April 2018

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PO BOX 106 954, AUCKLAND CITY 1143<br />

APRIL <strong>2018</strong><br />

Email: info@nzoptics.co.nz Website: www.nzoptics.co.nz<br />




1st Floor, Entrance B, 31-35 Carbine Rd<br />

Mt Wellington, Auckland 1060<br />

Phone 0800 SHAMIR<br />

New Zealand Account Manager<br />

Francois Cronje 021 449 819<br />


<strong>2018</strong> • Voted by New Zealanders • <strong>2018</strong><br />




At Specsavers we are focussed on providing the highest<br />

levels of optometry and dispensing care in all our New<br />

Zealand and Australian stores.<br />

Our equipment and technology strategies, our close working relationships<br />

with ophthalmology and various eye disease stakeholders alongside our<br />

major investments into dispensing qualifications all contribute to a singular<br />

purpose – to transform the eye health of New Zealanders and Australians.<br />

So, if you’re concerned at the 50 per cent undiagnosed glaucoma cohort<br />

and the under-indexing of diabetic retinopathy screenings; if you’re worried<br />

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

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

professional dispensing programs and technology – then we urge you to<br />

talk to us about how you can make a genuine impact at Specsavers.<br />

We’re on a clear mission to transform eye health in New Zealand and<br />

Australia – and we’d like you to join us on that mission.<br />

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

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

Reader’s<br />

Digest<br />

Quality Service<br />

Award<br />

<strong>2018</strong> • Voted by Australians • <strong>2018</strong><br />

Reader’s<br />

Digest<br />

Quality Service<br />

Award<br />

AITD<br />

Voted by New Zealanders<br />

Reader’s Digest<br />

Quality Service<br />

Award<br />

2017<br />

Best Customer<br />

Service in AU<br />

Optometry<br />

<strong>2018</strong><br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

2017<br />

Millward Brown<br />

Research<br />

No.1 for eye tests<br />

2016<br />

Excellence in<br />

Marketing<br />

Award<br />

2016<br />

Retail<br />

Store Design<br />

Award<br />

2016<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

<strong>2018</strong> Transforming eye health<br />

2 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

Oculo rolls out in NZ<br />

Oculo says it will now be rolling out its cloud-based secure<br />

messaging and clinical communication software, designed<br />

to better connect optometrists and ophthalmologists, in<br />

New Zealand over the next few of months.<br />

The launch will be kicked-off through Oculo’s agreement with<br />

Specsavers, which has signed a multi-year commitment to use<br />

Oculo on both sides of the Tasman. But Oculo is keen to sign up<br />

as many optometrists and ophthalmologists to its technology as<br />

possible to enable consistency in the quantity and quality of data<br />

shared.<br />

Oculo’s software provides a secure, online system for<br />

optometrists to identify ophthalmologists with particular<br />

specialities and to safely share clinical records, including patient<br />

data, photos and scans for referrals. The system was the brainchild<br />

of Professor Jonathan Crowston, managing director of the Centre<br />

for Eye Research Australia (CERA), and Peter Larsen, director of CERA<br />

and Specsavers optometry director. It was spun out from CERA as a<br />

standalone company in 2015.<br />

The Australian roll-out began in <strong>April</strong> 2016 and it’s now employed<br />

