the high rollers. I eased back in

the astronaut chair with all the confidence of

someone getting their money’s worth.

When the magnifying light elicited another

“Hmm” I wondered if it was some sort of

diagnostic code for unrecorded ailments. But no!

He rolled back his chair and said, “You’ve got RP.”

I chewed on this medical morsel for a moment

before asking, “Is that good?” He then treated me

to a short, honest opinion on the joys of retinitis

pigmentosa. Briefly, I could lose my sight or some

of it, I could lose all or some of it quickly or slowly

and it was inoperable. Not what I wanted to hear.

See what I mean about going out and looking for

trouble?

Somewhat poorer and not exactly buoyed with

hope I left, clutching an appointment for the

Dunedin Eye Clinic.

The clinic was all business, lots of fellow patients

dotted around the waiting area, half-hoping

and half-dreading the appointment and the

result. The staff here are frontline troops, a mix

of eager younger types and urbane, battle-worn

professionals who’ve seen it all before, and if the

line outside is anything to go by, they were going

to see a fair bit more of it.

Similar tests, same diagnosis, same prognosis,

but good, helpful advice on what to expect and

how to cope with it. Top marks all round for the

public health system. I left quite upbeat and halfconvinced

there wasn’t that much wrong with my

sight anyway. But on reflection I guess it was more

wishful thinking and a natural reluctance to face

the reality of life.

NZ Optics is pleased to welcome Trevor Plumbly

as a new contributor. Trevor will share more about

his life on the ‘dark side’ or as a ‘white caner’, as he

also likes to be called, in future issues.

*Trevor Plumbly is a retired arts and antiques dealer, diagnosed

with retinitis pigmentosa 15 years ago. Originally from Tunbridge

Wells in England, Plumbly, together with wife Pam, formerly

owned Plumbly’s Auction House

in Dunedin. In the 1980s, he was

one of the antique experts in the

popular television programme,

Antiques for Love or Money,

and became a well-known face

in Dunedin as a result. In 2008,

when sight loss put a stop to the

antiques dealing, Trevor and Pam

decided they wanted to be closer

to family, so they sold up and

relocated to Auckland. This is his

first column for NZ Optics.

6 NEW ZEALAND OPTICS April 2018


Greenlane ups low

vision services

The low vision (LV) clinic at Greenlane

Clinical Centre has recently welcomed

two new optometrists to its team. Deepa

Kumar and Deborah Chan, have joined Sandy

Grant, LV clinic coordinator and therapist, to

provide a multi-disciplinary low vision service

to patients referred by eye health specialists,

general practitioners, the Blind Foundation and

other ADHB departments.

The most common referrals are for patients

with macular degeneration (MD) and

glaucoma, although the clinic will accept

anyone with functional vision issues, said

Grant.

Patients seen at early stages of MD often

identify reading, handwriting and glare issues

as their main difficulties, while patients with

glaucoma, retinitis pigmentosa, hemianopias

or monocular vision may experience mobility

and reading issues. Other visual concerns

highlighted in the assessment are also

addressed through LV strategies such as

eccentric viewing, low vision aids, both optical

and non-optical (eg. magnifiers, task lamps,

signature guides), basic training with aids or

sighted-guide, information, peer support or

referrals, such as Blind Foundation membership.

Early intervention often alleviates many

patients and helps the patient develop coping

mechanisms, said Grant.

The low vision clinic runs Tuesday and

Thursday afternoons and on average about

four patients per clinic are seen. Wednesday

afternoons is a therapist-only clinic, though

Grant said she hopes to add another fullservice

clinic in the near future.

Patients referred to the clinic are interviewed

first by Grant and then the optometrist,

who refracts the patient and determines

magnification requirements. Follow-up

appointments are often required, or patients

can self-refer back should they feel their vision

has deteriorated.

Originally from Canada, and trained in

rehabilitation teaching, orientation and

Greenlane low vision optometrists Sandy Grant and Deepa Kumar

mobility, Grant came to New Zealand in 1992

to work for the Blind Foundation. “As the clinic

coordinator, I love the interaction with patients

and in playing my part on the LV team.

“It’s rewarding work, encouraging and

demonstrating what is possible to patients

through a variety of strategies, low vision

aids, appropriate support, referrals to enable

the patient to approach their low vision with

added confidence, motivation and a boost in

self-esteem.”

Grant said she’s excited about the recent

expansion of the clinic and is looking forward

to providing more patients with a range of

services to start them on their journey to living

successfully with low vision.

The LV clinic at Greenlane also recently made

a sizeable donation of older model (and never

used) magnifiers to volunteer ophthalmic

services overseas (VOSO) for their trip to the

Pacific Islands in an effort to support LV work

on this history-making VOSO trip. We wish

Naomi Meltzer and the rest of the VOSO team

all the very best for this new chapter in VOSO’s

evolution, said Grant. ▀

If you would like to a refer a patient to the low

vision service at Greenlane Clinical Centre,

referral forms can be found on the Healthpoint

website or email sandy@adhb.govt.nz. For

questions, call 09 3074949 extn 27641.

Calling mentors

The School of Optometry and Vision Science

(SOVS) at the University of Auckland needs more

externship mentors for their final year BOptom

students.

During their last year of study, each New Zealand

BOptom student undertakes a three-week externship

in a community-based optometry practice. Through

these externships, students gain further experience in

the direct examination and management of patients

away from the confines of the university clinics, says

Dr Geraint Phillips, SOVS senior lecturer and clinic

director. “Feedback from the profession shows many

optometrist mentors enjoy the exchange of ideas and

information with the next generation of optometrists.”

The externship period can be broken up so that the

student attends more than one practice, for example,

when a practice is keen on taking part, but cannot

host the student for the full three weeks. Optometrist

mentors supervise the student during their externship,

which includes being available to check the clinical

findings for every patient the student examines. Mentors

also complete an evaluation at the end of the student’s

externship; a format is provided with pre-set questions.

Optometrist mentors are invited to become

New vision-tech hub

Australian low vision service provider, Vision

Australia, has opened a new interactive

site so people who are visually-impaired

can experience the abundance of new technology

available to help them today.

Located in Vision Australia’s new Parramatta centre

in Western Sydney, the new Vision Store and Tech Hub

showcases the latest specialist adaptive technology and

how more mainstream devices can be optimised and

used to support people who are blind or have low vision.

“Whether it’s living independently, being active in their

community, finding employment or staying connected

with family and friends, technology is often the key to

unlocking opportunities for people who are blind or

have low vision,” said Ron Hooton, Vision Australia’s CEO.

“Individuals have different circumstances and goals and

what we have at Parramatta is a location where anybody

who is blind or has low vision can come and be exposed

to a huge range of technology that can support them

Honorary

Teaching

Fellows with

the University

of Auckland,

a position SOVS: Calling more optometry mentors

which offers full access to the extensive resources the

Auckland University library offers, including all of its

electronic resources (encompassing many excellent

journals); use of the title “Honorary Teaching Fellow

affiliated with the School of Optometry & Vision

Science at the University of Auckland”; preferential

and cost-reduced access to continuing professional

development events within SOVS; use of the following

phrase on practice websites and similar: “Our practice

provides teaching services for the University of

Auckland’s School of Optometry & Vision Science for

their Bachelor of Optometry degree”.

The School of Optometry & Vision Science is keen to

welcome new and returning mentors for externships

in June and July 2018. If you are interested in becoming

a new or returning externship mentor, please contact

Gini Parslow, practicum placement co-ordinator at

v.parslow@auckland.ac.nz or phone 027 406 8543. ▀

and get expert advice about what is likely to best suit

their needs.”

Technology advice is provided by Vision Australia

staff plus representatives from tech organisation

partners, including Samsung, Apple and Google,

and specialist adaptive technology providers such as

IrisVision and OrCam.

Other highlights of the new space include

demonstration home environments, including an

accessible kitchen and cooking aids (both low and

high-tech solutions); a living room with TV/voice

integration home devices; workplace/home study

tools; Google Home to control lighting and provide

audio cooking instructions; and other tools such as

Samsung’s voice-controlled screen magnification tech.

“Accessibility is a key consideration for people who

are blind or have low vision and we’ve taken that into

account with the design, layout and other features in

the space,” Mr Hooton said. ▀

We’re bringing more

optometry events and

webinars to you

MyHealth1st is revolutionising digital customer engagement

for independent optometrists.

Don’t miss our free events and webinars on how you can join

the digital revolution and put your business growth 1st.

Sign up now at:

myhealth1st.co.nz/optometryevents

April 2018

NEW ZEALAND OPTICS

7


Low vision in the 21st century

BY NAOMI MELTZER*

Last century, low vision services were regarded

as a last resort and an admission of failure.

Generally, when patients enquired as to

whether there was anything available to help

them see, the answer was either a tentative, ‘you

could buy a magnifier’ or a more defensive, ‘you’re

not bad enough for that yet’.

When medical and surgical options ran out,

the patient was dismissed with ‘there is nothing

more that can be done, sorry’. This was effective

at getting the patient out the door, but left them

emotionally and physically stranded, unable to

comprehend how to function visually when they

were neither blind nor seeing. More patients were

rendered functionally “blind” by this statement

than by any other documented pathology and,

sadly, many continue to exist in this state today,

convinced this statement remains true as it was

given by those they trusted.

For some, this attitude has continued into this

century, despite huge changes in medical, optical

and electronic technology, and the current view

of low vision as a spectrum of functional changes

that occur along the pathway between normal

vision and no light perception. A few weeks after I

started my low vision practice in 2011, I ran into an

ophthalmological colleague who told me, ‘I hope

you never get to see any of my patients!’ But for

many, there has been a shift in thinking towards

understanding that visual function cannot be

defined by the size of letter read on a high-contrast

distance chart or a monocular electronic visual field

analysis; and visual rehabilitation does not mean

restoring vision to normal, but the rehabilitation

of a person with visual loss to function within their

family, whanau, community or workplace.

Much of this change has been driven by the

realisation that even with the amazing advances

in medical science in the management of

ongoing problems such as glaucoma, macular

degeneration or other retinopathies, it is just that

– management of the condition – not restoration

of normal visual function. Thus, the best outcomes

are obtained when patients are given as much

information as possible on the range and type of

additional services available to them sooner rather

than later when all else has failed.

Times are changing for low vision patients, and about time too

Today, the modern low vision consultation reviews

how a patient with low or declining vision functions

in their everyday environment and how we can help

them use the vision they have more efficiently to

manage their day-to-day activities. This involves

taking a holistic view incorporating their general

health, and the impact of perhaps other health

problems such as stroke, Parkinson’s or diabetes

on their visual functioning; and their physical

environment – are they confined to one, poorly-lit

room in a rest home or actively participating in

sport or looking after other family members? Does

their visual problem extend to passive reading or

do they have other needs such as mobility or glare

control? Is there a history of amblyopia, binocular

vision instability or balance problems that has been

forgotten along the way or considered irrelevant due

to the patient’s poor distance acuity? Has the need

for prescription glasses to focus at near range been

overlooked as their vision deteriorated? Or do they

perhaps simply need reassurance there are options

available to help them if and when they need it?

A functional, low vision consultation helps assess

each patient on an individual, case-by-case basis,

going way beyond the ‘let’s see if a magnifier will

help’ approach.

Recently, a request for assistance from a resource

teacher brought home to me how much a bit of

lateral thinking and a good stock of low vision

aids can change an

otherwise ordinary

day. A 12-year-old

boy with low vision

due to retinopathy

of prematurity, copes

well in the classroom

with just his spectacle

prescription correcting

his hypermetropia and

high cyls plus a closeworking

distance to

use his accommodation

for extra magnification.

However, given he was

starting woodwork

and sewing and would

have to use sewing

machines, fretsaws and

grinding machines and the like, the resource teacher

was on the hunt for some additional magnification

for him.

She had found a magnifier attached to a

goose neck stand, but this got in the way of the

student and couldn’t be moved easily from one

piece of equipment to another. The boy was also

required to wear safety glasses for the woodwork

equipment so an initial idea to use a head loupe

was a non-starter, while a large magnifier on a

tilting wire frame, ‘just got in the way’. We settled

on a hands-free “embroidery” magnifier, which

sits against his chest with a cord around his neck

and is LED-illuminated. While only providing 2x

magnification (he needs 3.5x to read a mm ruler)

it was sufficient to help him see the needle or the

blade of the saw at a normal working distance.

What was exciting however, was watching the

student. He was like a kid in a candy store trying out

all my high-tech and low-tech electronic stuff. In his

lifetime, he will no doubt use way more high-tech

aids than are available today, but this exercise at

least showed both of us, how a simple low-tech, lowcost

magnifier and a good dollop of lateral thinking

can triumph. A very satisfying outcome all round. ▀

*After 30 years in general optometry,

Naomi Meltzer realised her passion

lay in visual rehabilitation and now

runs an independent, low vision

consultancy service in Auckland. She is

a MDNZ founding trustee, a qualified

CentraSight and eSight assessor and

OrCam trainer. For more, see the Low

Vision Services classified on p26.

Tackling trachoma and

other NTDs

BY ELLA EWENS

In December 2017, Dr Martin Kollmann, a

consultant ophthalmologist and associate

professor at the University of Nairobi, travelled

to New Zealand to address delegates from the

partnerships, humanitarian and multilateral

division of the New Zealand aid programme at the

Ministry of Foreign Affairs and Trade (MFAT). The

main aim of the visit was to build awareness of the

link between neglected tropical diseases (NTDs)

and poverty and demonstrate how tackling NTDs

is key to a region’s socio-economic development.

Dr Kollman, a senior advisor on NTDs for the

international charity CBM (formerly the Christian

Blind Mission), was accompanied by CBM NZ

chief executive, Stephen Hunt, and international

programmes manager, Linabel Hadlee.

NTDs are a diverse group of tropical infections,

especially prevalent in low-income populations in

developing regions. They are caused by a variety

of pathogens such as viruses, bacteria, protozoa

and helminths. The disabling and debilitating

effects of NTDs include blindness, mobility

impairment, preventing children’s growth and

development, malnutrition and extreme pain.

They are labelled ‘neglected’ because they affect

communities in extreme poverty. In some cases,

the uncontrolled spread of NTDs has resulted

in pastoral communities abandoning their land

to escape the transmitting pathogen but, as a

result of NTD control programmes, in more recent

times 25 million hectares of arable land has been

regained, feeding 17 million people annually.

Two of the most common blinding NTDs are

onchocerciasis (river blindness), found in Africa

and some parts of the Americas, and trachoma,

the leading cause of infectious blindness in

humans, caused by infection with the bacterium

Chlamydia trachomatis, which is still found in

Africa, the Americas, Asia, the Middle East and

the Pacific. Ethiopia carries 39% of the global

trachoma burden, with an estimated 74 million

people at risk and 40% of children aged 1-9

infected. Women are highly susceptible due to

greater exposure to young children, who typically

spread the disease. Trachoma is active in the

Pacific, particularly Papua New Guinea and

Australia in remote communities.

A doctor treats a trachoma sufferer in Ethiopia

Blindness from trachoma is irreversible. Infection

is spread through personal contact and by flies

that have been in contact with facial discharges

from an infected person. With repeated episodes of

infection over many years, a sufferer’s eyelashes may

be drawn in so they rub on the surface of the eye,

causing pain and permanent damage to the cornea.

CBM supports NTD control and elimination

programmes in 12 countries promoting the

SAFE (surgery, antibiotics, facial cleanliness

and environmental educational) strategy at

a community level. Over the last 12 years,

CBM has funded nearly 16 million mass drug

administration projects and almost 900,000

trachoma surgeries. CBM has also supported the

training and education of more than 83 million

health and community workers.

At his meeting with MFAT, Dr Kollmann

showcased a CBM-funded programme in

Amhara, Ethiopia which received an award for

its innovative approach embracing community

engagement and ownership. International aid will

not achieve its sustainable development goals

with an economic focus only, he said, but must

also focus on preventing and eliminating NTDs to

be successful.

Although NTD interventions have proved to

be very cost-effective, globally only 0.6% of

health expenditure targets NTDs, hence CBM’s

government awareness programme, which wants

aid givers to target more aid towards health to

support more NTD elimination programmes. This

will represent a tangible benefit for children,

women and adults; solidly contributing to poverty

eradication and sustainable development goals,

explained Dr Kollman.

Dr Martin Kollmann

Dr Martin Kollmann, a consultant ophthalmologist and associate professor at

the University Nairobi, is a senior CBM advisor, coordinating global activities

in the fight against diseases of poverty and inequity. He studied human

medicine in Germany and worked for three years with the German volunteer

service, DED, in rural hospitals in Ethiopia before completing his training in

ophthalmology at Munich University. He holds a degree in tropical medicine

and medical parasitology and an MBA in healthcare management. Today,

at the University of Nairobi Institute of Tropical and Infectious Diseases,

Dr Kollmann trains postgraduates, undergraduates and mid-level eye care

Dr Martin Kollmann, raising

awareness of trachoma and other

NTDs

professionals and is heavily involved in research. He has also developed an innovative sponsorship

programme, which supports training for young Africans at recognised institutions in the region.

8 NEW ZEALAND OPTICS April 2018


Constant Progress

ZEISS Precision Lenses

1912

Punktal ®

The first axially symmetric spectacle

lenses with point-focal Imagery, a

concept that still plays a significant

role in today’s lens designs. This

invention was enabled by a close

collaboration with Moritz von Rohr

and Alvar Gullstrand.

1935

Patent for AR coatings

ZEISS invents a process to create

durable coatings to reduce reflections

on optical lens surfaces.

1969

The photos of the first moon landing

were taken with ZEISS camera lenses.

1970

First photochromic spectacle lenses

A partnership with SCHOTT helps ZEISS

launch the world’s first brown glass

photochromic spectacle, known as

Umbramatic.