by more than 1,700 optometrists and 440 ophthalmologists,<br />

managing over 200,000 patients across Australia. An agreement<br />

with Glaucoma Australia last year also allows eye care professionals<br />

to refer patients directly to the charity for help and support.<br />

“Oculo is a fundamental component of our ability to measure<br />

clinical activity and outcomes,” said Larsen. “Through Oculo, we<br />

can access data on detection, referral and diagnosis rates to further<br />

improve clinical standards and contribute to transforming eye<br />

health in Australia and New Zealand. For example, Specsavers-wide<br />

Oculo screen shot<br />

Oculo data will<br />

provide us with<br />

the evidencebase<br />

to show<br />

how we are<br />

closing the gap<br />

on undiagnosed<br />

glaucoma in<br />

Australia and<br />

New Zealand.<br />

That sort of<br />

information<br />

has not been<br />

available before<br />

and helps not<br />

just us and our<br />

optometrists, but<br />

also government<br />

and other health<br />

stakeholders.<br />

It adds value<br />

because it allows<br />

us to specify the<br />

Oculo’s Dr Kate Taylor and Specsavers’ Peter Larsen<br />

impact we are<br />

making on patient wellbeing.”<br />

“There is so much innovation in eye care – the technologies<br />

available for diagnosis and management are really exciting,” said<br />

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

to use technology to enhance clinical communication so that<br />

practitioners can share digital information to increase the quality<br />

and efficiency of patient care.”<br />

Background<br />

Oculo was developed by CERA, a not-for-profit medical research<br />

institute based at the Royal Victorian Eye and Ear Hospital (RVEEH)<br />

in Melbourne, in collaboration with Specsavers, OPSM, and Bupa<br />

Optical. Its aim is to promote the efficiency and quality of clinical<br />

communications to support collaboration to improve eye care; to<br />

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

company’s launch back in 2016. “The team has invested thousands<br />

of hours to develop privacy and data security controls that mean<br />

that correspondence by Oculo is indeed better than a letter, and<br />

so much more. It has intelligent prompts and other features to<br />

enhance the quality of referrals and to create a shared eye e-health<br />

record.”<br />

Oculo’s major shareholders are CERA and an angel investor who<br />

had a life-changing intervention at the RVEEH and wanted to give<br />

back. No other individual or corporate involved in optometry or<br />

The hard end of<br />

eye health<br />


This month we are proud to include a handful of dedicated low<br />

vision stories and opinions, including an amusing view from<br />

the dark side (as he calls it) from our wonderful new low vision<br />

columnist, Trevor Plumbly (p6). Some put low vision patients in<br />

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

lots that can be done to help New Zealand’s low vision community<br />

and optometrists, new and experienced, are ideally positioned to<br />

help them lead more fulfilling lives, however bad their vision. One<br />

well-known low vision patient advocate, John Veale, has often been<br />

quoted in NZ Optics’ pages championing this area, saying how<br />

rewarding it is to help people with low vision, especially as their<br />

relatives and friends often choose to become your patients as well.<br />

The major causes of low vision will, of course, be a key topic at this<br />

year’s unmissable RANZCO NZ Branch conference in mid-May, which<br />

once again incorporates parallel meetings for our ophthalmic nurses<br />

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

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

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

visiting. We’ve also got all the happenings from sister conferences<br />

in Australia, past and future, and there’s news about RANZCO’s Eye<br />

Foundation, ORIA and a new worm that’s been found in patients’ eyes<br />

in the little-known Mariana Islands (p10-18).<br />

We also celebrate New Zealands’s hosting of the very well-received<br />

and smoothly organised (well done guys) Retina International world<br />

conference (p21) and the work of our combined School of Optometry<br />

and Vision Science and Department of Ophthalmology’s Summer<br />

students (p20).<br />

Meanwhile Style-Eyes tackles the lighter end of the eye health<br />

spectrum with a look at how pop-up stores could mean extra revenue<br />

and customers for the more entrepreneurial among you, and Chalkeyes<br />

gets his typing in a tizz about the lack of decent, compatible practice<br />

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

1stGroup (p23) might be able to help!<br />

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

cover or you want to comment on anything in NZ Optics. We always<br />

love to hear from you.<br />

Next month: all the happenings from CCLS<br />

NZ, the Ocular Therapeutics Conference<br />

and Excellence in Ophthalmology<br />

Lesley Springall, editor, NZ Optics<br />

ophthalmology has any stake. ▀<br />

0800 55 20 20<br />

First Sanderson<br />

Scholarship<br />

Less than a year after announcing the<br />

establishment of the Gordon Sanderson<br />

Scholarship, Glaucoma New Zealand (GNZ)<br />

has announced its first awardee – Hilary Goh,<br />

a fifth-year medical student for her summer<br />

research project investigating nailfold capillary<br />

abnormalities in glaucoma.<br />

Goh, who undertook her research project within<br />

the Department of Ophthalmology at the University<br />

of Auckland, is one of the top medical students at<br />

the University, said Professor Helen Danesh-Meyer,<br />

chair of GNZ. “She is razor sharp, dedicated and<br />

great with patients. She was a natural fit for the<br />

project as it was very demanding.”<br />

Goh’s project explored whether nailfold capillary<br />

health can be used as a biomarker for glaucoma<br />

progression, based on the hypothesis that glaucoma<br />

involves vascular dysautoregulation, explained Prof<br />

Danesh-Meyer, who was also Goh’s supervisor for<br />

the project. “There is some evidence to support<br />

this from Harvard which demonstrates there is<br />

a difference between the nailfold capillary of<br />

glaucoma patients compared to controls. Hilary’s<br />

project is an extension of this work to see if it<br />

correlates with glaucoma severity and progression.”<br />

Presenting her work at the Auckland Summer<br />

Student Symposium in March (p21), Goh concluded<br />

that primary open angle glaucoma (POAG)<br />

patients did indeed have nailfold capillary (NFC)<br />

abnormalities and abnormal NFC is associated with<br />

increased risk of POAG and more severe visual field<br />

loss. However, more studies were needed as was an<br />

improved capillary grading system, she said.<br />

Prof Danesh-Meyer said GNZ decided to<br />

award the first scholarship this year as they had<br />

received a number of pledges and donations<br />

since announcing the new scholarship in August<br />

last year. The scholarship was set up in honour of<br />

the much-admired Associate Professor Gordon<br />

Sanderson, a founding trustee of GNZ, who died<br />

earlier in the year.<br />

“Gordon was very passionate about GNZ and the<br />

prevention of blindness from glaucoma. He was<br />

Hilary Goh, recipient of the inaugural Gordon Sanderson Scholarship<br />

from Glaucoma New Zealand<br />

a huge advocate for students and relished seeing<br />

students involved in research,” said Prof Danesh-<br />

Meyer. “I know from personal experience that<br />

Gordon always helped provide opportunities to<br />

students to be involved in eye research. I was one<br />

of these students. GNZ is committed to ensuring<br />

his passion for students and research is continued<br />

through this scholarship.”<br />

GNZ will be advertising for applications for<br />

the 2019 scholarship from June this year. The<br />

scholarship is available to medical and optometry<br />

students, ophthalmologists or optometrists<br />

undertaking research or teaching experience in<br />

glaucoma from the Universities of Auckland, Otago<br />

or Sydney as these institutions had close ties with<br />

A/Prof Sanderson.<br />

To find out more or to contribute to the Gordon<br />

Sanderson Scholarship fund, please visit www.<br />

glaucoma.org.nz. ▀<br />

To read more about the 2017-<strong>2018</strong> Summer<br />

student projects, please turn to p21.<br />

www.re.vision.nz<br />

Dr Trevor Gray<br />

<strong>April</strong> <strong>2018</strong> NEW ZEALAND OPTICS<br />


News<br />

in brief<br />


An international collaboration of<br />

scientists has created a contact<br />

lens (CL) which can shift between<br />

magnified and normal vision. The<br />

lens, which increases peripheral<br />

vision three-fold, is safer and<br />

cheaper than surgery and will allow people with sight loss to read<br />

text better and see faces, said Dr Eric Tremblay, a Swiss Federal<br />

Institute of Technology designer. The lenses have tiny telescopes<br />

built into the centre which work like binoculars and are activated by<br />

specially-adapted glasses that recognise winks, but ignore blinks.<br />

The new lens could be available for sale in two years.<br />


Researchers from the Centre for Eye Research Australia (CERA)<br />

have started a six-month clinical trial to see if high-dose vitamin<br />

B3 (nicotinamide) can support existing therapies for glaucoma by<br />

protecting nerve cells from dying. The ability to recover from an<br />

eye injury diminishes with age, so CERA’s looking for treatments<br />

to boost recovery, said study lead Professor Jonathan Crowston. “If<br />

you can improve optic nerve recovery after an injury then we can<br />

reduce the risk of glaucoma progressing.”<br />


A Fudan University team in<br />

China has developed artificial<br />

photoreceptors to replace<br />

diseased and no longer<br />

functioning rod and cone cells<br />

within the retina. A study on<br />

laboratory mice, published<br />

in Nature Communications,<br />

showed the artificial photoreceptors, made from gold and titanium<br />

oxide nanowire arrays, could successfully convert light into<br />

electrical signals.<br />


A collaborative clinic at the University of New South Wales Centre<br />

for Eye Health, where optometrists and ophthalmologists work sideby-side,<br />

is providing beneficial for glaucoma patients. A study of the<br />

clinic’s first 18 months showed patients waited 43 days on average<br />

for an appointment; most (51%) were diagnosed with glaucoma; 41%<br />

had suspected glaucoma requiring monitoring; 2% had a different<br />

optical neuropathy; and 6% had no eye disease. The new model<br />

of care has great potential for helping to assess new, non-urgent<br />

outpatient referrals, said study co-author Dr Michael Hennessy.<br />


A Massachusetts Institute of Technology<br />

(MIT) spinout, PlenOptika has developed a<br />

highly accurate, portable autorefractor called<br />

QuickSee. Costing about a third of the price of<br />

traditional autorefractors, the device is ideal<br />

for developing countries and hard to reach areas, said the company.<br />

After six years in development, eight product iterations and clinical<br />

studies involving 1,500 patients across five countries, The QuickSee<br />

has just been released in India.<br />


The proposed merger of international eyecare heavyweights, Essilor<br />

and Luxottica, is all but a done deal after being unconditionally<br />

cleared by both the European and US Federal Trade Commissions.<br />

In other news, Essilor reported solid 2017 earnings with good<br />

overall performance in its lenses and optical instruments divisions,<br />

reflecting strong online sales and US growth, offsetting lower<br />

sales in other areas, notably Australia and Brazil.<br />


Supported by the Brien Holden Vision Institute (BHVI), the first<br />

School of Optometry has opened in Haiti, welcoming 17 new<br />

students, selected from 144 applicants, onto its Bachelor of Vision<br />

Sciences programme. Five years in the making, the new school,<br />

which is part of the Faculty of Medicine at l’Universite d’Etat d’Haiti<br />

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

currently have little or no access to eye care, said Dr Luigi Bilotto,<br />

BHVI’s director of global human resource development.<br />

O-SHOW <strong>2018</strong> – FILLING UP FAST<br />

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

in Melbourne, from 14-15 July, has been extraordinary, with just<br />

10 booths left to fill, said Finola Carey, ODMA CEO, adding she’s<br />

delighted, but not surprised by the response. ‘’Certainly, the fact<br />

that the O-Show is owned and organised by ODMA for the benefit<br />

of the industry, has been warmly received.”<br />


The necrotic photoreceptor layer in the blind<br />

retina is replaced by an Au–TiO2 NW array<br />

Scientists from Google and its health-tech subsidiary Verily<br />

are assessing a person’s risk of heart disease using computer<br />

learning and retina scans. Using deep learning algorithms,<br />

trained on retina data from 284,335 patients, combined with<br />

knowledge about the patient’s age, blood pressure and smoking<br />

habits, Google’s software successfully predicted 70% of future<br />

cardiovascular events, such as a heart attack or stroke, that would<br />

occur within five years of the retinal exam.<br />

Regarding the retina<br />


The first of the two-repeated autumn seminar evenings by<br />

Retina Specialists was held on 6 March in the leafy Auckland<br />

suburb of Parnell. Attending optometrists were greeted by the<br />

Retina Specialists team, wine and canapés.<br />

The all-female speaking line-up for the evening included Retina<br />

Specialists’ Dr Rachel Barnes, Associate Professor Andrea Vincent, Dr<br />

Dianne Sharp and Dr Narme Deva.<br />

A pictorial FAF journey<br />

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

fundus autofluorescence (FAF) in clinical practice, showing us “pretty<br />

pictures” depicting the presentation of various retinal dystrophies<br />

and disorders. FAF is a non-invasive technique, which highlights<br />

lipofuscin (the main fluroflore in the retinal pigment epithelium). FAF<br />

may detect abnormalities beyond the clinical exam and is useful in<br />

classifying various retinal dystrophies and disorders, she said.<br />

In albinism, where the retina is not metabolically affected, the<br />

FAF appears normal. However, in choroideremia (an X-linked retinal<br />

condition affecting males) widefield Optos images show patchy<br />

changes with scalloped edges where the retina is ‘metabolically<br />

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

zone seen between the good and bad metabolic areas of the retina.<br />

In PDE6B retinitis pigmentosa, FAF is very useful – visual results are<br />

closely correlated to FAF, so generally visual fields are not necessary<br />

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

Among other fascinating pearls, Vincent also revealed what she<br />

calls the ‘moustache sign’ of the adRP rhodopsin mutation – an<br />

inferior central rim of hyperfluorescence – and showed FAF images<br />

of eight siblings with different presentations of ABCA4 retinal<br />