1980

Gradal ® HS

ZEISS unveils the world’s first progressive

lens design based on splines. It is the

predecessor of freeform lenses.

1997

Patent for a new manufacturing process

With the Hof / Hanssen patent ZEISS sets a new

standard in progressive lens production. To date,

this manufacturing process has been licenced to

the entire ophthalmic market by ZEISS.

2000

Gradal Individual ®

Progressive Lenses

For the first time in history,

ZEISS offers personalised

parameters in the computation

of progressive lens surfaces.

2007

i.Scription ®

ZEISS launches the first lens

technology that incorporates

higher-order aberrations and

combines subjective refraction

and wavefront analysis.

2010

MyoVision ®

The world’s first lens that

enables a reduction in myopia

progression by an average of

30% in Asian children.

2014

Digital Lenses

ZEISS introduces a new first-pair lens

product category that is an eye care

solution for mobile devices

1992

Video Infral ®

The world’s first computer-based

centration device is introduced

by ZEISS to set new standards in

individualised lens fitting.

2015

DriveSafe Lenses

ZEISS develops an everyday

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2018

Watch this Space!

Our breakthrough innovations are the result of every decision we have made, every idea

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April 2018

NEW ZEALAND OPTICS

9


SPECIAL FEATURE: RANZCO 2018

Welcome to the RANZCO

NZ 2018 Conference

The New Zealand Branch

RANZCO committee

welcomes everyone

to Auckland for the 2018

conference.

This year we have decided to

not have a specific educational

theme, but rather to offer a

broad range of subspecialty

topics, useful to both

generalists and subspecialists

in medical, nursing and

orthoptic fields. The meeting

is combined with the NZ

Ophthalmic Nurses and the

NZ Orthoptic Society, offering

plenary sessions targeted to all attendees,

followed by concurrent streams for each group.

Our keynote speakers are Professor David

Mackey (genetic ophthalmologist, Australia),

Dr Brendan Vote (vitreoretinal and cataract

specialist, Australia), Associate Professor

Lyndell Lim (uveitis and retinal disease,

Australia), and Helen Gibbons (Clinical Lead

Nurse, UK). These speakers are internationally

renowned for their clinical and scientific

expertise and their dynamic presentations.

They will be joined by a further 60 speakers

covering a very wide range of topics including

anterior segment, cornea, cataract, uveitis,

glaucoma, retina, paediatrics, oculoplastics,

oncology, infectious disease, trauma, health

care provision, nursing, psychophysics, basic

science and emerging technologies.

The conference will be held at the Hilton

Hotel which sits in a prime waterfront location

in the heart of Auckland, adjacent to all the

central Auckland shopping and entertainment

venues.

We would like the conference to have a

relaxed, collegial, “weekend” feel, and as such,

BY DR SUE ORMONDE*

Auckland ‘city of sails’ and RANZCO NZ 2018 Meeting venue, the Hilton Hotel (centre,

waterfront)

the dress code is casual.

The conference dinner will be held at

The Maritime Museum, an iconic venue in

Auckland, that celebrates New Zealand’s long

and broad association with the sea. In line with

the casual tone of the meeting, the dinner

will offer a wide variety of quality street food,

street entertainers, and a live band.

We are very grateful to the multiple industry

sponsors who are facilitating the meeting

and there will be a large industry exhibition,

covering the latest and greatest ophthalmic

technology available in New Zealand.

The venue has a set capacity and so we

encourage early registration for what

promises to be a broad ranging, contemporary,

educational and fun meeting.

To register, please visit: https://

ranzcomeetingnz.cvent.com/2018

*Dr Sue Ormonde is a consultant ophthalmologist at Auckland

Eye and Greenlane Clinical Centre, a senior lecturer at the

University of Auckland and a member of the 2018 RANZCO

NZ organising committee together with Professor Trevor

Sherwin and Sue Raynel from the University’s Department of

Ophthalmology.

An enjoyable, educational

affair

The RANZCO New Zealand Annual Scientific

Meeting is one of the most important

meetings in the New Zealand ophthalmic

calendar and is unique in that it incorporates the

New Zealand Ophthalmic Nurses Group Meeting

and the New Zealand Orthoptic Society Meeting.

The programme

This year, the two-day programme from 11 – 12

May at Auckland’s Hilton Hotel, features concurrent

streams, focusing on each speciality, with

presentations ranging from five to 25 minutes from

more than 60 speakers (40 in the Scientific Meeting

alone) followed by question and answer sessions

from the floor.

The programme kicks off with a welcome function,

with canapés and drinks in the exhibitors’ hall of the

Hilton on Thursday 10 May from 5.30-7.30pm. This

year, the popular annual meeting dinner will be held

on Friday 11 May in The Maritime Room, just a short

walk from the Hilton, with views over Auckland’s

famous Viaduct Harbour. As well as the normal good

food, great atmosphere and general bonhomie, this

year’s organisers are also promising a few surprises

at the dinner, so definitely not one to be missed.

The main Scientific Meeting this year welcomes

a number of overseas specialist speakers, as

well as a plethora of local talent, many of whom

will be sharing their own unique experiences

across a number of different, and often unusual,

cases, including, ‘Duped by BDump’; an unusual

presentation of systemic lupus erythematous; and

panuveitis in Sweet’s syndrome.

Other topics include, New Zealand cataract risk

stratification, audit and paediatric surgical outcomes;

psychophysics; the development of a novel webbased

deep learning system, to identify common

retinal pathologies, and an open-source pupilometer;

Vogt-Koyanagi-Harada disease; orbital decompression

surgery in thyroid eye disease; keratoconus in Down

syndrome in New Zealand; corneal cross-linking

outcomes; and, tackling that biggest of questions, oft

lauded by eye health professionals: “are the eyes really

the window to the soul?”

Meet the speakers…

And that’s just some of the smaller sessions. As

a further taster of what’s on offer at this year’s

RANZCO NZ gathering, NZ Optics’ approached the

four keynote speakers from the Scientific Meeting

and the Nurses Meeting and asked them to tell us a

little bit about what they would be presenting, how

they came to be working in ophthalmology and what

they were most looking forward to from this years

meeting.

Professor

David Mackey

Internationally-renowned

genetic ophthalmologist,

Professor David Mackey is

managing director of the

Lions Eye Institute and

professor of ophthalmology

and director of the Centre

for Ophthalmology and

Professor David Mackey

Vision Science at the

University of Western Australia. Having devoted

his career to decreasing blindness from optic nerve

disorders, his work has helped revolutionise the

management of hereditary optic atrophy (Leber and

ADOA) and glaucoma.

In 1993 he initiated the Glaucoma Inheritance Study

in Tasmania, creating one of the largest glaucoma

biobanks in the world that led to the discovery of the

myocilin gene and its association with glaucoma.

His work with the Twins Eye Study in Tasmania and

Brisbane characterised the heritability of many ocular

measurements, while his Genome Wide Association

Studies have identified genes for myopia, corneal

thickness, intra-ocular pressure optic nerve size and

glaucoma. In 2007-8, he led the Norfolk Island Eye

Study, examining 800 mixed-race descendants of

the Bounty mutineers as part of a major genetic eye

study. In Western Australia, he has collected ocular

CONTINUED ON PAGE 12

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References: 1. AcrySof® IQ PanOptix® Toric IOL Directions for Use. 2. Charness N, Dijkstra K, Jastrzembski T, et al. Monitor viewing distance for younger and older workers. Proceedings of the Human Factors and Ergonomics Society 52nd Annual Meeting, 2008. http://

www.academia.edu/477435/Monitor_Viewing_Distance_for_Younger_and_Older_Workers. Accessed September 16, 2016. 3. Average of American OSHA, Canadian OSHA and American Optometric Association Recommendations for Computer Monitor Distances. 4. Alcon

Data on File. TDOC-0018723 (Dec 19, 2014). 5. Alcon Data on File. TDOC-0050480 (June 12, 2015) 6. Alcon Laboratory Notebook:14073:77-78. 7. Lane SS, Burgi P, Milios GS, Orchowski MW, Vaughan M, Schwarte E. Comparison of the biomechanical behavior of foldable

intraocular lenses. J Cataract Refract Surg. 2004;30:2397-2402. 8. Lane SS, Ernest P, Miller KM, Hileman KS, Harris B, Waycaster CR. Comparison of clinical and patient reported outcomes with bilateral AcrySof® Toric or spherical control intraocular lenses. J Refract Surg.

2009;25(10):899-901. 9. Wirtitsch MG, et al. Effect of haptic design on change in axial lens position after cataract surgery. J Cataract Refract Surg. 2004;30(1):45-51. 10. Nejima R, et al. Prospective intrapatient comparison of 6.0-millimeter optic single-piece and 3-piece

hydrophobic acrylic foldable intraocular lenses. Ophthalmology. 2006;113(4):585-590. 11. Rotational stability of a single-piece toric acrylic intraocular lens. J Cataract Refract Surg. 2010;36(10):1665-1670. 12. Alcon Data on File. TDOC-0016076 (Jul 30, 2013).

© 2018 Novartis. Alcon Laboratories (Australia) Pty Ltd. ABN 88 000 740 830. Phone: 1800 224 153; NZ Phone: 0800 101 106. NP4: A21702597704

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11


SPECIAL FEATURE: RANZCO 2018

Zeiss

Clarus 500 is the next generation, ultrawidefield

fundus imaging system from Zeiss,

providing true colour and high-resolution

across a 200-degree ultra-wide image.

The true colour images are essential for

differential diagnosis. Each can be split into

red, green and blue channels. In addition,

fundus auto-fluorescence images are

available, displaying important information

about RPE health. Utilising Zeiss optics, the

Clarus 500 achieves seven-micron resolution,

eyelash-free images allowing the user to

zoom in to visualise fine details. Lastly,

being based on a traditional fundus camera

design and utilising an IR preview, the

Clarus provides a more comfortable patient

experience whilst avoiding inconvenient

recaptures.

Device Technologies

Visit our stand at RANZCO NZ and experience

the revolutionary Topcon Triton Swept

Source OCT-A and other exciting innovations

first hand. Learn more about our range

of ergonomic and time-saving devices:

EndoOptik endo-camera and laser system,

Quantel lasers, a full range of chairs and

stands, new polarised Frey VA charts and

perimeters. Also on display will be the

Maestro OCT providing a one-click wide

scan plus all relevant retinal info. in a single

report. It’s an easy to use, reliable, affordable

and space-saving combo-OCT (anterior scan

and networking available). Plus we have the

agnostic Synergy Ophthalmic Data System

which integrates virtually every ophthalmic

device into one intuitive platform and is

compliant with all the major international

medical communication protocols.

CONTINUED FROM PAGE 10

and environmental data on 2000 20-year old Raine

Cohort participants. A follow-up study of these

participants at age 27 commenced in 2017, while

a new study he started in 2012 is examining the

positive-negative effects of UV sun exposure.

How did you come to focus on this area of eye

health?

I am an ophthalmic geneticist, which is an

uncommon subspecialty in ophthalmology. I’ve

always been interested in genetics, since school.

During medical school, I was also fascinated

by ophthalmology, so I combined them in my

fellowships at the Royal Children’s Hospital

in Melbourne, the Johns Hopkins Centre for

Hereditary Eye Disease in the USA and Moorfields

Eye Hospital in London.

Genetics are at the cutting edge of science and

we have been part of the major discoveries of

genes associated with many different eye diseases.

We learn new pathways for disease and can predict

those at high risk, and in diseases like glaucoma or

retinoblastoma we can intervene to reduce vision

loss.

Can you tell us about your talks this year?

I am giving four talks. First, an overview of where

genetics is taking us. Gene therapy to treat eye

disease has been in the press a lot of late with a

treatment just licenced in the US being marketed

at $850,000! (Luxturna, NZ Optics Feb 2018, p21).

However, we need to consider genetic testing to

prevent genetic eye disease, which may be cheaper.

Plus, the new technologies for visually impaired

people like smart phone apps and driverless cars

offer an exciting future of independence. We need

to follow all these paths.

Second, we have been studying families to find

glaucoma genes since the Glaucoma Inheritance

Study in Tasmania began in 1994. In the coming

months, several papers will show a large number

of genes causing adult glaucoma are also the ones

that cause childhood glaucoma.

Third, there is a global epidemic of myopia, where

a lack of time outdoors is a contributing factor.

However, in Australia and New Zealand, where we

already have the highest risk of skin cancer, what

will happen if we send our kids outdoors more to

prevent myopia?

Fourth, a disease I studied for my doctorate thesis

called Leber Hereditary Optic Neuropathy is now

undergoing clinical trials for a new gene therapy.

Dr Brendan Vote

Dr Brendan Vote is

a clinical associate

professor with the

University of Tasmania

and a vitreoretinal and

cataract specialist. He

was a medical officer in

the RAAF for six years

before commencing his

ophthalmology training

in Dunedin and completing retinal fellowships in

Auckland, Brighton and at Moorfields Eye Hospital

in London. He established the Tasmanian Eye

Institute in 2008 to offer research, educational

and ophthalmic service to the Tasmanian

community.

He is currently involved in multicentre trials

assessing intravitreal therapies in diabetic

maculopathy, age-related macular degeneration

(AMD) and vascular occlusion, including evaluating

the long-term effectiveness of Lucentis for the

treatment of MD in a large cohort of patients

treated now for more than 10 years. He has also

been an active researcher of femtosecond laser

in cataract surgery through the first prospective

comparative cohort study, which began in 2012.

Can you tell us about your topics at RANZCO NZ?

My first topic is ‘Lessons from my 10+ year macular

degeneration relationship utilising intravitreal

injections’; the second is, ‘Cataract surgery and a

doctor’s role in emerging technologies’; the third,

‘CRISPR-Cas 9 is the exponential game changer

in gene therapy; and the fourth, ‘Crypto currency,

Blockchain and healthcare – a dystopian future or

necessary evolution?’.

I am always excited by the technological

breakthroughs we are making. But I like to see

how these will apply in the real world beyond the

marketing and hype. I suppose that makes me an

enthusiastic sceptic; keen to try new things but

looking for the evidence it works.

What are you looking forward to at this year’s

meeting?

I think the New Zealand meeting is one of the best,

as it has the perfect mix of science and social, so I

always look forward to attending.

I enjoy hearing from speakers without industry

associations presenting their research and insights.

The New Zealand RANZCO Branch meeting has

always had this balance and I think this is where

more of our international scientific congresses

need to head.

Associate Professor

Lyndell Lim

Associate Professor

Lyndell Lim is principal

research fellow at the

Centre for Eye Research

Australia (CERA) at the

University of Melbourne,

where she also heads the

Clinical Trials Research

Unit. A consultant

ophthalmologist at the Royal Melbourne Hospital

and the Royal Victorian Eye and Ear Hospital

(RVEEH), where she leads the Ocular Immunology

Clinic, her sub-specialities include medical retina

and ocular inflammatory disease. Her current

areas of research include the possible role of

inflammation in the pathogenesis of several

retinal diseases such as AMD, as well as clinical

studies in diabetic retinopathy and uveitis.

At RANZCO NZ, A/Prof Lyndell Lim will be

presenting on cataract surgery in patients with

uveitis and diabetic macular oedema; and ‘the rise

and rise of infectious uveitis’. Other topics to be

confirmed.

Why eye health and research?

I became a doctor because I liked the idea of

helping people; an ophthalmologist, as it’s the

perfect blend of medicine and surgery; a uveitis

specialist, because no one patient with uveitis is

the same and there are so many unknowns; and a

researcher because it presents the chance to make

a real difference to patients’ lives.

As a doctor, you can help hundreds to thousands

in your lifetime of work. But as a researcher, you

have the chance to help millions.

What are you most excited about for this year’s

meeting?

The chance to talk about uveitis and my research

is always fun, especially with such a nice group of

people.

Ophthalmic nurses

keynote: Helen

Gibbons

Heading up the New

Zealand Ophthalmic

Nurses Group Meeting,

Helen Gibbons is currently

the clinical lead nurse

(education and research)

at Moorfields Eye Hospital

in London. She has

extensive clinical ophthalmology experience in

pre- and post-operative care, out-patients and

establishing a nurse-led ophthalmic emergency

clinic within a district general hospital. Gibbons

was the first nurse to be trained to perform

Nd:YAG laser capsulotomy and Nd:Yag laser

iridotomy. She has used her knowledge to help

develop more skilled nursing roles in a new eye

hospital in Accra, Ghana, and visits every 18

months to support the team.

How did you come to your profession?

At 18, I had a place to undertake my Enrolled

Nurse training but there was an 18-month wait,

so I got a job as a nursing auxiliary which was on

an ophthalmic ward. I loved ophthalmology. The

only other speciality I considered was cardiology,

however, on qualifying I was one of two people

from my set to be offered a job, mine was parttime

so I decided to apply back to my old ward and

focus on ophthalmology.

Throughout my career the patients have always

been my main focus. As a nurse practitioner, I

enjoyed treating my patients independently giving

the best care I could and when performing YAG laser

capsulotomies, I never tired of seeing the joy of

patients’ vision improving. Now, as an educator, I get

so much pleasure out of supporting and developing

future ophthalmic nurses, but I still enjoy patient

contact when I support staff in their clinical areas.

What are you focusing on at RANZCO NZ?

I am giving five presentations at the conference:

how we train our staff to understand what it’s like

to have a visual impairment; the research link nurse

programme we have introduced at Moorfields to

encourage nurses to take part in nursing research

and audit; advance practice roles for nurses at

Moorfields; the ‘New to Ophthalmology’ Induction

programme for staff new to ophthalmology; and

my work in Korle Bu, West Africa. All the topics are

relevant to everyday practice and I have learnt from

each experience and subject.

Craig: 027 565 7200 Robert: 027 565 7720 P: 0800 657 720 info@oppmed.co.nz

Corneal Lens Corporation (CLC)

Corneal Lens is very excited to be showcasing

our new eyecare range at the RANZCO NZ

conference.

Our premium range Evolve highlights four

different formulations which are designed

to target specific areas of dry eye. The

Evolve range is a generation 2 technology,

preservative-free delivery system, which

gives the multi-dose benefits of a single dose

unit with the familiarity of a standard bottle.

It has a soft, squeezable bottle to improve

ease of use offering the blue-tip technology

designed to improve accuracy of dispensing

a drop and maintaining a preservative-free

environment. The Evolve range consists of HA

2, Carmellose 0.5%, Hypromellose 0.3% and

Eyelid Wipes.

Designs for Vision

Designs for Vision is turning 40 and is

thrilled to be associated with RANZCO NZ.

To celebrate, DFV has assembled a number

of state-of-the-art instruments for delegates

to view and to talk to the experts about. The

Oculus Pentacam AXL, the gold-standard

for anterior segment analysis, now comes

with biometry including Barrett in the IOL

calculator. Combine this with the Corvis

ST for true IOP measurement, incredibly

sensitive ectasia detection and cross-linking

visualisation – the complete package for

the glaucoma and refractive surgeon. Also

on show will be the Tomey OA-2000 Optical

Biometer: topography, pachymetry, axial

length, pupil diameter, Barrett, all at a class

leading price.

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13


SPECIAL FEATURE: RANZCO 2018

What’s on in Auckland in May…

As well as being home to some of the country’s top restaurants, bars and tourist attractions,

Auckland, the city of sails, hosts a plethora of events throughout the year. Here’s our pick of just a

few on offer in May for those attending the 2018 RANZCO NZ conference who want to make a little

more of their stay.

Body Worlds exhibition 23 April to 13 July, the

Hilton Hotel

https://www.bodyworldsvital.com

The highly anticipated and internationally

acclaimed original exhibition of real human bodies

is being hosted by the same venue as RANZCO NZ

2018, the Hilton Hotel. Visited by more than 45

million people worldwide, the exhibition takes

you on an intricate journey of the workings of the

human body, through an authentic, visual display

of over 150 donated specimens.

The human bodies and body parts, donated for

the benefit of public education, have gone through

a meticulous year-long process of plastination, and

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visually demonstrate the complexity, resilience

and vulnerability of the human body in distress,

disease and optimal health.

World of Wine Festival 12-13 May, AUT’s City

Campus, opposite Auckland Art Gallery

https://theworldofwinefestival.nz/

New Zealand’s newest wine festival, is our first to

showcase purely international wines, designed to

open Kiwi sauvignon blanc drinkers’ eyes to new

producers, wineries, grapes, regions and styles.

The Auckland University of Technology’s (AUT’s)

Tasting Hall will play host to more than 130 wines

from 13 countries and a revolving wine bar. The

weekend also includes master classes and

special events, such as the Mas Daumas

Gassac vertical tasting, when the Southern

French winery’s head wine-maker Samuel

Guibert, will host a multi-vintage tasting of

the company’s legendary Grand Vin Blanc

and Rouge wines.

Mrs Warren’s Profession 1 – 16 May, ASB

Waterfront theatre, Wynyard Quarter

https://www.atc.co.nz/aucklandtheatre-company/2017-18/mrs-warrensprofession/

When Vivie discovers that her expensive

education was funded by her mother’s

earnings from a string of brothels, Vivie’s

thoroughly modern worldview is thrown

into tumult. Written in 1893, George

Bernard Shaw’s play was originally banned

by the censors for its subject matter and

the hypocrisies it exposed. What continues

to shock is how old taboos stay topical and

how little things have changed.

Celebrated New Zealand theatremaker

Eleanor Bishop returns from New

York to direct her own version of this

rarely-performed classic that takes a

Radiant Health &

Bausch+Lomb

Bausch + Lomb (B+L) is excited to

announce the launch of the next

generation Stellaris Elite phaco

system with ‘adaptive fluidics’.

Join us at the Radiant Health and

Bausch+Lomb stand at RANZCO

NZ where we will be showcasing

Stellaris Elite, and find out about

other new products B+L will have for

2018, especially in the VR segment.

We will also be demonstrating

Finevision trifocal and enVista IOLs.

Stem cells

restore

sight

Two patients with severe wet

AMD, implanted with a speciallyengineered

retinal pigment

epithelium cells patch, derived from stem

cells, have regained their reading vision

in a ground-breaking clinical study at

Moorfields Eye Hospital in London.

The study investigated whether the

diseased cells at the back of the patients’

affected eye could be replenished using the

stem cell-based patch. The patients were

monitored for 12 months and went from

not being able to read at all to reading with

normal reading glasses.

The study, published in Nature Biotech, is

a major milestone for the London Project

to Cure Blindness, a partnership between

Professor Pete Coffey from University

College London and Professor Lyndon da

Cruz, a Moorfields retinal surgeon.

contemporary lens to centuriesold

questions of sexuality and

empowerment.

‘Let me be myself’ – the story

of Anne Frank 9 Feb to 13 May,

Auckland Museum

http://www.aucklandmuseum.com/

visit/exhibitions/let-me-be-myself

Developed by Anne Frank House

in Amsterdam, this international

exhibition ‘Let Me Be Myself’ explores

what life was like for Anne Frank

and her family, looks at the events

surrounding the Holocaust and the

rise of the Nazi Party in Germany and

explores identity, prejudice, exclusion

and discrimination.

Best Comedy Show on Earth 13 May,

Sky City

https://www.skycityauckland.co.nz/

whats-on/theatre/best-comedyshow-on-earth/

Ten comedians, 100s of jokes and thousands of

laughs, get a sneak peak of the Auckland Comedy

Fest’s brightest stars and freshest talent in this

fast-paced stand-up showcase, billed as having

something to suit everyone.

Dans le Noir? Dining in the dark Thursday, Friday

and Saturday, from 6:30pm to 7:30pm, Rydges

Hotel

https://www.rydges.com/accommodation/newzealand/auckland/eat-drink/dans-le-noir-rydges/

Presented by Auckland’s Rydges Hotel and the

Blind Foundation, Dans le Noir is a unique, sensory

dining experience where patrons eat in complete

darkness, guided and served by low vision or blind

people. More than 1.3 million people have already

lived this experience worldwide. Organisers say

Swept Source OCT Angiography

RA:28042016/CS

The internationally-acclaimed ‘Body Worlds’ exhibition also at the Hilton

Jennifer Ward-Lealand stars in Mrs Warren’s Profession

DRI OCT Triton Plus

Multi-Modal Imaging

OCT-1Triton

First combined anterior and posterior

swept source Extremely fast scanning speed

DRI

100,000 A/Scans secondSeries

Retinal Journal 1021r1.indd 1

Swept Source OCT now with 1050nm OCT invisible wavelengths Angiography

penetrates

Cataracts and Haemorrhages

See. Discover. Explore.

Feeder vessels in a CNV with GA

OCT Angiography image taken with a Topcon OCT Triton

Courtesy OCT of Dr. Angiography Carl Glittenberg, MD image Karl Lansteiner taken Institute with for a Topcon Retinal Research OCT and Triton Imaging

Courtesy of Dr. Carl Glittenberg, MD Karl Lansteiner Institute for Retinal Research and Imaging

The Topcon Swept Source DRI OCT-1 Triton Series 1 features a 1 micron, 1050nm light

source with a scanning speed of 100,000 A Scans/Sec., providing multi-modal fundus

imaging.The DRI OCT-1 Model Triton rapidly penetrates all ocular tissue without being obscured by

media opacity or NZ hemorrhage. ) 0508 See you DEVICE at AAO Booth (338 3732. 423)

sales@device.co.nz www.device.co.nz

Color FA FAF OCT-A

1. Not for sale in the US.

For more information visit, newsgram.topconmedical.com/tritonangexport

DRI OCT-1Trito

Swept Source OCT now with OC

See. Discover. Exp

Feeder vessels in a CNV with GA

Auckland plays host to NZ’s first international wine show in May

a full immersion in this sensual dining adventure

will impress you as a once in a lifetime experience.

OCT Ang

Courtesy of Dr. Carl Glittenberg, MD Karl Lans

The Topcon Swept Source DRI OCT-1 Triton Series 1

source with a scanning speed of 100,000 A Scans/

imaging.The DRI OCT-1 Model Triton rapidly penetrates all ocular tiss

media opacity or hemorrhage. See you at AAO Booth 3732.

Color FA FAF OCT-A

1. Not for sale in the US.

For more information visit, newsgram.topconmedical.com/tritonangexport


ONZ: Ophthalmology

with one voice

BY MOIRA MCINERNEY, ONZ EXECUTIVE DIRECTOR

The board of ONZ is delighted

to announce that we have

welcomed many new members

to the organisation over the last

four months. With 85 members,

ONZ truly represents the majority of

ophthalmologists in New Zealand.

This growth in membership is due to

two factors, a more visible profile and

a wish on behalf of ophthalmology to

speak with one voice on current affairs.

With this voice, ONZ can unite our

ophthalmologists, giving them the

tools and techniques to deal with the

many commercial issues in their field.

This initiative is never more important

than now with ophthalmologists

facing many challenges in funding in

both the private and public sectors. As

their central representative body, we

are forging relationships with providers

and advisors. We are fortunate to have

great resources on the board, but more

importantly amongst our members. Let

us not succumb to the Kiwi “she’ll be

right” attitude, evidenced elsewhere,

such as Auckland traffic and Hawke’s

Bay water, two prime examples of poor

leadership and planning.

ONZ’s role to represent

ophthalmologists and their patients’

interests can already be seen in our

lobbying of insurers for the Xen

implant, MIGs in general and Ozurdex.

We have worked within the board but

also had great engagement from Sonya

Bennett to move a plan and direction

forward, in a coordinated fashion,

for funders to come to the party on

technology for glaucoma care. Another

example, with thanks to Rebecca Stack,

is our support and facilitation of the

Clinical Leaders Forum on 27 March in

Wellington. Plus, there is our Business

Forum, ‘The Other Matters’ (see below),

which will run just after the RANZCO

NZ Branch meeting in May in Auckland.

We will be asking members to help

us coordinate our efforts over the next

few weeks by way of information and

thoughts, but also by directing general,

non-contract insurance queries to

ONZ. This will help ophthalmologists

to speak with one voice on behalf of

all our members, old and new. We

also expect to increase our presence

at meetings and via email to let

you all know we are now working

in a unified fashion to amplify the

voice of concerned New Zealand

ophthalmologists.

ONZ: The Other Matters

This year, in an attempt to ensure more

members can attend, we will hold

our ONZ Business Forum on Saturday

12 May, from 5pm to 7 pm at the

Hilton, directly following the RANZCO

NZ Branch meeting. Please join us

for this event and drinks afterwards.

Invites will be issued shortly or see our

website for information.

Finally, ONZ is helping to find

placements for the RANZCO-sponsored

ophthalmology leadership programme.

If you are interested, or know of

someone who is interested, please

email us at admin@ophthalmologynz.

co.nz.

RANZCO to run Foundation

The Royal Australian and New Zealand College of

Ophthalmologists (RANZCO) has wound up its charitable

arm, the Eye Surgeons’ Foundation (ESF) as a separate legal

entity and will run its own version, together the administration

of its research arm, the Ophthalmic Research Institute of

Australia (ORIA) in-house to save costs.

The ESF had been operating for 15 years to raise money

to support medical research and sustainable development

projects across the Asia-Pacific region. “In recent years the

pressures of an increasingly competitive charity sector

have meant that it has been difficult to build a sustainable

fundraising base to meet the costs of a standalone charitable

organisation,” said Dr David Andrews, RANZCO CEO. “It was

clear, therefore, that changes to the organisational model

were required to ensure that the support provided by ESF

fundraising could be continued.”

The ESF Board decided to wind up ESF on 30 September 2017

and made their final distribution of funds to international

development projects. To ensure the ESF legacy continues,

however, the majority of its functions are being taken in-house

where the running costs can be reduced, said Dr Andrews.

New worm found in eye

A

new

species of parasitic nematode has now been

identified in three previously healthy, relatively young

residents of Saipan, the largest island of the USmanaged

Northern Mariana Islands in the Pacific.

According to a case report published by the Marianas Eye

Institute in the American Journal of Ophthalmology, the three

patients, identified over a 20-year period, all had the same

unidentified worm in their eyes, causing corneal opacification,

conjunctival injection and uveitis.

“This is a fascinating series of cases,” said Dr David Khorram, the

co-founder and prior ophthalmologist at Marianas Eye Institute.

“When the first patient came into us in 1997 with a live worm in

their eye, we knew we were seeing something never seen before.

We weren’t sure what to do. We tried removing the worm which

didn’t work; we tried killing the worm with a laser, but it didn’t

die. Finally, with the help of Dr Stephen Gee in Hawaii, a special

technique was used to successfully extract the worm.”

The first worm was handed to a pathologist for analysis and

identification, but was lost, while the second worm to be found

(some years later) was removed, but was not intact and could

RANZCO is now looking to appoint a new “Foundation

committee”, including representatives from its indigenous and

international development committees, the ORIA Board and Save

Sight Society NZ and RANZCO fellows interested in philanthropy

and education, to run an in-house version, which can continue to

raise funds for education and research. RANZCO will be able to

accept donations from Australian members directly or from New

Zealand members through the NZ Branch, though not from the

public, except as bequests. The donations will be used to fund

early stage research through ORIA, and education programmes.

ORIA

ORIA will also be administered in-house by RANZCO following

the retirement of executive officer Anne Dunn-Snape last year,

after 15 years in the role, and a request by ORIA’s board. Unlike

the situation with ESF, ORIA remains a separate legal entity,

though much of the day-to-day administration will now be

run by RANZCO staff, again providing reduced overheads for

ORIA and maximising the benefit that can be achieved with

the available funds, explained Dr Andrews. The ORIA Board will,

however, continue to manage the research organisation and set

its direction and strategic priorities.

not be successfully analysed

or identified. The third and

final case was identified in

2008. The worm was removed

intact and sent for analysis

Intrastromal haze and poorly visible worm

inferiorly (circled)

and identification to the Armed Forces Institute of Pathology in

Washington, DC, and was found to be a completely new parasite.

The published case report describes the details of each of the

three cases, showing that each worm was an isolated finding,

with no other worms found in other parts of the body. All the

patients were young and healthy. It is not known how the

worm entered the eye, but it is speculated that it was probably

introduced through an insect bite and grew within the body,

migrating to the cornea, said Dr Khorram. “Although these are

the first three reported cases in the world, now that doctors

know that a tiny worm can live in the cornea, we are certain

that more cases will be found.”

Future clinical findings regarding this newly described

nematode are needed to further develop understanding of the

disease, he added.

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NEW ZEALAND OPTICS

15


SPECIAL FEATURE: RANZCO 2018

ANZGS 2018

Toomac Ophthalmic

Toomac Ophthalmic is proud to introduce

the latest development in MIGS, the Glaukos

iStent inject, a tiny surgical implant that can

effectively lower IOP in adult patients with

mild to moderate open-angle glaucoma.

Trabecular micro-bypass technology

developed by Glaukos has taken a leap

forward with the new titanium microbypass

stent that’s preloaded in a single-use

sterile inserter. Come and see our stand at

RANZCO NZ, where Ian and Mark together

with the Glaukos representative will be

happy to answer all your questions. Also

new for RANZCO NZ is the MALOSA singleuse

instrument range. See us for a bespoke

surgical pack.

Allergan – Xen

The latest innovation in glaucoma

management, the XEN Gel Implant, is

now available in New Zealand for patients

whose condition is not well managed with

glaucoma drops. The unique technology

is based on the same principle as

trabeculectomy, creating a new outflow

channel bypassing trabecular and scleral

resistance forming a diffuse, low-lying bleb.

As the technique becomes more familiar,

the XEN procedure can offer a less intensive

and less time-consuming alternative to

the mainstay trabeculectomy. In the APEX

clinical study, 70% of patients with XEN

achieved an IOP of ≤ 15mmHg following the

treatment with a significant reduction in

glaucoma drop use. See the Allergan stand

for more.

BY DR GRAHAM REEVES*

This was the first gathering of the group

formerly known as ANZGIG, now the

Australian and New Zealand Glaucoma

Society (ANZGS), where glaucoma subspecialists

from the region come together to meet colleagues,

discuss difficult cases and gain insights from both

local and international speakers.

This year’s conference in Sydney from 23 to 24

February commenced with presentations on a

variety of rare conditions and challenging cases

with robust discussion about different approaches.

The second session of paper presentations

included two projects introducing new technology

into patient testing. The first showed that an

iPad-based perimetry programme could deliver

similar results to a Humphrey visual field analyser.

While there are some minor technical issues to

fine tune, this is a promising development. The

second looked at use of home tonometry to detect

significant diurnal IOP variation in patients whose

clinic IOPs had been unremarkable but whose

glaucoma was progressing.

The afternoon started with a fascinating nonophthalmic

lecture by invited speaker Mr Peter

Ellerton from the University of Queenslands’

Critical Thinking Project. He delivered a thoughtprovoking

lecture on the nature of critical thinking

and deliberate practice in gaining and maintaining

skills or expertise. It highlighted the importance

of contact with our peers to challenge biases that

may influence our decision making.

This was followed by Professor John Salmon,

from Oxford University who shared his views on

‘Diagnosing glaucoma. The seven deadly sins’.

These included the mistakes of not taking a good

history, not doing gonioscopy, not using sufficient

magnification to examine the optic disc (leading

to disc haemorrhages being overlooked) and not

correlating disc changes with visual field findings.