dystrophies, where the whole retina may be affected.<br />

AMD new treatments?<br />

Dr Barnes spoke about the new treatment options for age-related<br />

macular degeneration (AMD). She begun her presentation by<br />

outlining the goals of the different treatments for both dry and wet<br />

AMD, and enthusiastically explained what else waits in the wings in<br />

the long journey to market.<br />

The first drug she discussed, Roche’s lampalizumab, an antigenbinding<br />

fragment of a humanised, monoclonal antibody directed<br />

against complement factor D (CFD), had showed promising initial results<br />

in early trials with a 20% reduction in geographic atrophy. The phase III<br />

results, however, showed no benefit at all. Nano-second laser may also<br />

have an application in early dry AMD, with pilot studies indicating a<br />

reduction in drusen. Phase III results are expected later this year.<br />

Looking at possible treatments for wet AMD, Barnes reminded us<br />

gravely that there is no permanent cure for this devastating disease<br />

and that real-world results often fall short of drug trials due to under<br />

treatment. A new pigment-derived growth factor, which it was hoped<br />

would work to reduce fibrosis and help mature vessels to regress,<br />

looked hopeful early on but was ineffective in phase III trials. Roche,<br />

however is still in the game, with its drug, also based on angiopoitein<br />

(a proangiogenic cytokine involved in neovascular AMD), and is<br />

persevering with the expensive trials required.<br />

A new formulation of ranibizumab (Lucentis: a recombinant<br />

humanized IgG1 monoclonal antibody fragment that binds to and<br />

inhibits vascular endothelial growth factor A) delivered by a port<br />

system is also an exciting possibility with more results planned soon,<br />

said Dr Barnes. Gene therapies using new viral vectors are also being<br />

trialled. While many trials seem to show early promise and then fall<br />

at the final hurdle, brolucizumab is in Phase III trials and results are<br />

looking very positive. With its small molecule size allowing higher<br />

potency in the eye, results are showing significant reduction in retinal<br />

thickness and better performance than aflibercept (Eylea), she said.<br />

Lastly Dr Barnes discussed the new imaging technique, OCT-A<br />

that offers a quick, non-invasive 3D method to image the retinal<br />

vasculature. It is particularly useful for showing the structure<br />

of choroidal neovascularisation and for visualising occult<br />

neovascularisation not visible by any other means, she said.<br />

MD and the ageing eye<br />

Dr Sharp presented a practical presentation on MD in the ageing<br />

eye. The high metabolic demand of the macular area of the retina<br />

makes it particularly susceptible to oxidative damage, she said.<br />

With more than 10% of babies born today destined to become<br />

centenarians, MD is more relevant today than ever.<br />

A recent model-of-care, commissioned by the government,<br />

highlighted the national low understanding of the disease and areas<br />

requiring improvement, such as speed to treatment. This model set out<br />

the importance of prompt care and said the time from first diagnosis<br />

to first treatment should be no more than one week. The Beckman<br />

classification can be used to identify different stages of AMD and help<br />

to predict the risk of progression at each stage, she said.<br />

“Small fine drusen (or druplets as they are sometimes called) are<br />

not MD and it is wrong to call them this. Soft drusen combined with<br />

pigment changes are high risk. Give the patient an Amsler Grid test<br />

www.nzoptics.co.nz | PO Box 106954, Auckland 1143 | New Zealand<br />

Drs Narme Deva, Dianne Sharp and Rachel Barnes<br />

Stuart Campbell and Richard Chinn<br />

and monitor them closely.” Those with choroidal neovascularisation<br />

can particularly be helped by getting them treatment fast, she added.<br />

Dr Sharp also shared some data from UK records over a 12-month<br />

period, showing that the starting vision level is of great importance.<br />

Optometrists present were also interested in discussing RANZCO’s<br />

revised referral pathway for MD. “Too often a patient stops attending<br />

appointments after anti-VEGF treatments because their vision<br />

is good, only to have problems reoccur,” said Dr Sharp, providing<br />

examples of the sequelae of neovascular MD. Patients must be<br />

educated that this is a chronic disease that requires long-term<br />

management, she stressed.<br />

DR, risks and treatment<br />

Dr Deva tackled diabetic retinopathy, a main cause of the blindness in<br />

working-age people. One third of diabetics will have retinopathy and<br />

for a third of those it will threaten their vision. To reduce risk during<br />

the early stages, optometrists must ask about how well patients are<br />

controlling their blood sugar levels, she said, citing data that intensive<br />

therapy, reduced the risk of developing retinopathy by 76%. A good<br />

understanding of the disease and encouraging patients to form good,<br />

healthy-eating and monitoring habits is key in these early stages.<br />

The second question that optometrists should ask is, “how is<br />

your blood pressure?” said Dr Deva. The Wisconsin epidemiologic<br />

study of diabetic retinopathy showed that lowering blood pressure<br />

can half the risk of retinopathy. The third question centres around<br />

cholesterol levels, and while this is not as well-supported by clinical<br />

data as blood sugar levels, good cholesterol control can reduce the<br />

progression of retinopathy, she said.<br />

Dr Deva then summarised the treatments for diabetic retinopathy<br />

and associated macular oedema focusing on lasers and anti-VEGF<br />

injections. Widefield imaging is helping us monitor treatments over<br />

time, she said. Keeping to the technological theme, Dr Deva also<br />

discussed the growing interest in artificial intelligence and the rise<br />

of studies using machines that can perform deep learning (see NZ<br />

Optics March <strong>2018</strong> issue, p14), “that is, showing a machine data and<br />

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

future replace optometrists and ophthalmologists, analysing many<br />

data points, from diagnosis and classification to risk assessment, in<br />

mere minutes, and suggesting appropriate treatment plans.<br />

Concluding remarks<br />

Sandhya Mathew and Surekha Parag<br />

Hilary Rayner, Retina Specialists practice manager, said the evening<br />

was a great success. “It was wonderful to see so many people at our<br />

event and we are looking forward to meeting our next group in a<br />

couple of weeks. Everyone is busy these days so we really try to make<br />

the education meetings we hold interesting and useful and we really<br />

appreciate the effort that people make to come along.” ▀<br />

Retina Specialists’ Spring seminar evenings will be held on the 4 and<br />

18 September.<br />

For general enquiries or classifieds please email info@nzoptics.co.nz<br />

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

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<br />

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

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<br />

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<br />

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<br />

those of NZ Optics 2015 Ltd or the editorial team.<br />

4 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

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<strong>April</strong> <strong>2018</strong><br />