These ‘sins’ were illustrated by cases from his

vast clinical experience and even for those seeing

glaucoma patients on a daily basis they were a

timely reminder of possible pitfalls.

Dr Shenton Chew from Auckland outlined the

campaign he was involved in to try and highlight

the burden of overdue follow-up patients and

Drs Nicholas Johnston and Sonya Bennett at ANZGS

showed how well-organised patient advocacy can

achieve tangible results.

A number of new treatment techniques were

showcased at the meeting, including Associate

Professor Paul Chew from the National University

of Singapore who discussed the increasing use

of micropulse diode laser in different clinical

situations. Another promising new technique

was the use of tissue glue in reducing the size of

dysaesthesetic trabeculectomy blebs.

Associate Professor Paul Healey from Sydney gave

the Gillies lecture titled ‘100 years of progress in

glaucoma’. This highlighted three paradigm shifts

that have occurred over this time. The first was the

move from using IOP as a defining feature to a risk

factor in glaucoma. The second was to understand

the chronic nature of glaucoma so that when we

assess patients with glaucoma we are considering

both the current state (determining how it may

be affecting quality of life) and also the rate of

progression (how the patient is likely to be affected

in the future). Lastly, he presented data showing

low rates of glaucoma medication adherence in

Australia. This showed the importance of patient

education and participation in treatment decisions

given that for many patients their only symptoms

are from the treatments we prescribe.

Professor Salmons’ final talk detailed the seven

Drs Jesse Gale and Graham Reeves at ANZGS

types of challenging patients who require glaucoma

surgery. Most in the audience could think of patients

who fell into at least one of these categories.

These included “the patient who has researched

the options on the internet”, “the patient at risk of

visual loss from the surgery” and the “the patient no

one else will do”.

The final session covered minimally-invasive

glaucoma surgery (MIGS) with a collection of

experts sharing their experience with different

devices including the iStent inject and the Cypass

supraciliary stent and offering advice on patient

selection and technical tips. Associate Professor

Michael Coote from Melbourne gave a salient talk

about the costs involved with adding these new

techniques to our armamentarium, both in terms

of the financial costs and the risk of losing skills

needed for traditional glaucoma surgery.

Overall this was a very interesting meeting and

I look forward to next year when it will be timed

to coincide

with the World

Glaucoma

Congress in

Melbourne.

*Dr Graham Reeves is a glaucoma subspecialist practicing at

Manukau Superclinic and the Eye Institute.

Rethink glaucoma management

The power of simplicity 1

Reference: 1. Allergan XEN directions for use.

The XEN ® Gel Implant is intended to reduce intraocular pressure in patients with primary open angle glaucoma where previous medical treatments have failed.

Always refer to full instructions before use. Adverse events should be reported to your local Allergan office, Australia 1800 252 224 or New Zealand 0800 659 912.

XEN ® is a registered trademark of AqueSys, Inc., an Allergan affiliate. Trademark of Allergan, Inc. ©2017 Allergan. All rights reserved. Allergan Australia Pty Ltd, 810 Pacific Highway,

Gordon NSW 2072. ABN 85 000 612 831. Allergan New Zealand Limited, Auckland. NZBN 9429 0321 20141. ANZ/0016/2017e. DA1731CB. Date of Preparation: October 2017.

16 NEW ZEALAND OPTICS April 2018


ANZCS 2018

BY DR JENNIFER COURT*

This year’s annual Australia and New Zealand Cornea Society

(ANZCS) meeting was held in Sydney in February and was

organised by Drs Con Petsoglou, Noni Lewis and Chameen

Samarawickrama and Jane Treloggen from the NSW Tissue Bank.

The well attended meeting, originally developed by Professor

Douglas Coster in the 1980s, is now in its 35th year. The venue for this

year’s gathering was the InterContinental Hotel, set back from the

bustling Circular Quay which had been wonderfully decorated for the

‘Year of the Dog’ Chinese New Year Festival.

In the first session, entitled ’Cutting Edge’, invited guest speaker

Associate Professor Jod Metha of the Singapore National Eye Centre

kicked off proceedings with an interesting talk on developing nonsurgical

therapies for TGFBI (transforming growth factor beta-induced

gene) dystrophies by identifying peptide targets to reduce corneal

opacity formation. Dr Greg Moloney then described his experiences

introducing a successful keratoprosthesis service in Sydney, using the

osteo-odonto keratoprosthesis (OOKP) technique, with his colleague

and friend Dr Shannon Webber who provides maxillofacial expertise.

Professor Gerard Sutton from the Save Sight Institute introduced

the iFix pen and iFix bio-ink, which was the winner of the inaugural

‘Big Idea’ research funding challenge last year. His 3D-printed

technology promises the exciting prospect of a biocompatible

transparent ‘ink’ delivered by a handheld device that actually

facilitates cell proliferation and thus ulcer repair.

Dr Petsoglou and microbiologist Professor Wieland Meyer provided

a detailed account of the recent ‘therapeutic goods recall’ by the

Lions NSW Eye Bank following an apparent cluster of cases of candida

endophthalmitis in DSAEK cases with pre-cut tissue. The honest and

detailed account of the course of events and thorough investigation

provided reassurance to surgeons of the quality and safety of service

strived for.

The annual report from the Australian Corneal Graft Registry was

received with interest, as usual. The number of DMEK cases continues

to rise with good visual outcomes, but reduced survival compared

with penetrating keratoplasty and Descemet’s stripping endothelial

keratoplasty (DSEK) in-keeping with results from around the world.

But the numbers remain small and the follow-up short for now.

Professor Stephanie Watson presented the Keratitis Antimicrobial

Resistance Surveillance Program (KARSP) update. Resistance remains

low and is stable; others were encouraged to join the programme.

The first day concluded with a debate on whether femtosecondassisted

pterygium surgery was a ‘welcome application of new

knowledge’ (W.A.N.K.) or not. The fiercely argued cases for and

against reflected the scientific but still humorous tone of the

meeting! For now, at least, the audience was not swayed towards the

femtosecond technique.

The relaxed and informal meeting dinner, hosted in The Pavilion in

the Royal Botanical Gardens, was a welcome opportunity to catch up

with colleagues and meet new friends, and was very well attended.

It was a particularly pleasure to chat to invited guest speaker Dr Mike

Straiko, from the Devers Eye Institute in Portland, Oregan, prior to his

informative and instructive talk which began the DMEK session on

Saturday morning. His presentation was full of videos and pearls of

wisdom for those starting out with this often tricky to master technique

for replacing Descemet’s membrane and the corneal endothelium with

a true anatomical likeness. The significantly lower rejection risk of DMEK

versus DSEK and PK and the improved quality of vision remains the

significant attraction for mastering this technique. There were more tips

to come the following day too, for those attending the Sydney DMEK

course, organised by Dr Moloney, where Dr Straiko was joined by A/Prof

Mehta and Drs John Males and Andrew Apel.

Later on the Saturday, Professor Minas Coroneo presented cases of

ocular surface squamous neoplasia (OSSN) treated medically with

retinoic acid and interferon, and topical cidofovir for refractory cases,

with very promising success.

This year’s Blandford Lecture was given by Professor Gordon Wallace

of the University of Wollongong who provided a fascinating look at

3D bio-printing and its exciting potential applications in medicine

and ophthalmology.

The next session

focused on crosslinking

with talks

covering the use of a

soft contact lens to

allow treatment of thin

corneas; iontophoresis;

combining the treatment

with intra-stromal

corneal ring segments in

anisometropic patients

from asymmetric disease

with clear corneas; and

Professors Gordon Wallace and Charles McGhee

the effective treatment of

children. Attention was

drawn to the potential for rapid progression in children with need for

close monitoring. The Doug Coster lecture titled ‘Corneal endothelial

cell engineering – it’s not just culture’ was given by A/Prof Mehta.

The afternoon then split into concurrent sessions on eye banking

and ‘News from the lab’ focusing on dry eye, which included

Auckland’s own Associate Professor Jennifer Craig as one of the

speakers. Topics discussed in this session included how a poor blink

can lead to ‘drop-out’ and atrophy of the meibomian glands and

how blink exercises can be helpful; how intense pulsed light (IPL)

can restore meibomian gland function with an accumulative effect;

and how the cholesterol-lowering agent, atorvastatin, is being

investigated as a novel treatment for evaporative dry eye.

Dr Tom Cuneen then shared how patients with Stevens Johnson

Syndrome, the rare blistering skin reaction that can devastate the

LEAVE A LEGACY

OF VISUAL FREEDOM.

Professors Laurie Hirst and Minas Coroneo, A/Prof Jod Mehta and Dr Jacqueline Beltz who led the

femtosecond laser-assisted pterygium debate

ocular surface, can benefit from early amniotic membrane transplant.

He described his effective surgical technique that can be performed

outside the operating theatre, if necessary.

The conference then ended with an interesting interactive complex

case presentation and video session.

Overall the meeting provided open, in-depth discussion with

informative and entertaining speakers in a friendly and informal

manner. There is a lot of exciting research in the field of cornea and

I, for one, am looking forward to seeing where bio-printing, corneal

endothelial regeneration and novel treatments for previous ‘surgical’

diseases will take us next.

*Dr Jennifer Court is a senior corneal fellow at the Department of Ophthalmology at

the University of Auckland

OptiMed

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to view our latest technology. Be sure to check out the

Eidon Ultra-Wide Field Confocal Scanner for high-resolution

fundus imaging as well as other innovations and diagnostic

equipment. OptiMed NZ will have product specialists available

to answer all your queries. Robert, Craig and Richard invite you

to come and discuss your interests, have a chat or just “hang

out”.

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April 2018

NEW ZEALAND OPTICS

14/3/17 10:00 am

17


SPECIAL FEATURE: RANZCO 2018

Calling all Kiwi doctors to AUSCRS 2018

BY DR DAVID KENT*

This year’s annual meeting of the Australasian Society of Cataract

and Refractive Surgeons (AUSCRS) will be held at Macquarie

Conference Centre, Peppers (previously known as the Outrigger),

Noosa from Wednesday 17 October to Saturday 20 October.

Since its beginnings in 1996, AUSCRS has been the only local

Australian and New Zealand annual meeting devoted to cataract and

refractive surgery. Despite this, it remains poorly attended by New

Zealand ophthalmologists many of whom are refractive surgeons

and almost all of us are cataract surgeons. I’d like to encourage

more attendance at our local meeting by New Zealand-based

ophthalmologists many of whom would find this a useful and very

enjoyable meeting to attend.

AUSCRS is a much less formal meeting than either the American or

European cataract and refractive surgery meetings. Dress has always

been casual with no jackets, suits or ties and the meeting has always

intentionally been held at “resort” destinations in Australia and New

Zealand, making it very “family friendly” to attend. The relaxed and

friendly atmosphere, is also more than complemented by the high

calibre of speakers drawn from across the world and locally.

There’s lots of discussion and debate, and plenty of opportunity to

freely discuss topics with both internationally-renowned and local

experts, truly unrivalled by similar meetings. Another annual AUSCRS

highlight and tradition is the imaginative themes and formats of

the sessions, with local and international speakers often dressing

up in entertaining costumes, sometimes bordering on the bizarre.

It has been very entertaining over the years to see world-renowned

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Drs Dean Corbett, Peter Ring, Michael Merrimen and David Kent demonstrating the more relaxed

attire favoured at AUSCRS at the 2015 conference in Noosa

ophthalmologists dressed up in amusing costumes debating often

quite controversial topics.

Some New Zealand ophthalmologists appear to be put off

attending AUSCRS because of a perception the meeting is largely for

refractive surgeons. This has never been the case and most of the

meeting remains primarily concentrated on advances in cataract

surgery. So any New Zealand ophthalmologist who performs cataract

surgery would also find AUSCRS a very useful meeting to attend.

Another unique part of AUSCRS is the advanced trainee session on the

Wednesday morning where some of the leading Australasian cataract

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Noosa, venue for AUSCRS 2018

and refractive surgeons present a series of educational lectures and

interactive sessions for senior registrars and fellows. Feedback from

registrars has always been very positive for this programme.

The conference-proper starts with an opening street party on

Wednesday evening, then there are three days of academic sessions on

Thursday, Friday and Saturday with the Gold Medal Lecture on Thursday

morning. The meeting finishes with the AUSCRS Gala Event on Saturday

night, leaving Sunday for delegates to sight-see and travel home.

The overseas speakers are yet to be announced for this year’s

AUSCRS, but usually include some of the world’s leading cataract and

refractive surgeons. Professor Graham Barrett continues to preside

over AUSCRS and there really isn’t anyone better in Australasia with

the experience and academic mana to be the leader of our local

cataract and refractive surgery meeting.

I believe most New Zealand ophthalmologists should consider

attending AUSCRS as they will truly enjoy it and find the calibre of

education second-to-none. We should also all be supporting this

‘local’ meeting to keep it sustainable in the long term. So, I hope

you’ll join me at AUSCRS 2018 in Noosa this October.

For more: please visit http://www.auscrs2018.org.au/

*Dr David Kent is a consultant ophthalmologist with Fendalton Eye Clinic and

Christchurch Eye Hospital. He has co-authored many papers and presented at many

international meetings on laser refractive surgery. He is a member of both the

American and Australasian Societies of Cataract and Refractive Surgery, and the New

Zealand AUSCRS council representative.

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Dr Jacqui Beltz overseeing new VR training at RVEEH

The Royal Victorian Eye and Ear Hospital (RVEEH) has introduced

state-of-the-art virtual reality simulators to train the next

generation of eye surgeons.

The RVEEH’s new Eyesi Surgical simulators allow ophthalmology

trainees to learn highly specialised micro-surgery skills in a safe

and controlled environment, and the trainer to objectively monitor

and track an individual’s progress, said Dr Jacqueline Beltz, RVEEH

ophthalmologist and training director for the Victorian Branch of

RANZCO. “Practice is vital to learn any skill and microsurgery is no

exception. Virtual reality simulation provides a setting that forgives

failure, and allows trainees to develop fine motor skills as well as

learn from their errors without causing harm.”

Studies have shown that patient outcomes are improved when

trainees have undertaken virtual reality training. Virtual reality

simulation training will be used alongside traditional training

methods, including wet and dry labs, to increase the breadth of

surgical training for young ophthalmologists, said Dr Beltz. “With the

data that is collected, we can track each individual trainee’s progress,

identifying and addressing any gaps that may require extra practice

or additional teaching. We can also compare trainees’ progress both

locally and globally, so we can evaluate and improve our training

programme.”

The first stage of RVEEH’s virtual reality training programme will

focus on preparing first year trainees for cataract surgery. Future

programmes will include training for vitreoretinal surgery and

complication management. ▀

18 NEW ZEALAND OPTICS April 2018


Case study: Mycobacterium chelonae keratitis

following cataract surgery

BY DR LUCY LU, DR JENNIFER COURT AND

PROFESSOR CHARLES MCGHEE*

Here we present a rare case of postcataract

surgery and corneal wound

infection caused by the non-tuberculous

mycobacterium species Mycobacterium chelonae.

This case illustrates the difficulties in diagnosis and

treatment of this uncommon condition to increase

awareness of this potentially devastating infection

among optometrists and ophthalmologists.

Case history

A usually fit and well, 85-year-old, New Zealand

European female presented with redness, pain and

reduced vision in her left eye, eight weeks after

routine, uncomplicated, cataract phacoemulsification

with intraocular lens implantation.

Visual acuity OS at presentation was reduced

to 6/30 unaided, 6/15 with pinhole (previously

6/7.5 corrected post-op). The left cornea had a

1.0 x 2.8mm stromal infiltrate in the temporal

clear corneal wound site, without an overlying

epithelial defect. The anterior chamber exhibited

2+ cells but no hypopyon. The vitreous was quiet

and the fundus examination was normal. She was

admitted to hospital and treated with intensive

topical antibiotic drops (hourly cefuroxime 5%

and tobramycin 1.36%). However, the intraocular

inflammation worsened so she underwent anterior

chamber washout, vitrectomy and administration

of intravitreal antibiotics (ceftazidime and

vancomycin). Oral doxycycline, ciprofloxacin and

prednisone were added. Surprisingly, aqueous

and vitreous samples were entirely negative for

bacterial and fungal culture as well as for viral PCR.

After slow improvement, she was discharged on

day 16 on topical ciprofloxacin and prednisolone 1%.

She was monitored closely as an outpatient and the

infection waxed and waned over the subsequent

two months (Figs 1 and 2). A large corneal biopsy

also failed to identify any causative organism.

Therefore, after 13 weeks of treatment, ciprofloxacin

was cautiously tapered and stopped, however, the

infection recurred with greater severity with an

overlying corneal melt and the prospect of corneal

perforation. Subsequently, a superficial keratectomy,

accompanied by a focal, partial-thickness, tectonic

corneal graft (5mm), was performed to excise the

majority of the lesion, approximately four months

after initial presentation.

Two weeks later, white flecks were noted in the

graft-host-interface (Fig 3) and a rapidly growing

mycobacterium species, Mycobacterium chelonae

was also isolated from the superficial keratectomy.

This isolate was notably resistant to ciprofloxacin

and doxycycline, but sensitive to clarithromycin,

tobramycin and linezolid on standard MIC (mean

inhibitory concentration) testing. Therefore,

intensive topical tobramycin and linezolid were

started, and topical prednisolone withheld.

Despite intensive, appropriate, dual-antibiotic

topical treatment the inflammation increased and

the overlying graft became oedematous and opaque

(Figs 4a and 4b). Consequently, the lamellar graft

was removed to reduce the infective load and allow

better drug penetration to the underlying host

cornea. After an extended two-month course of

treatment, the infection gradually settled, almost 10

months after her initial cataract surgery (Fig 5). Her

vision at this stage was 6/15 unaided, 6/9 pinhole

and her eye was comfortable. She is expected to

continue on low dose topical antibiotics, under close

monitoring, for up to a year.

Discussion

Non-tuberculous mycobacteria (NTM) refers to a

group of Mycobacterium species other than the

Mycobacterium tuberculosis complex. NTM exist

ubiquitously in the environment including in soil

and drinking water. They are rare causes of systemic

and ocular infections, particularly related to trauma

and surgery 1 . The Mycobacterium chelonae species is

an insidious yet aggressive pathogen that has been

reported as a devastating cause of post-LASIK and

post-cataract surgery keratitis and endophthalmitis 2-6 .

There are several cases of Mycobacterium chelonae

keratitis after clear cornea cataract surgery reported

in the literature, many requiring significant

intervention such as corneal transplant, but typically

with poor visual outcomes 4-6 .

Known risk factors for developing mycobacterial

keratitis include trauma, ocular surgery, poor tear film

integrity, inappropriate use of topical corticosteroids

and contact lens use 4 . Systemic conditions such as

diabetes mellitus or immunosuppression increase the

susceptibility to infection. Our patient did not have

any of these risk factors, other than routine postoperative

steroid drops.

Fig 1. Recurrence of dense stromal infiltrate at the temporal clear

corneal wound with keratic precipitates, two weeks after discharge from

hospital, while on treatment with topical ciprofloxacin

Fig 4a. Progessive infection with development of interface fluid affecting the

temporal, lamellar tectonic corneal graft with loosening of sutures (6 weeks

post-op)

Fig 5. After two months of continuous topical Linezolid and Tobramycin,

the base of the previous patch graft site had epithelialised and was

clinically free of infection

Post-operative Mycobacterium chelonae keratitis

has an insidious onset, with variable time between

surgery and onset of symptoms, from days to

months. The affected cornea may exhibit a “cracked

windshield” appearance around the edges of a

stromal infiltrate, often without an overlying

epithelial defect. Infiltrates may have irregular

margins or stellate lesions, mimicking a fungal

keratitis 1 .

NTM infections are particularly dangerous

because most routinely used topical antibiotics

are ineffective against them, and antibiotic

resistance is a significant issue 7 . A review of

in vitro microbiological susceptibilities of

NTM showed the following susceptibilities:

clarithromycin (93%), amikacin (81%), linezolid

(36%), moxifloxacin (21%), and ciprofloxacin

(10%). In the M. abscessus/chelonae subgroup,

only 1% were susceptible to ciprofloxacin 8 . In

addition, Mycobacterium chelonae can be difficult

to culture, with fastidious growth requirements,

which increases the risk of false negative reports

and delayed diagnosis as in this case 7 .

Mycobacteria keratitis requires aggressive

treatment, ideally with multiple fortified topical

antibiotics with consideration of systemic cover

(such as oral clarithromycin) if severe 7, 8 . An

extended treatment course is required.

As illustrated in the presented case,

Mycobacterium chelonae keratitis can take a

prolonged, waxing and waning course that

may falsely reassure the clinician of impending

resolution. Negative corneal scrapes in a nonresponding

infection warrants surgical biopsy to

enable correct diagnosis and prevent complications,

such as infective scleritis or endophthalmitis.

Surgical debridement of infected tissue may reduce

the bacterial load and also improve antibiotic

penetration into deep stroma, where organisms

may have been seeded into a surgical wound.

While mycobacterial ocular infection is rare, it

must be kept in mind by all ophthalmic health

providers when evaluating any atypical post-laser

or post-surgical infection. NTM are a particular

diagnostic and treatment challenge compared

to other microbes due to delays in pathogen

identification, multiple antibiotic resistances and

a higher likelihood to require surgical intervention.

Therefore, maintaining a high level of suspicion

in unusual cases, obtaining early, accurate

microbial diagnosis, with aggressive and extended

antimicrobial treatment and early surgical

intervention are key to minimising morbidity and

maximizing visual outcome. ▀

Fig 2. Apparent early control of keratitis after three months of treatment.

Note the quiescent eye but suspicious white deposits in stroma.

Ciprofloxacin was stopped at this stage

Fig 4b. Anterior segment optical coherence tomography (AS-OCT) image through infected graft, demonstrating fluid in the graft-host interface

References

1. Kheir WJ, Sheheitli H, Abdul Fattah M, Hamam RN.

Nontuberculous mycobacterial ocular infections: A Systematic

Review of the Literature. Biomed Res Int. 2015;2015:164989.

2. Freitas D, Alvarenga L, Sampaio J, Mannis M, Sato E, Sousa L, et

al. An outbreak of Mycobacterium chelonae infection after LASIK.

Ophthalmology. 2003 Feb;110(2):276-85.

3. John T1, Velotta E. Nontuberculous (atypical) mycobacterial

keratitis after LASIK: current status and clinical implications.

Cornea. 2005 Apr;24(3):245-55.

4. Martinez JD, Amescua G, Lozano-Cárdenas J, Suh LH. Bilateral

Mycobacterium chelonae keratitis after phacoemulsification

cataract surgery. Case Rep Ophthalmol Med. 2017;2017:6413160.

5. Servat JJ, Ramos-Esteban JC, Tauber S, Bia FJ. Mycobacterium

chelonae-Mycobacterium abscessus complex clear corneal

wound infection with recurrent hypopyon and perforation after

phacoemulsification and intraocular lens implantation. J Cataract

Refract Surg. 2005 Jul;31(7):1448-51.

6. Ramaswamy AA, Biswas J, Bhaskar V, Gopal L, Rajagopal

Coming

soon

Fig 3. Appearance of the (5mm) temporal, lamellar tectonic corneal graft

post-op, day 19, demonstrating white interface specks on retro-illumination,

heralding the return of infection

R, Madhavan HN. Postoperative Mycobacterium chelonae

endophthalmitis after extracapsular cataract extraction and

posterior chamber intraocular lens implantation. Ophthalmology.

2000 Jul;107(7):1283-6.

7. De la Cruz J, Behlau I, Pineda R. Atypical mycobacteria keratitis

after laser in situ keratomileusis unresponsive to fourthgeneration

fluoroquinolone therapy. J Cataract Refract Surg. 2007

Jul;33(7):1318-21.

8. Girgis DO, Karp CL, Miller D. Ocular infections caused by

non-tuberculous mycobacteria: update on epidemiology and

management. Clin Exp Ophthalmol. 2012 Jul;40(5):467-75.

*Dr Lucy Lu (pictured) is a clinical research

fellow and Dr Jennifer Court is a senior

corneal fellow with the Department of

Ophthalmology at Auckland University.

Professor Charles McGhee is department

head, a consultant ophthalmologist and

chair of RANZCO’s Cornea Society

iStent inject is intended to provide safe and effective

IOP reduction by addressing OAG at the primary

site of resistance to outflow

iStent inject:

• Re-establishes physiological outflow to significantly decrease IOP

• Reduces or eliminates drug burden

• Indicated with and without cataract surgery

• Developed by Glaukos Corporation, the corporate founder

of Micro-Invasive Glaucoma Surgery (MIGS)

Toomac

Ophthalmic

DIVISION OF TOOMAC HOLDINGS LTD

32D Poland Road, Wairau Valley, Auckland

Tel: 0508 443 534 Email: mark@toomac.co.nz

©2018 Glaukos Corporation. Glaukos and iStent inject

are registered trademarks of Glaukos Corporation.

GL33071 Glaukos iStent Inject QtrPage Adv.indd 1

March 2018

16/3/18 10:28 am

NEW ZEALAND OPTICS

19


Summer Students Symposium 2018

The ninth joint Auckland University Department of

Ophthalmology and School of Optometry and Vision

Science Summer Student Symposium in March

was an upbeat affair. Amusingly chaired by Professor

Trevor Sherwin, 17 students from across the departments

presented projects and findings from their 10-week

studies in rapid, strictly-timed, four-minute sessions.

The presentations crossed the gamut of eye disorders

and concerns from glaucoma and aging to dry eye and

drug delivery mechanisms, each attracting a number

of questions and sparking discussion among the

70-strong audience.

School of Medicine head, Professor Alan Merry, and

Associate Dean (research) Professor Andrew Shelling

from the University’s Faculty of Medical and Health

Sciences had the tough job of selecting the best

presentations on the night. “It’s a challenge to present

in four minutes and the standard this evening was

uniformly very high,” said Prof Merry.

The following is summary of the presentations:

• Spheres of Influence, Catherine Tian (Tom Cat Trust)

– 1st prize

• Influence of high glucose and inflammation on

barrier properties of retinal pigment epithelial (ARPE)

cells, Charisse Kuo – 2nd prize

• Differentiation of transition zone stem cells into

corneal endothelial cells, Hannah Ng (Eye Institute) –

3rd prize

• Comparison and review of visual field referrals to

ADHB glaucoma clinic, Catherine Kwak

• Crystallin protein modification and spatial mapping

in an aging lens model, Jerry Shen

• Evaluating the long-term usability of ex-vivo

bovine corneas for drug delivery applications, Darshan

Shrestha (Buchanan Charitable Foundation)

• The effect of erythropoietin on the vasculature of

the premature sheep retina: a cellular and molecular

characterisation, Muthana Noori

• Nailfold capillary abnormalities in glaucoma, Hilary

Goh (Gordon Sanderson Scholarship from Glaucoma

New Zealand, see full story p3)

• Review of glaucoma referrals to ADHB glaucoma

clinic, Tess McCaffrey

• Confirmation of UV filter distribution in the

aging human lens, Arwa Ibrahim (Molecular Vision

Laboratory)

• To give or not to give? Should I provide feedback

during acuity measurement, Maggie Xu

• Monitoring age-related changes of the vitreous of

the eye using MRI, Louisa Howse

• Evaluating the utility of an eyelid massage device

for the management of meibomian gland dysfunction,

Jasmine Feng (NZAO Education and Research Fund)

• Effect of temperature on the thickness of the

human ocular choroid measured with optical coherence

tomography, Sungyeon Kim

• The effect of virtual reality on the tear film and

ocular surface, Joyce Wong

• Adaptation of jumping spider behaviour to a

modified focal environment, Aimee Aitken (Paul Dunlop

Memorial Research Scholarship, NZAO)

• Visual impairment in stroke in a New Zealand

context: patient characteristics in the CBR Stroke

Recovery Clinic, Carla Fasher ▀

The 2017-2018 Summer students

Sam Simkin, Chelsea Wood and Dr Hannah Kersten

Safal Khanal, Soheil Mohammadpour and Lily Chang

PHOTO BY TREVE DROMGOOL

Prof Trevor Sherwin, Salim Ismail, Catherine Tian and Jason Xu Jane McGhee, Dr Rachel Barnes and A/Prof Bruce Hadden Dr Andrew Collins, Joanna Black, Monica Acosta and A/Prof Sam Schwarzkopf

BOOK REVIEW

The Neuro-Ophthalmology Survival Guide,

second edition

By Anthony Pane, Neil R. Miller and Mike Burdon

REVIEWED BY DR STEPHEN BEST*

I was delighted to be invited by the NZ Optics’

editorial team to review this book as I had not

taken the opportunity to read the previous

edition, although I had heard many references

to it from colleagues both here, in New Zealand,

and in Australia, where the principle author, Dr

Anthony Pane is based.

I have listened to Anthony’s presentations over

the years and appreciate his directness about

the potential pitfalls (sometimes known as

medico-legal watch cases) of neuro-ophthalmic

conditions that might have irreversible sightthreatening

sequelae or be life-threatening

emergencies seen in routine ophthalmic clinics,

but potentially under-diagnosed! Additionally,

I have spent time with, and greatly respect, Drs

Neil Miller and Michael Burdon, so anticipated

this small text book would be a good read and

live up to expectations!

I was not disappointed; especially after reading

the first chapter ‘Staying out of trouble’ which

lists 20 neuro “rules” to keep you out of strife.

Each rule is illustrated with a case example and

cross-referenced to the expanded discussion

on that topic in subsequent chapters. This

chapter alone should pique interest about

common neuro-ophthalmic conditions and,

as stated in the introduction, you can’t avoid

neuro-ophthalmology – neuro-ophthalmology is

special, you want your patients to see well, you

want your patients to stay healthy, you want to

stay out of trouble, you want to pass your exam

(if you still have it ahead of you).

This is a short text book designed to be of

everyday practical use for ophthalmologists,

trainees, optometrists and neurologists, based

on clinical symptoms, examination checklists,

management flowcharts and referral guidelines.

There are 12 chapters (340 pages) that cover

blurred vision or field loss, swollen disc(s), double

vision, unequal pupils and unexplained eye pain,

orbital pain or headaches.

The final chapter outlines

neurophthalmic history

and examination, with

particular reference to giant

cell arteritis and an excellent table 13.1 titled

‘Localizing value of visual field defects’. This last

chapter, in my opinion, should be a must read

for all ophthalmic trainees not only to reinforce

sound clinical practice but also to help with

challenging formal examinations.

The chapter on ‘Double vision’ is a wonderful

synthesis of an extremely complex topic, but

presented in an easily understandable and

clinically significant format. While the discussion

on cranial mono-neuropathies and localising

value flowcharts should guide clinicians to

appropriate investigations in particular third

nerve disease processes that might have very

serious consequences!

One of my favourite chapters, however, dealt

with ‘Seeing things’. Patients may see things

because of eye, optic nerve or brain disease and

unusual visual symptoms need to be explained.

Visual illusions and hallucinations are explained

with excellent cartoons and flow charts, and

Anthony reminds the reader that if the patient

presents with visual phenomena that are not

consistent with visible intraocular disease

processes then referral to a neuro-ophthalmologist

or a neurologist is appropriate with neuro-imaging

to check for serious brain disease.

This is a great book to have close to your

consulting room and, as with many modern texts,

when you purchase the second edition it comes

with an eBook version which is downloadable to

your electronic screen ensuring great portability

and a fantastic set of clinical videos.

*Dr Stephen Best is a consultant ophthalmologist, with

sub-specialities in glaucoma and neuro-ophthalmology, with

Auckland Eye and the Greenlane Clinical Centre.

20 NEW ZEALAND OPTICS April 2018


NZ hosts the world of retina

BY DR HANNAH KERSTEN*

The biennial Retina International World Congress was held

for the first time in Auckland on the 10 and 11 February.

With recent host cities including Taipei and Paris, Auckland

had a lot to live up to!

The Retina International Congress is a unique meeting,

bringing together the world’s foremost retinal scientists and

clinicians, patients and their families, health professionals and

patient advocates. The scientific programme, organised by local

retina specialist Associate Professor Andrea Vincent, boasted an

incredible line-up of 11 international speakers as well as many

local and national presenters. The speakers and delegates were

joined by a large group of volunteers, from the Blind Foundation

and the University of Auckland, to assist the many low-vision or

blind delegates.

Speaking to such a diverse audience was always going to be a

difficult task, but the speakers more than rose to the challenge.

The scientific programme was opened by Professor Elise Héon,

from the University and Hospital for Sick Kids in Toronto, who

gave a brilliant clinical overview of inherited retinal disease,

putting into context much of what was going to be discussed at

the meeting. This was followed by a presentation by Professor

Eric Pierce, from Harvard Medical School, summarising the

genetic causality of inherited retinal diseases and current

therapeutic approaches for treating these conditions. Both

opening speakers spoke of the difficulties associated with the

current inherited retinal disease nomenclature; many disease

names (for example, retinitis pigmentosa) cover a range of

genetic mutations and phenotypes.

The second session of the day covered the somewhat daunting

topic of Genetics and Gene Therapy. A/Prof Andrea Vincent,

outlined the clinical findings that can provide clues to the genetic

diagnosis in inherited retinal disease, while Associate Professor

Alex Hewitt (Tasmania) provided an overview of the advances

in genetic testing for retinal disease. He included a memorable

analogy, where each DNA nucleotide was a matchstick,

explaining how changes in the ‘matchstick’ configuration

can lead to genetic disease. Professor Jean Bennett, from the

University of Pennsylvania, then took to the stage to discuss the

enormous amount of work that goes into conducting a clinical

trial, and the phenomenal costs involved (up to US$1.8 billion if

conducted by a pharmaceutical company!).

In the afternoon, the meeting broke off into two parallel

sessions, ‘Retinal degenerations’ and ‘AMD and other

maculopathies’. I attended the AMD session and one of the

highlights was Professor Mark Gillies from Sydney discussing

the Australian Fight Retinal Blindness project and the role of big

data. He emphasised the importance of natural history disease

studies – by understanding the course of disease in individuals,

we are able to gather information that cannot be acquired

through clinical trials alone.

In this session, we also heard from a number of local speakers;

Drs Narme Deva, Rachel Barnes, David Squirell and Dianne

Sharp covered a range of topics including advances in treating

age-related macular degeneration (AMD) and diabetic eye

disease, and the latest in retinal imaging for AMD.

Claire Fitzgerald, Gary Williamson and Margaret McLeod from the Blind Foundation with

volunteer Nancy and Martine Able-Willamson

Diego Sonderegger, Drs David Squirrell, Graham Wilson and Angus Hatfield-Smith

Part III Optom students and volunteers Linda Zhou, Lusi Yu, Joyce Wong and Kate Lee

Speakers Dr Daniel Chung, Prof Elise Héon, A/Prof Andrea Vincent and Dr Thomas

Edwards

Blind Foundation’s Sue Emirali and Gail Mann (third left) with Jenny and Kyle Dobson

The final session of the day included presentations by Associate

Professors Alice Pébay, from Melbourne, and Alex Hewitt on using

stem cells to model eye disease, and CRISPR gene editing in retinal

disease. A/Prof Hewitt explained that although the possibilities for

CRISPR gene editing in humans are vast and exciting, it could be

many years before they are used in patients with retinal diseases.