Low Vision Day: a real eye-opener<br />


How do you tell someone they’re losing<br />

their sight? What can you do to really<br />

help a low vision patient? How do you<br />

explain the often-complex web of support and<br />

technology available? These, and many other<br />

important questions were the focus of the School<br />

of Optometry and Vision Science (SOVS) Low Vision<br />

Day on 1 March.<br />

The day included lectures, workshops and a panel<br />

discussion where students had the opportunity to<br />

talk directly with low vision patients and ask them<br />

questions about their lives and the help they had<br />

or hadn’t received.<br />

Nick Lee, New Zealand Optometry Student<br />

Society (NZOSS) president, said it was the first<br />

time many students had had an opportunity<br />

to be exposed to true low vision patients. The<br />

day provided a safe and encouraging learning<br />

environment and the students he spoke to really<br />

appreciated the opportunity to talk openly to<br />

patients who had low vision and were comfortable<br />

with and open about their condition, he said.<br />

“Previously, it felt like there was a certain negative<br />

stigma surrounding low vision patients, but<br />

everyone who volunteered their time was just<br />

happy to be helped and helped our learning too.”<br />

Samantha Simkin from the Blind and Low<br />

Vision Education Network NZ (BLENNZ), started<br />

the day with a talk about BLENNZ’s role helping<br />

low vision and blind children access education.<br />

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

Ophthalmologists, optometrists and teachers can<br />

refer to BLENNZ. As there are different levels of<br />

support available, it’s important to refer even in<br />

cases when the child is perhaps not fulfilling all<br />

the criteria, said Simkin.<br />

Katy Webber, a counsellor with the Blind<br />

Foundation (BF), talked next about how BF can<br />

support adults and children alike, with different<br />

practical and emotional aspects of their life, to<br />

work towards a more independent and fulfilled<br />

life. Webber said the perception that BF is only for<br />

adults is wrong, BF and BLENNZ work together<br />

with the age group 0-21, but where BLENNZ’s<br />

focus is on education, BF focuses on supporting<br />

the individual in their daily life. So, it’s important<br />

to always make two referrals, one for BLENNZ and<br />

one for BF, she said.<br />

Low vision patients Trevor Plumbly (see Blind<br />

ignorance, this page), Susan Grimsdell, Camille Guy<br />

and Michael Lloyd made up the much-anticipated<br />

panel for the day’s discussion session. From<br />

sharing their life stories and answering the many<br />

questions put to them by the audience, it was clear<br />

life with low vision isn’t all bad, but it certainly has<br />

its challenges. “It doesn’t stop me from doing the<br />

things I want to do, I just need to find another way<br />

to do them,” explained Lloyd.<br />

The discussion covered everything from good<br />

and bad optometry visits, with most saying ‘telling<br />

it, how it is’ was the preferred way to receive and<br />

deliver bad news, to how public spaces could<br />

be improved to better support our low vision<br />

community.<br />

The three afternoon<br />

workshops were practical,<br />

providing insights into<br />

adaptive technology, how<br />

to best communicate with<br />

patients with low vision and<br />

how to use electronic devices<br />

designed to assist patients<br />

with low vision, orientation<br />

and mobility. The latter<br />

included role-play testing<br />

techniques for correctly<br />

performing sighted-guide<br />

assistance.<br />

The day ended with a<br />


Dr Logan Robinson,<br />

MB ChB, PG Dip Ophth BS (Distinction),<br />


An experienced cataract surgeon<br />

with an enthusiasm for vitreoretinal<br />

surgery, Logan, completed a medical<br />

degree in 2003 at the University of Otago<br />

and completed a Postgraduate Diploma<br />

in Ophthalmic Basic Sciences (with<br />

distinction) in 2008.<br />

Continuing his professional development<br />

via a fellowship in vitreoretinal surgery<br />

at Wellington Hospital, Logan then moved to the UK, completing a second<br />

vitreoretinal surgery fellowship at the Manchester Royal Eye Hospital.<br />

Returning to Christchurch in 2015, Logan took up a position as a consultant<br />

ophthalmologist at Christchurch Hospital and subsequently joined us at SES.<br />

Away from work Logan enjoys spending time with his young family and is an<br />

avid sports fan, enjoying mountain biking, golf and fishing.<br />

From everyone at SES, ‘Welcome aboard Logan’.<br />

128 Kilmore Street, Christchurch, New Zealand<br />

PO Box 21023, Edgeware, Christchurch 8143<br />

t: +64 3355 6397 f: +64 3 355 6156<br />

e: info@southerneye.co.nz www.southerneye.co.nz<br />

refraction clinic, offering<br />

students an opportunity<br />

to perform a low vision<br />

refraction test. Student<br />

Andrew Kim said this part<br />

of the day was one of his<br />

highlights and a valuable<br />

experience. Melissa Zhu<br />

said it was one of the most<br />

rewarding and challenging<br />

practical learning sessions<br />

she’d experienced.<br />

“As students, we mostly<br />

encounter patients with<br />

no pathology or patients<br />

who have pathology but<br />

are sufficiently sighted<br />

enough to come to our<br />

clinics. The duty of telling someone they will lose<br />

their driving and independence was a topic on a<br />

lecture slide I had once thought was far, far away.<br />

It was easy to avoid. (So) I felt most challenged by<br />

the hard truth that there are simply no cures yet to<br />

restore vision in some patients.<br />

“This led to a sense of collective awkwardness<br />

when we faced our volunteers in the clinic; as if we<br />

have, somehow, failed to do our jobs. However, by<br />

talking to the volunteers both in clinic and in the<br />

panel, I have come to see people living fulfilling<br />

lives with their vision problems. This was the<br />

Blind ignorance<br />


Sight loss, I discovered, is such a gradual<br />

process that it’s generally detected by others<br />

before the victims themselves.<br />

Certainly, the indications I had came at me,<br />

rather suddenly. I was sitting down, quietly<br />

enjoying a cup of tea, when my wife Pam said:<br />

“we really need to talk”. Now anyone with<br />

any experience of married life or full-time<br />

employment, knows that when someone says<br />

that, good news is not about to follow.<br />

The conversation started innocently enough,<br />

along the lines of, “do you realise how often you’re<br />

bumping into things lately?” I put on, what I hoped<br />

was a pensive, reasonable expression, waiting<br />

for the final verdict and sure enough it arrived.<br />

“You need to get your eyes tested again, but go to<br />

someone a bit more high-tech than old Charlie.”<br />

I thought that was a bit harsh, Charlie had done<br />

my glasses for years and never given me any grief.<br />

Anyway, if there was bad news out there why go<br />

looking for it? I tried the usual, “I’ll think about it”<br />

and “as soon as work eases off a bit”.<br />

Occasionally this ploy works, but not this<br />

time and a couple of days later off I went, feet<br />

dragging, to the high-tech optometrist (HTO).<br />

Mentally debating the difference between an<br />

‘HTO’ and a normal optometrist, I decided it was<br />

probably the size of the bill.<br />

The HTO looked more like a cemetery for posh<br />

spectacle frames than a place to get your sight<br />

fixed. The decor was a floor to ceiling sort of<br />

glaucoma grey which matched the hair colour<br />

of the chirpy, competent looking women behind<br />

the counter. My optometrist was a really pleasant<br />

young Australian woman who shuffled and dealt<br />

the test lenses with all the panache of a Las<br />

Vegas croupier. Whilst I gained confidence from<br />

this dexterity, she obviously wasn’t satisfied. She<br />

followed up the first act by shining a magnifying<br />

torch into my eyes muttering ‘Hmm’.<br />

It’s a personal opinion of course, but a ‘Hmm’<br />

coming from anyone in the medical game has got<br />

to be one of scariest expressions in the English<br />

language. Its only got two meanings; a) “I haven’t<br />

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

want to be the one to tell you.”<br />

We talked about my vision and I mentioned<br />

having problems driving at night. She trumped<br />

this by saying, “I don’t think you should be driving<br />

in daylight either and you definitely need to see a<br />

specialist.” Not really what I wanted to hear.<br />

Seeing a specialist implied that what I had was<br />

beyond her ability, and then there was the cost.<br />

With Charlie, it was in and out with glasses for<br />

around $300 but this little number was looking<br />

like $600 plus, with the specialist in the game, I<br />

was starting to feel like I was involved in some<br />

sort of optical pyramid scheme.<br />

The specialist oozed professional competence.<br />

He sat me in front of an ancient-looking machine,<br />

explained the process, gave me a buzzer and said,<br />

“press this when you see the lights.” After a while<br />

he said, “when you’re ready,” and then, with a<br />

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

Tish Peat, Susan Cordery and Amelia Hardcastle<br />

highlight of my day,” explained Zhu.<br />

“The most important message to me was that<br />

we, as practitioners, cannot carry a misguided idea<br />

that low vision’ is a euphemism for the traditional<br />

meaning of ‘blindness’, and therefore an end to a<br />

person’s productivity in society. We must treat the<br />

subject with sensitivity but not taboo, as our role is<br />

to help our patients do the best in life with their own<br />

vision – whether that means spectacles, surgery,<br />

CCTVs or a referral to the Blind Foundation.” ▀<br />

See p21 for more on low vision and the world of<br />

retina.<br />

touch of insistence, “when you see the lights.”<br />

Anxious to please, I finally spotted one and<br />

jabbed the button in triumph. He didn’t cheer,<br />

but I thought I detected a bit of relief in his<br />

expression. From there we moved into the surgery,<br />

which really looked as if it could do the biz: bright<br />

lights, lots of neatly laid-out implements that<br />

looked essential and expensive, with a patient<br />

chair that could have been salvaged from a<br />

space shuttle. He did the old shuffle and deal<br />

with the test lenses, not quite with the flourish<br />

of the optometrist, but more measured, as if he<br />

was catering to the high rollers. I eased back in<br />

the astronaut chair with all the confidence of<br />

someone getting their money’s worth.<br />

When the magnifying light elicited another<br />

“Hmm” I wondered if it was some sort of<br />

diagnostic code for unrecorded ailments. But no!<br />

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

I chewed on this medical morsel for a moment<br />

before asking, “Is that good?” He then treated me<br />

to a short, honest opinion on the joys of retinitis<br />

pigmentosa. Briefly, I could lose my sight or some<br />

of it, I could lose all or some of it quickly or slowly<br />

and it was inoperable. Not what I wanted to hear.<br />

See what I mean about going out and looking for<br />

trouble?<br />

Somewhat poorer and not exactly buoyed with<br />

hope I left, clutching an appointment for the<br />

Dunedin Eye Clinic.<br />

The clinic was all business, lots of fellow patients<br />

dotted around the waiting area, half-hoping<br />

and half-dreading the appointment and the<br />

result. The staff here are frontline troops, a mix<br />

of eager younger types and urbane, battle-worn<br />

professionals who’ve seen it all before, and if the<br />

line outside is anything to go by, they were going<br />

to see a fair bit more of it.<br />

Similar tests, same diagnosis, same prognosis,<br />

but good, helpful advice on what to expect and<br />

how to cope with it. Top marks all round for the<br />

public health system. I left quite upbeat and halfconvinced<br />

there wasn’t that much wrong with my<br />

sight anyway. But on reflection I guess it was more<br />

wishful thinking and a natural reluctance to face<br />

the reality of life.<br />