Dr Kent Small then spoke about his work in North Carolina Macular

Dystrophy with patients from across the world.

The interesting topics continued on day two of the

programme, with ‘Scientific Breaking News’. Professor Bennett,

who conducted the first gene therapy treatment trial for

patients with inherited retinal disease, spoke about the recent

FDA approval of Luxturna (or voretigene neparvovec-rzyl to use

its proper name) for the treatment of patients with mutations

in the RPE65 gene. Professor Pierce gave an update on the

ReNeuron clinical trial of human retinal progenitor cells for

patients with advanced retinitis pigmentosa. Dr Sharp discussed

treatment difficulties in patients with polypoidal choroidopathy

and retinal angiomatous proliferation. Professor Gillies gave an

overview of AMD clinical trial results, including brolucizumab

as a potentially longer-lasting treatment for neovascular AMD

and lampalizumab, trialled for the treatment of geographic

atrophy. Finally, Dr Tom Edwards from Melbourne, gave an

overview of the safety and efficacy of a robot-assisted retinal

surgery system. The robot is able to make very fine movements,

particularly important in patients with fragile retinas (including

patients with inherited retinal disease). In the video, ‘Robot

vs. Surgeon’, the robot was much steadier, with slower, more

deliberate movements.

The futuristic theme continued, with a session on artificial

vision. Dr Edwards discussed the first attempt at artificial vision

(back in 1968!) and the considerable progress that has been

made since then. Artificial vision requires an intact inner retina,

so retinitis pigmentosa is often a good target. Dr Penny Allen

from the Royal Victorian Eye and Ear Hospital, talked about

Bionic Vision Australia’s suprachoroidal retinal prosthesis, and

presented the results of a prototype clinical trial, where all

three patients showed improvement in navigational ability

following the surgery. Dr Thiran Jayasundera, a New Zealandtrained

retinal specialist now working in the USA, was the first

to implant the Argus II over a decade ago. Today, there have

now been over 350 Argus II implant surgeries. He discussed the

Argus II’s surgical procedure and clinical journey. Because the

implant only provides very basic vision, pre-operative vision

needs to be light perception or worse, he said.

The afternoon was again split into parallel sessions, with

separate sessions for patients and professionals. I chaired one of

the patient sessions, which included an illuminating presentation

by ophthalmic nurses Sandy Grant and Olga Brocher on the

services offered by the Auckland District Health Board’s low

vision clinics. Blindness consultant Jonathan Mosen, blind since

birth, talked about why it is the best time in history to be a blind

person. Technology was also the focus of the Blind Foundation’s

adaptive technology trainer Matthew Rudland, who turned our

attention to the Seeing AI app for those with visual impairment,

while the Blind Foundation’s Sandra Budd detailed some of the

Foundation’s services.

Following the parallel sessions, Professor Gerald Chader from

the Doheny Institute in the USA, gave the closing keynote

presentation, summarising the decades of laboratory and

clinical work that have led to clinical trials and better outcomes

for patients with retinal disease.

Feedback about the conference was positive, with attendees

commenting on the high quality of the speakers and the fantastic

networking opportunities available. The next Retina International

World Congress will be held in Reykjavik, Iceland, in 2020; the

perfect excuse to organise a trip to the Northern Hemisphere. ▀

*Dr Hannah Kersten is a lecturer in the School of Optometry and Vision Science at

the University of Auckland and a member of the local organising committee for the

2018 Retina International World Congress.

Focus on

Eye Research

Retinal detachment,

epiretinal membranes

and anti-VEGF for DMO

VISUAL RECOVERY AFTER RETINAL

DETACHMENT WITH MACULA-

OFF: IS SURGERY IN THE FIRST 72H

BETTER?

Frings A, Markau N, Katz T et al

British Journal of Ophthalmology.

2016;100:1466 -1469

Unlike macula-on retinal detachment,

which is often treated as an

“ophthalmic emergency” and repaired

swiftly before the macula detaches,

macula-off retinal detachment

is usually considered less of an

emergency. However, determining

the ideal time for repair of maculaoff

retinal detachment before

compromising the visual prognosis

can be difficult. The purpose of this

study was to evaluate the influence

of lag-time between the onset of

central visual acuity loss and surgical

intervention of macula-off retinal

detachment.

A retrospective review of 1727 patients

was undertaken, with 89 patients

meeting the inclusion criteria. The

main outcome measure was final

visual acuity as a function of symptom

duration of macula-off detachment.

Symptom duration was defined as the

time from the onset of loss of central

vision (macula detachment) to surgical

intervention.

The results showed there was no

clinically significant difference in

final visual acuity in those operated

within 10 to 30 days of macula-off

retinal detachment. But patients with

symptom duration of three days or

less achieved best final visual acuity

(p


for optometrists and eye care professionals

with

Professors Charles

McGhee & Dipika Patel

Series Editors

Should glaucoma patients avoid caffeine?

BY DR JINNY YOON AND

PROFESSOR HELEN DANESH-MEYER*

Caffeine is a popular psychostimulant that

acts as an adenosine receptor antagonist at

physiological concentrations. It is the most

widely used drug in history, consumed daily by

more than 70% of New Zealanders in the form of

coffee, tea, chocolate and caffeinated soft drinks. It

has been estimated that adults aged between 20

and 64 years are exposed to an average of 3.5mg

of caffeine/kg body weight/day 1 .

Historical studies suggest some

ophthalmologists have long expressed concerns

about the effect of caffeine on intraocular pressure

(IOP) in glaucoma patients 2,3 . To date, IOP remains

the only treatable risk factor in primary open

angle glaucoma (POAG), the most common type

of glaucoma. Thus, establishing the link between

caffeine and IOP is of great importance for

improving the management of POAG.

Effect of caffeine on IOP

A number of clinical trials have investigated the

immediate effect of caffeine on IOP. The effect

of caffeine has been regarded as controversial

due to inconsistencies amongst study findings.

These inconsistencies can be attributed to variable

study protocols, such as sources and doses of

caffeine, methods of tonometry and time points

of IOP measurement. Additionally, participant

characteristics and severity of glaucoma were

often not clearly documented in some studies.

Nonetheless, a careful review of the literature

reveals a common trend.

In young and healthy volunteers without history

of ocular diseases, no significant changes in IOP

were detected up to four hours following ingestion

of caffeine capsules 4,5 . One study, however,

demonstrated a post-caffeine increase in IOP of

2-3 mmHg in healthy volunteers aged between

20 and 29 and this increase was maintained for

three hours 6 . However, the volunteers drank a litre

of coffee in this study and the authors did not

delineate the effects of volume overload and high

dose caffeine.

Several randomised controlled trials and

subsequent meta-analysis of those studies

reported IOP changes in patients with POAG or

ocular hypertension following caffeine ingestion.

There was a statistically significant increase in

IOP when the patients were exposed to 180mg of

caffeine in coffee, equivalent to approximately one

double-shot espresso 7,9 (see Table 1). The metaanalysis

showed the weighted mean IOP differences

before and after coffee consumption in patients

with glaucoma or ocular hypertension: 0.347 at

30 minutes, 2.395 at 60 minutes and 1.998 at 90

minutes (95% confidence interval 0.078-0.616,

1.741-3.049, 1.522-2.474, respectively) 7 .

A major shortcoming of this meta-analysis is the

lack of age-matched controls, leaving the effect of

aging unknown. The healthy controls were mostly

in their 20s. The age range of glaucoma patients

were not stated in the papers but were expected

to be in a much older age group. Furthermore,

the authors did not differentiate high tension

POAG from ocular hypertension, or normo-tension

POAG, when they could represent distinct disease

entities. Despite these weaknesses, the consensus

is that caffeine, at least transiently, induces a small

increase in IOP in glaucomatous eyes, but not in

young healthy eyes.

What is the pathophysiological significance

of the IOP change?

Two large-scale epidemiologic studies addressed

the question whether caffeine consumption is

associated with the development or progression

22 NEW ZEALAND OPTICS April 2018

of glaucoma. The Blue Mountains

Eye Study, a cross-sectional

study conducted in Australia,

investigated correlation between

IOP and regular daily caffeine

intake in POAG patients 10 .

The participants completed

questionnaires on their pattern

of coffee consumption and

underwent comprehensive

glaucoma assessment. The

study demonstrated a positive

association between daily coffee

drinking and high IOP, only in

people with POAG. POAG patients

who drank coffee daily had higher

mean IOP (19.6mmHg) than

those who did not (16.8mmHg).

This result reached statistical

significance after adjusting for

age, sex, systolic blood pressure,

myopia, current smoking and

diabetes.

A large-scale prospective study

of health professionals in the

USA showed an association

between coffee consumption

and development of POAG in

people with a family history of

glaucoma¹¹. A large number of

health professionals over 40 years of age and

without a history of POAG were followed up for

18 years in this study. Daily caffeine intake of up

to 600mg per day (approximately four doubleshot

espresso coffees or five cups of brewed

coffee) was not associated with increased risk

of developing POAG as shown by relative risks

of around 1. With over 600mg of daily caffeine

intake, the relative risk increased slightly to

1.61. Notably, in people with a family history

of glaucoma, high caffeine intake of more than

600mg per day increased the relative risk from

0.94 to 2.01. In other words, people with a family

history were twice as likely to develop POAG as

those without, if they were heavy coffee drinkers

(>600mg per day).

Taken together, there is still insufficient evidence

to support caffeine as an independent risk factor

for the development of POAG, but people with

POAG or with a family history of glaucoma (ie.

genetic susceptibility) may be more vulnerable to

the effects of caffeine.

Mechanism of caffeine-induced IOP

elevation

The main mechanism of caffeine’s effect is via

adenosine receptor antagonism and subsequent

increase in sympathetic tone and a slight

elevation of blood pressure¹². In young and

healthy volunteers, 200mg of oral caffeine led

to significant retinal vasoconstriction one hour

post-ingestion 4 . This was negatively correlated

with mean arterial pressure, suggesting an

auto-regulatory response to increased blood

pressure. Another study demonstrated that

ingestion of 300mg of caffeine caused an increase

in the resistive index of retrobulbar arteries in

young and healthy volunteers¹³. Hypothetically,

the increase in systemic blood pressure will

increase pressure within the ciliary arteries,

which in turn will increase ultrafiltration and

aqueous production, thereby elevating IOP.

Increased arterial pressure can also increase

venous pressure and reduce aqueous clearance,

thereby contributing to elevated IOP. Caffeineinduced

vasoconstriction was however not

associated with high IOP in the young and

healthy, suggesting the presence of an unknown

homeostatic mechanism to maintain the IOP.

Table 1. Average IOP before and after caffeine ingestion in patients with normo-tension glaucoma and ocular hypertension 9

Coffee and glaucoma?

Consequently, more questions arise as to

why caffeine elevates IOP in only glaucoma

patients. Several researchers postulate there

may be an inherent susceptibility to the effect

of caffeine in glaucomatous eyes. There is

mounting evidence that vascular and autonomic

dysfunction is a key pathologic process in

glaucoma (for a comprehensive review, see

reference 14). Doppler ultrasound imaging

studies demonstrated that POAG patients failed

to auto-regulate central retinal artery blood

flow during postural change. Gene expression

studies identified impairment of nitric oxidemediated

smooth muscle cell relaxation and

excessive plasma levels of endothelin, a potent

vasoconstrictor, in response to physiological

perturbations in POAG patients. Polymorphisms

of nitric oxide synthase and caveolin, which lead

to impaired vasodilation, have been associated

with POAG. Genetic dysautonomic conditions

such as familial dysautonomia and nail-patella

syndrome are associated with subtypes of

POAG. Moreover, examination of the nail bed

capillary network revealed abnormal peripheral

microvascular circulation in glaucoma patients.

It is possible that caffeine produces a pathologic

haemodynamic response and consequent IOP

change in glaucoma patients with structurally

and functionally impaired microvasculature.

The debate continues…

Based on the evidence accumulated to date,

glaucoma patients may be advised to avoid

caffeine intake for 90 minutes before IOP

measurement, in order to obtain a more accurate

IOP reading. However, there is no known clinical

benefit of avoiding caffeine in the long-term

management of POAG and without clear

evidence we are more likely to cause unnecessary

anxiety associated with caffeine consumption.

A few crucial questions remain to be answered

before clinicians can make evidence-based

recommendations on caffeine consumption.

l If caffeine transiently elevates IOP, does

frequent coffee drinking lead to sustained

elevation in IOP? What is the effect of repetitive

caffeine intake?

l Vasoconstriction was observed in healthy

eyes following caffeine administration, but the

haemodynamic response to caffeine is yet to be

explored in glaucoma patients.

l The link between chronic caffeine exposure

and the severity of glaucoma has not been

established. Is chronic caffeine exposure

associated with more advanced POAG? Does

withholding caffeine provide any long-term

benefit in terms of POAG progression?

These questions need to be addressed in

future studies to establish evidence-based

recommendations. In the meantime, it would be

reasonable to advise patients to avoid excessive

caffeine intake if IOP control is critical since

even a small reduction in IOP has been shown to

reduce the risk of glaucoma progression 15 . ▀

References

1. Ministry for Primary Industries. Caffeine. New Zealand:

2012 November.

2. Leydhecker W. Influence of coffee upon ocular tension in

normal and in glaucomatous eyes. Am J Ophthalmol. 1955

May;39(5):700-5.

3. Davis RH. Does caffeine ingestion affect intraocular

pressure?. Ophthalmology. 1989 Nov;96(11):1680-1.

4. Terai N, Spoerl E, Pillunat LE, Stodtmeister R. The effect

of caffeine on retinal vessel diameter in young healthy

subjects. Acta Ophthalmol (Oxf). 2012 Nov;90(7):524.

5. Adams BA, Brubaker RF. Caffeine has no clinically

significant effect on aqueous humor flow in the normal

human eye. Ophthalmology. 1990 Aug;97(8):1030-1.

6. Okimi PH, Sportsman S, Pickard MR, Fritsche MB. Effects of

caffeinated coffee on intraocular pressure. Appl Nurs Res.

1991 May;4(2):72-6.

7. Li M, Wang M, Guo W, Wang J, Sun X. The effect of

caffeine on intraocular pressure: a systematic review and

meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2011

Mar;249(3):435-42.

8. Higginbotham EJ, Kilimanjaro HA, Wilensky JT, Batenhorst

RL, Hermann D. The effect of caffeine on intraocular

pressure in glaucoma patients. Ophthalmology. 1989

May;96(5):624-6.

9. Avisar R, Avisar E, Weinberger D. Effect of coffee

consumption on intraocular pressure. Ann Pharmacother.

2002 Jun;36(6):992-5.

10. Chandrasekaran S, Rochtchina E, Mitchell P. Effects of

caffeine on intraocular pressure: the Blue Mountains Eye

Study. J Glaucoma. 2005 Dec;14(6):504-7.

11. Kang JH, Willett WC, Rosner BA, Hankinson SE, Pasquale

LR. Caffeine consumption and the risk of primary

open-angle glaucoma: a prospective cohort study. Invest

Ophthalmol Vis Sci. 2008 May;49(5):1924-31.

12. James JE. Critical review of dietary caffeine and blood

pressure: a relationship that should be taken more

seriously. Psychosom Med. 2004;66(1):63-71.

13. Ozkan B, Yuksel N, Anik Y, Altintas O, Demirci A, Caglar Y.

The effect of caffeine on retrobulbar hemodynamics. Curr

Eye Res. 2008 Sep;33(9):804-9.

14. Pasquale LR. Vascular and autonomic dysregulation in

primary open-angle glaucoma. Curr Opin Ophthalmol.

2016 Mar;27(2):94-101.

15. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L,

Komaroff E, et al. Factors for glaucoma progression and

the effect of treatment: the early manifest glaucoma trial.

Arch Ophthalmol. 2003 Jan;121(1):48-56.

Dr Jinni Yoon

Prof Helen Danesh-Meyer

About the authors

*Dr Jinny Yoon is a neuroophthalmology

research fellow.

She studied neuroscience at

the University of Auckland

and graduated with a PhD.

After completing basic medical

training in Auckland, she

followed her passion for

eye health and joined the

Department of Ophthalmology.

Professor Helen Danesh-Meyer

is an international authority

on glaucoma and neuroophthalmology

and chair of

Glaucoma NZ. She is a sought

after international speaker, has

published more than 150 articles

and is a respected international

journal editor.


MyHealth1st now in NZ

BY LESLEY SPRINGALL

Klaus Bartosch knows more than most the

importance of being able to act on a whim and

book a health appointment quickly and easily,

out of hours.

The co-founder of patient booking and engagement

software MyHealth1st, and managing director of

the platform’s parent company 1stGroup, had just

finalised plans for his Vision Crusaders cycling team

to complete the Australian Ride to Conquer Cancer

fundraising races when his family urged him to get

the swelling of his right knee looked at. Bartosch

thought it was just a symptom of his recently

diagnosed arthritis, but given his family’s concerns he

somewhat begrudgingly went online, using his own

platform, at 9pm to book an appointment the next

day with a local doctor.

He had no white blood cells left in his body. The

doctor packed him off to a specialist pronto and he

was diagnosed with advanced-stage leukaemia and

committed to hospital for emergency treatment.

If he’d gone cycling; if it had not been so simple to

book the appointment, he could easily have died, he

says. The memory is a powerful one, and few at the

Auckland launch of MyHealth1st didn’t tear up when

Bartosch went on to share how his daughter took

his place in the endurance race, raising the promised

funds for much-needed cancer research.

That was 2013 and neatly illustrates why Bartosch,

together with an experienced team of online and

health practice veterans, had joined forces to shake up

the age-old way of booking healthcare appointments

and engaging with patients.