NZ Optics is pleased to welcome Trevor Plumbly<br />

as a new contributor. Trevor will share more about<br />

his life on the ‘dark side’ or as a ‘white caner’, as he<br />

also likes to be called, in future issues.<br />

*Trevor Plumbly is a retired arts and antiques dealer, diagnosed<br />

with retinitis pigmentosa 15 years ago. Originally from Tunbridge<br />

Wells in England, Plumbly, together with wife Pam, formerly<br />

owned Plumbly’s Auction House<br />

in Dunedin. In the 1980s, he was<br />

one of the antique experts in the<br />

popular television programme,<br />

Antiques for Love or Money,<br />

and became a well-known face<br />

in Dunedin as a result. In 2008,<br />

when sight loss put a stop to the<br />

antiques dealing, Trevor and Pam<br />

decided they wanted to be closer<br />

to family, so they sold up and<br />

relocated to Auckland. This is his<br />

first column for NZ Optics.<br />

6 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

Greenlane ups low<br />

vision services<br />

The low vision (LV) clinic at Greenlane<br />

Clinical Centre has recently welcomed<br />

two new optometrists to its team. Deepa<br />

Kumar and Deborah Chan, have joined Sandy<br />

Grant, LV clinic coordinator and therapist, to<br />

provide a multi-disciplinary low vision service<br />

to patients referred by eye health specialists,<br />

general practitioners, the Blind Foundation and<br />

other ADHB departments.<br />

The most common referrals are for patients<br />

with macular degeneration (MD) and<br />

glaucoma, although the clinic will accept<br />

anyone with functional vision issues, said<br />

Grant.<br />

Patients seen at early stages of MD often<br />

identify reading, handwriting and glare issues<br />

as their main difficulties, while patients with<br />

glaucoma, retinitis pigmentosa, hemianopias<br />

or monocular vision may experience mobility<br />

and reading issues. Other visual concerns<br />

highlighted in the assessment are also<br />

addressed through LV strategies such as<br />

eccentric viewing, low vision aids, both optical<br />

and non-optical (eg. magnifiers, task lamps,<br />

signature guides), basic training with aids or<br />

sighted-guide, information, peer support or<br />

referrals, such as Blind Foundation membership.<br />

Early intervention often alleviates many<br />

patients and helps the patient develop coping<br />

mechanisms, said Grant.<br />

The low vision clinic runs Tuesday and<br />

Thursday afternoons and on average about<br />

four patients per clinic are seen. Wednesday<br />

afternoons is a therapist-only clinic, though<br />

Grant said she hopes to add another fullservice<br />

clinic in the near future.<br />

Patients referred to the clinic are interviewed<br />

first by Grant and then the optometrist,<br />

who refracts the patient and determines<br />

magnification requirements. Follow-up<br />

appointments are often required, or patients<br />

can self-refer back should they feel their vision<br />

has deteriorated.<br />

Originally from Canada, and trained in<br />

rehabilitation teaching, orientation and<br />

Greenlane low vision optometrists Sandy Grant and Deepa Kumar<br />

mobility, Grant came to New Zealand in 1992<br />

to work for the Blind Foundation. “As the clinic<br />

coordinator, I love the interaction with patients<br />

and in playing my part on the LV team.<br />

“It’s rewarding work, encouraging and<br />

demonstrating what is possible to patients<br />

through a variety of strategies, low vision<br />

aids, appropriate support, referrals to enable<br />

the patient to approach their low vision with<br />

added confidence, motivation and a boost in<br />

self-esteem.”<br />

Grant said she’s excited about the recent<br />

expansion of the clinic and is looking forward<br />

to providing more patients with a range of<br />

services to start them on their journey to living<br />

successfully with low vision.<br />

The LV clinic at Greenlane also recently made<br />

a sizeable donation of older model (and never<br />

used) magnifiers to volunteer ophthalmic<br />

services overseas (VOSO) for their trip to the<br />

Pacific Islands in an effort to support LV work<br />

on this history-making VOSO trip. We wish<br />

Naomi Meltzer and the rest of the VOSO team<br />

all the very best for this new chapter in VOSO’s<br />

evolution, said Grant. ▀<br />

If you would like to a refer a patient to the low<br />

vision service at Greenlane Clinical Centre,<br />

referral forms can be found on the Healthpoint<br />

website or email sandy@adhb.govt.nz. For<br />

questions, call 09 3074949 extn 27641.<br />

Calling mentors<br />

The School of Optometry and Vision Science<br />

(SOVS) at the University of Auckland needs more<br />

externship mentors for their final year BOptom<br />

students.<br />

During their last year of study, each New Zealand<br />

BOptom student undertakes a three-week externship<br />

in a community-based optometry practice. Through<br />

these externships, students gain further experience in<br />

the direct examination and management of patients<br />

away from the confines of the university clinics, says<br />

Dr Geraint Phillips, SOVS senior lecturer and clinic<br />

director. “Feedback from the profession shows many<br />

optometrist mentors enjoy the exchange of ideas and<br />

information with the next generation of optometrists.”<br />

The externship period can be broken up so that the<br />

student attends more than one practice, for example,<br />

when a practice is keen on taking part, but cannot<br />

host the student for the full three weeks. Optometrist<br />

mentors supervise the student during their externship,<br />

which includes being available to check the clinical<br />

findings for every patient the student examines. Mentors<br />

also complete an evaluation at the end of the student’s<br />

externship; a format is provided with pre-set questions.<br />

Optometrist mentors are invited to become<br />

New vision-tech hub<br />

Australian low vision service provider, Vision<br />

Australia, has opened a new interactive<br />

site so people who are visually-impaired<br />

can experience the abundance of new technology<br />

available to help them today.<br />

Located in Vision Australia’s new Parramatta centre<br />

in Western Sydney, the new Vision Store and Tech Hub<br />

showcases the latest specialist adaptive technology and<br />

how more mainstream devices can be optimised and<br />

used to support people who are blind or have low vision.<br />

“Whether it’s living independently, being active in their<br />

community, finding employment or staying connected<br />

with family and friends, technology is often the key to<br />

unlocking opportunities for people who are blind or<br />

have low vision,” said Ron Hooton, Vision Australia’s CEO.<br />

“Individuals have different circumstances and goals and<br />

what we have at Parramatta is a location where anybody<br />

who is blind or has low vision can come and be exposed<br />

to a huge range of technology that can support them<br />

Honorary<br />

Teaching<br />

Fellows with<br />

the University<br />

of Auckland,<br />

a position SOVS: Calling more optometry mentors<br />

which offers full access to the extensive resources the<br />

Auckland University library offers, including all of its<br />

electronic resources (encompassing many excellent<br />

journals); use of the title “Honorary Teaching Fellow<br />

affiliated with the School of Optometry & Vision<br />

Science at the University of Auckland”; preferential<br />

and cost-reduced access to continuing professional<br />

development events within SOVS; use of the following<br />

phrase on practice websites and similar: “Our practice<br />

provides teaching services for the University of<br />

Auckland’s School of Optometry & Vision Science for<br />

their Bachelor of Optometry degree”.<br />

The School of Optometry & Vision Science is keen to<br />