Background

Since launching in Australia in 2012, first in dentistry

before moving into other health areas, MyHealth1st

has netted more than 6,000 customers and booked

more than 6.5 million online appointments. It

began selling the platform to Australian optometry

practices just over a year ago and today books online

appointments for more than 1,200 Australian practice

owners; over 60% of the country’s independent

optometry market.

Of the optometry bookings made online in Australia

today, 43% are new customers and 57% are existing.

But perhaps the most interesting statistic of all, says

Bartosch, is that 70% of all online bookings are made

during business hours, demonstrating that the vast

majority of patients, if given the choice, would rather

book online than have to call a practice.

A Kiwi case study

Sharing the Auckland launch platform in March for

MyHealth1st in New Zealand, was Whangarei-based

practice Visualeyez director Craig Robertson.

Frustrated by his own business’ inability to allow

new and existing customers to book online, last year

Robertson asked his practice management software

provider, Optomate, for help and was referred

to 1stGroup. After just two months of using the

MyHealth1st booking system, Robertson was hooked.

It helped drive bookings to his practice, was simple

to use and integrated seamlessly with Optomate,

his website and his Facebook page, he says. He also

can’t wait to add 1stGroup’s patient recall service,

EasyRecall, to his online marketing toolbox, despite

the extra cost, he says, as soon as it becomes available

in New Zealand.

“As a consumer I want to be part of the digital

revolution. I want to contact people with emails

and book online and I found it very frustrating that I

couldn’t do that with my own practice, so that’s why

I tried it. It’s a cost effective, very simple platform. It’s

easy,” Robertson told the Auckland launch audience.

More compelling numbers

Of the 30-plus practice owners and managers at the

Auckland launch, all the ones NZ Optics’ spoke too

were having the same frustrations and were keen to

provide an easy and effective online booking service

to their current practice management systems. Many

Klaus Bartosch presenting at the Auckland launch

Klaus Bartosch, MD of MyHealth1st platform, and Visualeyez director Craig

Robertson at the Auckland launch

signed up on the night.

Bartosch, quoting from an international survey, says

these frustrations are common among consumers,

with 90% saying they wanted to use digital channels

to manage their healthcare, 88% preferring digital

reminders and a worrying 37% who switched

providers to ones who offered online appointments.

Using an online booking and engagement platform

like MyHealth1st allows you to convert your website

and social media traffic into booked appointments,

24/7, says Bartosch. To date, the average return

on investment for practices which have joined

MyHealth1st’s booking and patient recall service

is A$5,000 to A$20,000 a month per practice, with

an average 41% of bookings being new patients,

according to the ASX-listed company’s own data.

Other services

As well as its patient online booking and EasyRecall

services, 1stGroup will also be rolling out its

EasyFeedback service, allowing patients to engage

more easily with the practice and let it know how it’s

performed and what it can do better. The company

also runs a free, optional contact lens service,

designed to encourage more patients to consider

contact lenses as an option. On average, those

practices which have opted in to the contact lens addon

are having 20% more discussions about contact

lenses, says Bartosch, 62% of which are converted

into contact lens sales.

As in Australia, 1stGroup also intends to launch

a MyHealth1st portal in New Zealand in June or

July, which acts as an independent online directory

to drive consumers to your practice, says Bartosch.

Once a consumer selects and books with a practice,

however, those consumers won’t see any competitor

practices when they decide to sort out their next

booking, just the first practice they booked with, and

complimentary local healthcare service providers,

such as dentists or GPs, until they’ve built up a group

of their preferred suppliers and can then use the

portal to book all their health requirements online,

whatever the time of day or night, he explains.

The pitch

Given the way the internet is changing the way we

do business, you can’t just sit idly by, Bartosch tells

his audience. “Here we are, in the age of the internet

and yet nearly all of us still require patients to pick

up a telephone in business hours to do something as

simple as book an appointment… Can you imagine

booking hotels like we used to… looking for a job,

browsing for a home?

“The way we do business is changing, whether we

like it or not. We can’t stop it. The question is how are

you going to engage

with it, leverage

it, get ahead of

the curve and do

it, before others

do!” ▀

Focus on Business

sponsored by

Independent spirit, collective strength

FOCUS Too small ON BUSINESS for

How

independent

to become

advice?

a better

BY DAVID PEARSON*

independent

the optical sector assume that

Many small business owners in

company boards are for the big

boys, yet the BY benefits JANE SMITH* of independent

directors or advisors apply to all businesses,

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provide access to a broader base of skills

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THE INDEPENDENT OPTOMETRY GROUP, PROVIDING

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ADVICE

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AND SERVICE INDEPENDENTS NEED TO THRIVE.

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THE INDEPENDENT OPTOMETRY GROUP, PROVIDING THE ADVICE

The To find AND Independent out SERVICE more contact Optometry INDEPENDENTS Neil Group, Human NEED providing on 0210 TO THRIVE. 292 the 8683 advice

and service or neil.human@iogroup.co.nz

independents need to thrive

To find out more contact Neil Human On 0210 292 8683

To find out more contact Neil or neil.human@iogroup.co.nz

Human on 0210 292 8683 or neil.human@iogroup.co.nz

April 2018 NEW ZEALAND OPTICS

14 NEW ZEALAND OPTICS April 2018

that is the case, it is still worthwhile having

an external advisor. That person will be an

advisor to the board and still participate

in discussions, but will not be a formal

director, and they can carefully define the

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boundary over which they will not cross so

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that they do not become deemed a director.

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In the current competitive environment,

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businesses need to take extra steps to gain

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market share or improved margin. A person

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quidendistem to your business ut quianduntem advisers – accountants quunt. and

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Once you have found the appropriate

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and given sufficient material to properly

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understand your business, your part of

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the industry and the market environment.

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They need to know what the problems and

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change from the way you have previously

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operated and should result in a significant

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improvement to the way the business

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operates and its performance as a whole.

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Um About facimusam the author la doluptatum quae. Erspe

sandae *David Pearson ex estiores is managing pa dollitiuste partner of pro chartered quaturiat

ellaut accountants alit et and dolore business ni doluptatiur? advisors BDO Central Osamus and

arciant. has a speciality Um facimusam interest in advisory la doluptatum services to quae. the

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He

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has extensive

experience

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assisting both

small and medium

About sized the entities Author

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dolo etur range re omnihilique of advisory

pa voloreptat. services. Caes For que se

nihiliquodi more information

bea sequatur?

Atio. Lorrovidia contact David peliquamus at

utenderat david.pearson@

enimpore

exerorepuda bdo.co.nz parum or visit re id

quidi www.bdo.nz

distr? Atio. Lorrovidia

peliquamus utenderat

enimpore exerorepuda

23


Style-Eyes

A unique way to sell more

Tapping into the ‘pop-up’ phenomena

BY RENEE LUNDER*

Commerce has rapidly changed over the past

decade and the optometry game is not

immune. Today, many customers begin their

eyewear search online rather than in traditional

storefronts, especially when it comes to the

younger generation. Social media plays a huge part

in their buying decisions too.

To ensure you’re adequately tapping into this

burgeoning market, here’s an interesting and yet

innovative way you may not have considered to

help you increase your revenue.

Why try a pop-up?

hold too much merchandise. People understand

the exclusivity of a pop-up so don’t expect you to

have more than one of anything!

Fashion update

Jono Hennessey

The latest releases from Jono Limited Edition includes the 2018

Liberty of London fabric collection, transformed using Hennessy’s

unique technique of fabric lamination to create these beautiful

new models. Both are available in three different colours

featuring Liberty’s classic paisleys and garden-inspired designs,

including gold detailing. Distributed by Phoenix Eyewear.

Ogi Eyewear

Neubau

Ogi’s latest releases are a continuation of the brand’s statementmaking

styles and bold colour options. The masculine, larger

frame is designed with marbled acetate and accented with

subtle stainless-steel temple detailing, and is “ultra-wearable,”

said the company. While the delicate, cat-eye silhouette of the

other model, pictured here, is available in subdued pastels, with

transparent touches of acetate in a primarily translucent frame,

making it beautifully balanced. Distributed by BTP DesigNZ.

A glimpse of the future was on display this year at Neubau’s MIDO

stand, where the company launched its new 3D-printed frames.

The 3D printing process allows for exceptionally precise detailing,

environmentally sustainable production and the highest standards of

quality, said the company, for example, fine details and textures appear

like engravings, all of which would be hard to achieve in conventional

manufacturing. Neubau’s 3D models will be available from April in

seven striking colour finishes combined with stainless steel in gold,

silver, rose, black ink and black ink matte. Distributed by Euro-Optics.

Carter Bond

Also by Jono Hennessy, Carter Bond’s new luxury vintage collections include

this lightweight stainless-steel

frame; classic and stylish, it’s

available in matt and shiny

finishes. Distributed by

Phoenix Eyewear.

At its most basic level, a pop-up is a small, physical

store with an expiry date – think temporary, not

permanent. There are many options when it comes

to running one, but the most common is a standalone

pop-up at an event such as a farmers’ or crafts’

market, or perhaps it’s a way of using a vacant

tenancy space within a shopping centre to attract

new customers.

There are many varieties on the pop-up theme,

such as a collaboration with another store (where

you take over a small space within their store and

you both benefit from increased traffic); a kiosk

or booth at a shopping centre or along a busy

shopping strip; or align yourself with a specific space

or event such as an art gallery or trade show. The

possibilities are only limited by your imagination

and resourcefulness. For example, an interesting

collaboration might be with a local bookstore. After

all, bookworms often wear glasses!

Each space

has its own

pros and

cons but

the good

usually

outweighs

the bad.

The major

benefit of

a pop-up

means you

get to target a whole new selection of customers,

many of whom may not even know you exist!

Depending on the pop-up location, the foot traffic

can be considerable and you may also be a novelty

attraction (an optometrist selling their wares at a say,

craft market) and pull a bigger crowd.

One further tip, is to try to pick a location close to

your physical store, or within reasonable traveling

distance, should customers need an eye test and

updated prescription for their new glasses. Or

perhaps consider taking the whole kit and caboodle

to them, like US-based Warby+Parker has done

with its mobile optometry store bus or, closer to

home, Auckland-based EyeLove EyeCare’s mobile

optometrist service for rest homes.

A great way to test the waters

A pop-up can help you move old stock, but it may

be an even better way to test out a new brand or

concept. Perhaps you’ve always had a penchant for

funky eyewear or custom work, but never taken the

plunge because it’s too risky for your bricks-andmortar

store. A pop-up gives you the chance to try

it out.

You can do small orders of new stock – be it

outrageous, one-offs or bespoke – and also keep

up to date with what’s on trend without having to

Be brave with your pop-up merchandise (Face à Face and Silhouette)

Furthermore, by its very nature, a pop-up is not

forever. Some are just for one day, at an event of

you choosing, so the cost outlay can be kept to a

minimum. Others may require more investment

with a 30 or 60-day lease for retail space, for

example.

Whatever avenue you pick, at the end of the

exercise, it makes business sense to review success

based on foot traffic, how long customers spent

looking at particular products, sales conversion

rates and general feedback and follow-up from

clients. Compare this to your traditional storefront

and online sales too (if you have them) to

determine viability.

Support pop-ups with social media

If you like

the sound of

a pop-up, it’s

important

to realise

its success

relies on a

thorough

social media

campaign

launched Support your pop-up venture with social media

before it,

run alongside it and maintained after it. While this

may sound a little daunting or labour-intensive,

pop-ups really are a fantastic way to generate

social buzz, increase your brand awareness and

bring more traffic to your website and physical

store (especially if there’s a competition or discount

voucher attached to them!).

Like many of us, you may find yourself completely

stuck when it comes to social media. To combat

this, considering hiring a student – with or without

optometry experience – for a few hours a week

to run the campaign for you. A further option

is to do some research online about how to run

a successful social media campaign. There’s a

plethora of blog posts and articles on this verypopular

topic. Another great recourse is to get your

kids to do it (or a well-loved niece or nephew)!

Should you decide to go ahead with a pop-up,

start your social media campaign early to build

up anticipation. Flog the pop-up on all your social

media channels (Facebook, Snapchat, Instagram

and Twitter). Don’t have those? You should get

them set up as they are important, especially if you

want to capture the youth market.

Lastly, it doesn’t hurt to advertise your pop-up

using more traditional methods such as direct

flyers, local papers and word-of-mouth in your

store too.

So go on, give it a pop-up!

*Renee Lunder is an Australian freelance journalist and proud

specs wearer. “They are as much a part of me as my limbs! My

children have only ever known me with them. I wouldn’t be ‘Mum’

without them!”

Vanni

Pantone’s annual celebration of colour, nominated ‘ultraviolet’ as

the colour of the year, something Italian frame maker Vanni picked

up as a challenge. The ultraviolet that rages on the catwalks and

among the 2018 accessory collections is a colour that is both for

the strong and more peaceful hearted, said the company. “We think

that violet is an unconventional colour that gives a vibrant and

interesting look.” The Vanni violet is streaked into the acetates of its

Monochromo collection and used as “assertive” block colour in its

Colours range. Distributed by Little Peach.

Coco Song

Coco Song’s new collection introduced at Mido is a tribute to

faraway cultures with beautiful colours and dreamy detailing.

The Sunset Horizon model featured here has a delicate

feather on silk between the acetate layers of the

frame front and temples, creating incredible colour

contrasts, with semi-precious stones inserted in the

enamelled metal profiles. Available direct.

Stars and their Eyes…

Ella Fitzgerald

The first lady of song, Ella Fitzgerald was

one of the most prolific jazz recording

artists of all time. She began her sixdecade

career when she was just 16 years

of age. Fitzgerald was famous for her scat

improvisation and her almost three-octave

range. Throughout her career she

won 13 Grammy awards (more

than any other jazz musician) and

was awarded honorary doctorates,

from Yale and Dartmouth, and the

National Medal of Arts.

Fitzgerald, however, had type

II diabetes which had a massive

impact on her life, causing vascular

problems, congestive heart failure

and eventually leg amputation. From

the early 1970s, when Fitzgerald was

in her 50s, she began to have vision

problems from advanced diabetic

retinopathy, leading to severe vision

problems from her late 60s.

AC/DC

AC/DC and Vinylize launched the

loudest eyewear collection ever at

Vision Expo East, New York in March, presenting three

different optical frames in three sizes and three sunglass

models made from the vinyl of the multi-platinum album

‘Back in Black’ records themselves. Model Hell, featured

here, is named after “Hell’s Bells” the first track on side A

– an absolute must for AC/DC fans! Available direct.

A shy woman, who was very sensitive to

criticism, she spent her last years in the garden

of her Beverly Hills mansion in a wheelchair with

her son and granddaughter. “I just want to smell

the air, listen to the birds and hear Alice laugh,”

she said. She died, aged 79 in 1996.

24 NEW ZEALAND OPTICS April 2018


Bellinger returns to NZ

New Zealand frame distributor Euro Optics has

added Danish brand Bellinger to its portfolio.

Carl Doherty, Euro Optics’ managing director,

says Bellinger is already a familiar brand among

high-end independent eyecare professionals and is

well-established in Europe and North America.

Some New Zealand practices used to stock

Bellinger in the past when a previous distributor

was selling it, explains Doherty. “We liked the new

Bellinger collections and saw an opportunity to

re-launch this well-respected brand back into the

New Zealand market.”

Feedback received from customers so far has

been extremely positive, he says. “Bellinger is a

top-quality product that prides itself on being

different and special. The acetate mixes that

Bellinger uses are unique. They add extra textures

to the acetate.”

For example, some frames have a small amount

of glitter mixed into the acetate, says Doherty,

through a production technique not that dissimilar

to making candy. “The acetate is made of cotton

mixed with acetone and alcohol forming a

homogeneous dough. It’s filtered, kneaded, heated

and finally pushed into large blocks; only then, the

creative work with Bellinger techniques begins.”

The most amazing effects are obtained by

mixing, heating and twisting up to five different

types of acetate together until the desired effect is

achieved, he adds.

Innovative Mido trends

Mido is to eyewear,

what Oscar night is to

cinema,” said Giovanni

Vitaloni, Mido president at this

year’s event in Milan.

Organisers said the 48th

Mido event this year welcomed

more than 58,000 eyewear

professionals and 1,305 exhibitors

across three days to seven

pavilions, showcasing eyewear,

technology and new innovations,

the latter being the theme of

this year’s event. Mido organisers

noted a strong increase in foreign

attendees, resulting in a 4.9%

increase in overall attendance and

5% in the exhibitor space.

Phoenix Eyewear’s Mark

Collman, a veteran of 21 Midos,

said this year’s fair certainly delivered. “In typical

Italian style, especially during Milan fashion

Bellinger back in New Zealand

Bellinger’s latest range is now available from Euro

Optics. ▀

Mark Collman and Phillip Wilson with Robert Morris of William Morris (centre) at Mido

week, the event was full of immaculately dressed

locals, oceans of espresso and prosecco, gorgeous

promo girls, lavish stands plus the

occasional sneaky pick pocket.”

When queried about the latest

trends, both Collman and his

colleague Phillip Wilson agreed

it’s clear the double bridge metal

aviator is back with a vengeance

both for men and women. Metal

frames were also once again

at the forefront of many of the

new optical collections, which

the Phoenix team thought was

interesting as metal frames have

long been a great seller in New

Zealand and growing still. For

all lovers of colourful acetates,

however, it’s not all gloom as

Collman and Wilson said plastic still

pretty much dominates the fashion

scene, many in large 70s and 80s

inspired oversized looks.

“I honestly feel that after a couple

of flat years this year’s vibe was the

most optimistic and positive I have

experienced in recent times,” said

Collman. “Everyone we came across

supplying the independent eyewear

sector were really busy and in great

shape which has to be good for the

future!” ▀

CPD for NZ DOs at AVC

A

comprehensive

dispensers’

education programme, with

CPD points for accredited Kiwi

dispensing opticians, will run alongside the

optometrists’ programme for the first time

at the Australian Vision Convention (AVC) in

Brisbane, Queensland from 7–8 April, 2018.

Supported by AVC sponsor Rodenstock,

the inaugural Dispenser Programme features five

sessions on the latest lens technologies, patient

communication strategies and advantages of

premium lenses:

• Resolving non-tolerance issues with digital

lenses – Nicola Peaper, sales and professional

services manager, Rodenstock

• The digital world needs digital lenses, not

progressives – Steven Daras, course coordinator,

optical dispensing, TAFE

• Wham, Bam, Pow. How position

of wear measurements will knock your

patients out – Leigh Robinson, Consultant

and Training Facilitator, Spectrum Optical

• Dispensing to enhance sports

performance – Helen Venturato,

optometrist and principal consultant at

Helen Venturato Consulting

• Complex cases and compensated

values – Grant Hannaford, adjunct senior lecturer at

School of Optometry and Vision Science, UNSW and

director, Academy of Advanced Ophthalmic Optics

The programme runs from 10.45am to 3.15pm

on Sunday 8 April and has been accredited for

Kiwi dispensing optician attendees with 2.5 CPD

points. For more or to register, please visit: https://

oa.optometry.org.au. ▀

Essilor Transitions’ prize

draw

A

patient

from Noel Templeton’s

Marlborough Optical practice is the first

to win one of three patient prize trips to

Fiji, courtesy of Essilor New Zealand’s Transitions

promotion.

All patients from Essilor-partner independent

optometrists who purchase Transition lenses

from 1 February until 30 April are eligible to enter

one of three-monthly draws to win a three-night

package at the Sofitel Fiji Resort on Denarau

Island. The draws take place on the 9th of March,

April and May, with an independent guest asked

to make the draw on Essilor’s behalf. This month,

the drawee was none other than NZ Optics’ own

editor Lesley Springall. There’s also an additional

draw in April for practice eye care professionals,

linked to their Transition lens sales.

Each prize package includes economy return

flights for two people to Nadi from Auckland,

Wellington or Christchurch, and shared

accommodation at the Sofitel Fiji Resort. Draw

Essilor’s Chris Aldous with NZ Optics’ Lesley Springall who was invited

to draw the first prize winner in the Transitions Fiji promotion

One closed on 28 February; draw two closes on

31 March; and draw three closes on 30 April

2018. Entry is open to all New Zealand residents

purchasing Transitions Lenses from selected

independent optometrists in New Zealand

and limited to one entry per person per pair of

Transitions lenses sold.

0800 573 224

April 2018

NEW ZEALAND OPTICS

25


The power at our finger tips…

by

Chalkeyes

“Red sky in the morning, shepherds warning.

Red sky at night, shepherds delight.”

The Mavis Beacon Teaches Typing software had me type this over

and over. We had just decided that we were going to ditch paper and

use our practice management system for clinical records too.

Until now we had only used our system for recording dispensing

details, generating lens orders and doing the billing, so this was a

big move for us. Our major concern was losing the data when the

system went down. Should we do an interim period of recording

everything twice? One hard copy and one soft copy? Do automatic

backups really work?

Paper records were real! Even if they were lost to misfiling at least

one patient a day; and how the hell did you figure a system for

filing Scottish surnames? Then there was handwriting, of course. I

couldn’t really blame my colleagues because I couldn’t even read my

own in the end. But it wasn’t until the system did go down that we

fully appreciated digital records. They could be re-birthed; emerging

from the panic like nothing had ever happened.

THE

EVENT

SEPT. 28 TH

OCT. 1 ST

2018

Digital record cards are normal now, as are

those awkward silences when the healthcare

practitioner turns their attention, and usually

their backs, away from us to write something up.

A mutually disagreeable experience! Both the

record and the personal interaction suffer. There

are not too many practitioners of my generation

(and this Chalkeyes has been around for a while)

or older, that have ever really adapted. The records

show this very clearly.

Compare, if you will, the oldest optometrist in

your practice’s notes with the youngest. Many

records are not to standard with the notes very

brief and incomplete – not really an accurate or

complete record of what was examined and how

the patient responded. At the end of the day, how

can you do both in such a limited time?

A complex case was referred to me recently

and the accompanying information was a fax of

a handwritten card. It was almost completely

indecipherable. Once my recoil wore off and I was

able to work it out I was immediately struck by

how much information had been recorded on that messy page, in

abbreviations, ticks, scribbles and sketches. I’ll bet it was all done

while chatting to the patient too. We have definitely lost something

going digital!

But there is also lots to be gained if we could just have better

systems that work for us and our patients, and if they were

compatible with each other.

I have, at one time or another, had the opportunity to look at all

the available digital record systems used in New Zealand. Some

practitioners are definitely better at recording than others, maybe

it’s Mavis Beacon, but then maybe it’s talking to the patient instead

of pecking at their keyboard with their backs turned.

The last decade has been transformative in eyecare. The

technology that is now found in most practices is mind boggling

compared with when I started out! Automated perimetry and

digital fundus imaging is an expectation. Even OCT today is almost

normal. Widefield confocal images are also becoming standard

as are topography, digital eye charts and many other things.

Modern optometrists are able to get a very good idea of what is

going on in and behind our patients’ eyes. Yet, typically, all of this

technology runs on its own separate databases – I use seven – on

different platforms and all of it poorly integrates with the practice

management system, digital or written.

I am sure this is not just a Kiwi thing. American practice

management advice recommends having a “scribe” in your

consulting room to record your results. I suppose you would mumble

your findings as you go along for them to record on a laptop.

Personally, I don’t think I’d like doing that very much!

All the practice management systems on the market today have

strengths and weaknesses, but are all ultimately similar. Our

practice uses the Sunix Vision system, written in Foxpro. A Microsoft

product that has been unsupported by them since 2007, written for

the IT environment of the 1980s and ‘90s. A heritage application

that surely can’t have much more to offer for the future. Although

it is totally inadequate, it is familiar and no worse than the other

systems when you look at the big picture.

We use many hacks to get it to work better for us. We import

clinical images, once they’ve been zoomed and manipulated to

highlight the detail we try to record, via the windows clipboard

into Microsoft Paint, to attach them to patient’s files. We have to

remember to record pinhole acuities on referral letters because

that field can’t be transferred and contact lens orders are treated as

consultations, which is just downright obstructive. And that’s just a

few of the things I find frustrating about just our system!

It’s hard not to get a little sad about all this. It’s a major

opportunity that is being missed. We all use databases that record

findings from a diversity of people of different ages and stages, from

all walks of life and in all sorts of states of health. We record notes

on the same findings, using the same techniques in very much the

same way, albeit that the specifics are a little loose. Imagine if this

data could be anonymised and pooled. What learnings are hidden in

those little boxes on our screens; across all our patients from across

the country, or even the world!

We’ve got the gadgets, now let’s get the software. Surely it can

be better that this! The current providers seem complacent and are

unlikely to cannibalize their own market share to disrupt things. The

“new cloud system” by Sunix seems to have burned off. It is time for

better, surely! Is our industry too small? Are we too difficult?

This Chalkeyes would like to challenge someone from all those

competing software providers to do better, to share better, to really

make a difference for individual practices and, in-turn, the wider eye

health world to better record and share our data. Now wouldn’t that

be a technological advance worth talking about!

In the meantime, I better keep practicing my typing…

“Red sky in the morning, shepherds warning.

Red sky at night, shepherds delight.”

MORE CLASSIFIEDS ON PAGE 28

For all your optical and ophthalmic needs

nzowa.org.nz

Refer your low vision patients to Naomi Meltzer,

optometrist specialising in low vision rehabilitation.

For appointments and information

low vision

services

Phone (09) 520 5208 or 0800 555 546 Email info@lowvisionservices.nz

www.lowvisionservices.nz

Oasis spa open for business

Auckland Eye’s new Oasis Spa, premium

dry eye treatment facility, has opened for

business.

Patients referred to the new Oasis Spa or those

simply seeking help for dry and itchy eyes, will

be given a full clinical evaluation of the likely

causes of their eye irritation and a tailored

treatment plan, in what Auckland Eye says is “a

luxurious, relaxing environment.”

Traditional approaches to dry eye, such as

lid margin hygiene, topical lubricants and

antibiotics or steroids, for example, only help

a percentage of patients, whereas a tailoredtreatment

approach, undertaken at the spa,

should help far more patients, both with efficacy

and compliance, explained Auckland Eye’s Dr

Dean Corbett. “The Spa is a means to provide a

more complete service to our eye patients.”

The quality of a patient’s tears and tear film

and the health of their meibomian glands will

all be assessed. Treatments include Lipiflow

and Lumenis’ Optima intense pulsed light (IPL)

technology, often in the comfort of the spa’s

massage chairs.

Though the Oasis Spa has only been open for a few weeks, and

Auckland Eye isn’t going to begin marketing it more widely until it

has had an opportunity to assess what works best, the team have

already received positive feedback about the equipment, treatments

and staff skills, said Dr Corbett.

There are also plans to expand the spa’s offerings to treat rosacea

and possibly some other cosmetic conditions, he added. ▀

Auckland Eye’s Oasis Spa, a

luxurious take on eye care

26 NEW ZEALAND OPTICS April 2018


PUT DOWN YOUR

ROOTS IN REGIONAL NZ

PERMANENT ROLES IN YOUR CHOICE OF REGIONAL LOCATION

Multiple opportunities available across both the North and South Islands to suit your career aspirations

Specsavers’ growing New Zealand store network offers a variety of roles catering

to different development needs and are available for optometrists at all stages of

their career.

Joining one of our regional New Zealand stores provides an ideal opportunity to

firmly establish yourself within a community while progressing your clinical skills.

You will be equipped with the latest ophthalmic equipment and presented with

a range of interesting conditions across a high-volume patient base – all with the

support of an experienced dispensing and pre-testing team, the mentorship of the

store partners, and access to an exemplary professional development program.

Or if you’re ready to move into practice ownership, our regional New Zealand stores

present an attractive business venture. With average annual sales running at $2.4

million per store, and Support Office training and assistance available every step of

the way, there’s no better time to uncover the leader within you.

Ask us about the opportunities we have waiting for you – contact Chris Rickard

on 027 579 5499 or via chris.rickard@specsavers.com

VIEW ALL THE OPPORTUNITIES AVAILABLE ON SPECTRUM-ANZ.COM

Voted by New Zealanders

Reader’s Digest

Quality Service

Award

2017

Best Talent

Development

Program

2017

Best Customer

Service in NZ

Optometry

2017

Millward Brown

Research

No.1 for eye tests

2016

Excellence in

Marketing

Award

2016

Retail

Store Design

Award

2016

Retail

Employer

of the Year

2015

Overall

National

Supreme Winner

2015

Franchise

Innovation

Award

2015

NZ Franchise

System of

the Year

2014

Retail

Innovator

of the Year

2014

April 2018

NEW ZEALAND OPTICS

27


To advertise in NZ Optics’ classified pages

contact: Susanne Bradley at susanne@nzoptics.co.nz

OPTOMETRIST / PALMERSTON NORTH

Our client provides leading edge eyecare services seven days per

week and is seeking to employ an additional full-time Optometrist

from June 2018 or sooner.

The successful candidate will be sharing a monthly roster with

three other full-time Optometrists. The equipment is superb, the

wider team are all highly experienced.

Salary level is $125k for the right candidate, subject to experience.

There is also an opportunity (long term) to purchase a shareholding

in the business.

If this sparks your interest, please contact Stu Allan at OpticsNZ

(confidentiality assured). Applications for this position close at

5pm, Wednesday 18 April 2018.

OpticsNZ, PO Box 1300, Nelson or

Tel (03) 5466 996 or 027 436 9091 or email stu@opticsnz.co.nz

DESIGNER FRAMES FOR SALE

Spectacle frame inventory for sale. Designer frames offered at

below wholesale prices. Prefer to sell entire lot to single buyer.

Fendi, Marchon, Flexon, Coach, Calvin Klein etc. About 350 in total.

Please contact seller at tyghbn73@gmail.com or 0210483139

DUNEDIN PRACTICE FOR SALE

If you are looking for your first practice or wish to add scale to

existing operations, this long-standing and very well-run practice,

which is showing impressive performance, could be the answer.

Enquiries welcome to Stuart Allan at OpticsNZ, Tel (03) 5466 996,

027 436 9091 or stu@opticsnz.co.nz

PART-TIME DISPENSER/

OPTICAL CONSULTANT

1-2 week-days per week plus 2-3 Saturdays

per month.

Hours: 10 -5.30pm week days, 10 -5pm Saturdays

Hourly rate $25-40 depending on experience

Become part of the team at Parker & Co, Newmarket, Auckland, selling

fabulous eyewear. You will be working with a small team of experienced

consultants/Dispensers and Optometrist who love eyewear and

helping people to find the perfect fit of eyewear and lenses.

We are not a chain, we don’t pressure sell. We love what we do, and

we need someone to join the team. If you have two or more years

experience in the industry and this sounds like you please email

lynne@parkerandco.nz

OPTOMETRIST / HASTINGS /

SUNNY HAWKES BAY

Our client provides leading edge eye care services seven days per

week and is seeking to employ an additional full-time Optometrist

from May 2018 or sooner.

The successful candidate will be sharing a monthly roster with two

other highly experienced full-time Optometrists. The equipment is

superb and the wider team are all highly experienced as well.

Salary level is $125k for the right candidate, subject to experience.

There is also an opportunity (long term) to purchase a shareholding

in the business.

If this sparks your interest, please contact Stu Allan at OpticsNZ

(confidentiality assured). Applications for this position close at 5pm,

Wednesday 18 April 2018.

OpticsNZ, PO Box 1300, Nelson or

Tel (03) 5466 996 or 027 436 9091 or email

stu@opticsnz.co.nz

OPTOMETRIST

HAMILTON

Paterson Burn Optometrists

are currently looking for a passionate TPA endorsed Optometrist to

join our team.

Working with Paterson Burn Optometrists will offer you the ability

to develop your clinical skills to full potential and the opportunity

to specialise in your desired field. You will have the ability to work

independently and, with fourteen other optometrists in the group,

you will be part of a larger group of highly qualified, experienced

and dedicated optometrists.

Our Optometrists have special interests in Low Vision, Children’s

Vision, Ortho K, Specialised contact lens fits, Dry eye and Irlen

lenses. You will also have the opportunity to meet regularly for

peer review sessions while gaining CE points within our practice.

As an Optometrist with Paterson Burn Optometrists you will be

able to provide exceptional patient care with access to the most up

to date technology and state of the art equipment (OCT, Corneal

Topographer, Medmont VFA’s, IPL etc).

This position is for 4-5 days per week, including some Saturdays.

If this sounds like you, please send your CV with a covering letter to

sandri@patersonburn.co.nz

OPTOMETRIST

NEW PLYMOUTH

We are looking for an experience TPA qualified, full-time

Optometrist to join our team at Browning & (Matthews), New

Plymouth. This is a busy, well equipped practice with a great

support team.

Please contact Michelle Diez on 027 246 7499 or email

michelle.diez@matthews.co.nz

DREAM OF

TRAVELLING

Have you ever wanted to travel NZ? Do you like

flexibility and crave variety? OPSM New Zealand is

looking to expand its relief team with a combination

of area and regional floats. As a float you will be

exposed to lots of different patients and locations

across New Zealand. We are looking for Optometrists

who share our passion, and want to join our customer

focussed teams in making a difference to how people

see the world.

We are looking for optometry floats in these

key locations:

• GREATER WELLINGTON AREA

• AUCKLAND & WAIKATO AREA

• NATIONAL (NZ WIDE) REGION

Alternatively OPSM NZ is also on the lookout for locums

willing to service the Wellington, Bay of Plenty and

Waikato regions.

JOIN OUR TEAM

If interested in joining our fun loving team, please contact

Jonathan Payne

Jonathan.Payne@opsm.co.nz or call 021 195 3549

OPSM.CO.NZ/CAREERS

READY FOR

A CHANGE?

When you join OPSM, you work within a team who are

committed to providing the best possible eyecare solution

with exceptional customer service. You will work with world

class technology and have many opportunities for professional

development. You can also make a real difference in the

way people see the world by participating in our OneSight

outreach program. OPSM New Zealand is looking for

passionate Optometrists to join the team in these locations:

THAMES

Located on the doorstep of the Coromandel, Thames is

a gateway to outdoor adventures and fantastic beaches.

An opportunity has arisen for a full time optometrist to

join an amazing team in our community based store with

interesting and appreciative clientele. Only 1 hour outside

of South Auckland, Thames is close enough to enjoy the

big city, without the traffic or house prices!

MT MAUNGANUI

Why visit this holiday hot spot when you can live there!

Our brand new Mt Maunganui store is looking for a fresh

optometrist eager to grow with the store. Located only 800

meters from the beach, with relaxed easy going clientele.

If you are seeking for a great mix of work and play,

whether its surfing or just relaxing at the beach –

“The Mount” is the ultimate summer destination.

LOWER HUTT

A rare vacancy has arisen in our much sort after Lower

Hutt practice. We are currently looking to expand our

energetic and vibrant team. Only 15 minutes from the

capital, Lower Hutt is close enough to enjoy the sport,

culture and cuisine that central Wellington has to offer.

JOIN OUR TEAM

If you are interested to find out more about joining the

team, contact Jonathan Payne for a confidential chat.

jonathan.payne@opsm.co.nz or call 021 195 3549

OPSM.CO.NZ/CAREERS

28 NEW ZEALAND OPTICS April 2018

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