welcome new and returning mentors for externships<br />

in June and July <strong>2018</strong>. If you are interested in becoming<br />

a new or returning externship mentor, please contact<br />

Gini Parslow, practicum placement co-ordinator at<br />

v.parslow@auckland.ac.nz or phone 027 406 8543. ▀<br />

and get expert advice about what is likely to best suit<br />

their needs.”<br />

Technology advice is provided by Vision Australia<br />

staff plus representatives from tech organisation<br />

partners, including Samsung, Apple and Google,<br />

and specialist adaptive technology providers such as<br />

IrisVision and OrCam.<br />

Other highlights of the new space include<br />

demonstration home environments, including an<br />

accessible kitchen and cooking aids (both low and<br />

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

integration home devices; workplace/home study<br />

tools; Google Home to control lighting and provide<br />

audio cooking instructions; and other tools such as<br />

Samsung’s voice-controlled screen magnification tech.<br />

“Accessibility is a key consideration for people who<br />

are blind or have low vision and we’ve taken that into<br />

account with the design, layout and other features in<br />

the space,” Mr Hooton said. ▀<br />

We’re bringing more<br />

optometry events and<br />

webinars to you<br />

MyHealth1st is revolutionising digital customer engagement<br />

for independent optometrists.<br />

Don’t miss our free events and webinars on how you can join<br />

the digital revolution and put your business growth 1st.<br />

Sign up now at:<br />

myhealth1st.co.nz/optometryevents<br />

<strong>April</strong> <strong>2018</strong><br />



Low vision in the 21st century<br />


Last century, low vision services were regarded<br />

as a last resort and an admission of failure.<br />

Generally, when patients enquired as to<br />

whether there was anything available to help<br />

them see, the answer was either a tentative, ‘you<br />

could buy a magnifier’ or a more defensive, ‘you’re<br />

not bad enough for that yet’.<br />

When medical and surgical options ran out,<br />

the patient was dismissed with ‘there is nothing<br />

more that can be done, sorry’. This was effective<br />

at getting the patient out the door, but left them<br />

emotionally and physically stranded, unable to<br />

comprehend how to function visually when they<br />

were neither blind nor seeing. More patients were<br />

rendered functionally “blind” by this statement<br />

than by any other documented pathology and,<br />

sadly, many continue to exist in this state today,<br />

convinced this statement remains true as it was<br />

given by those they trusted.<br />

For some, this attitude has continued into this<br />

century, despite huge changes in medical, optical<br />

and electronic technology, and the current view<br />

of low vision as a spectrum of functional changes<br />

that occur along the pathway between normal<br />

vision and no light perception. A few weeks after I<br />

started my low vision practice in 2011, I ran into an<br />

ophthalmological colleague who told me, ‘I hope<br />

you never get to see any of my patients!’ But for<br />

many, there has been a shift in thinking towards<br />

understanding that visual function cannot be<br />

defined by the size of letter read on a high-contrast<br />

distance chart or a monocular electronic visual field<br />

analysis; and visual rehabilitation does not mean<br />

restoring vision to normal, but the rehabilitation<br />

of a person with visual loss to function within their<br />

family, whanau, community or workplace.<br />

Much of this change has been driven by the<br />

realisation that even with the amazing advances<br />

in medical science in the management of<br />

ongoing problems such as glaucoma, macular<br />

degeneration or other retinopathies, it is just that<br />

– management of the condition – not restoration<br />

of normal visual function. Thus, the best outcomes<br />

are obtained when patients are given as much<br />

information as possible on the range and type of<br />

additional services available to them sooner rather<br />

than later when all else has failed.<br />

Times are changing for low vision patients, and about time too<br />

Today, the modern low vision consultation reviews<br />

how a patient with low or declining vision functions<br />

in their everyday environment and how we can help<br />

them use the vision they have more efficiently to<br />

manage their day-to-day activities. This involves<br />

taking a holistic view incorporating their general<br />

health, and the impact of perhaps other health<br />

problems such as stroke, Parkinson’s or diabetes<br />

on their visual functioning; and their physical<br />

environment – are they confined to one, poorly-lit<br />

room in a rest home or actively participating in<br />

sport or looking after other family members? Does<br />

their visual problem extend to passive reading or<br />

do they have other needs such as mobility or glare<br />

control? Is there a history of amblyopia, binocular<br />

vision instability or balance problems that has been<br />

forgotten along the way or considered irrelevant due<br />

to the patient’s poor distance acuity? Has the need<br />

for prescription glasses to focus at near range been<br />

overlooked as their vision deteriorated? Or do they<br />

perhaps simply need reassurance there are options<br />

available to help them if and when they need it?<br />

A functional, low vision consultation helps assess<br />

each patient on an individual, case-by-case basis,<br />

going way beyond the ‘let’s see if a magnifier will<br />

help’ approach.<br />

Recently, a request for assistance from a resource<br />

teacher brought home to me how much a bit of<br />

lateral thinking and a good stock of low vision<br />

aids can change an<br />

otherwise ordinary<br />

day. A 12-year-old<br />

boy with low vision<br />

due to retinopathy<br />

of prematurity, copes<br />

well in the classroom<br />

with just his spectacle<br />

prescription correcting<br />

his hypermetropia and<br />

high cyls plus a closeworking<br />

distance to<br />

use his accommodation<br />

for extra magnification.<br />

However, given he was<br />

starting woodwork<br />

and sewing and would<br />

have to use sewing<br />

machines, fretsaws and<br />

grinding machines and the like, the resource teacher<br />

was on the hunt for some additional magnification<br />

for him.<br />

She had found a magnifier attached to a<br />

goose neck stand, but this got in the way of the<br />

student and couldn’t be moved easily from one<br />

piece of equipment to another. The boy was also<br />

required to wear safety glasses for the woodwork<br />

equipment so an initial idea to use a head loupe<br />

was a non-starter, while a large magnifier on a<br />

tilting wire frame, ‘just got in the way’. We settled<br />

on a hands-free “embroidery” magnifier, which<br />

sits against his chest with a cord around his neck<br />

and is LED-illuminated. While only providing 2x<br />

magnification (he needs 3.5x to read a mm ruler)<br />

it was sufficient to help him see the needle or the<br />

blade of the saw at a normal working distance.<br />

What was exciting however, was watching the<br />

student. He was like a kid in a candy store trying out<br />

all my high-tech and low-tech electronic stuff. In his<br />

lifetime, he will no doubt use way more high-tech<br />

aids than are available today, but this exercise at<br />

least showed both of us, how a simple low-tech, lowcost<br />

magnifier and a good dollop of lateral thinking<br />

can triumph. A very satisfying outcome all round. ▀<br />

*After 30 years in general optometry,<br />

Naomi Meltzer realised her passion<br />

lay in visual rehabilitation and now<br />

runs an independent, low vision<br />

consultancy service in Auckland. She is<br />

a MDNZ founding trustee, a qualified<br />

CentraSight and eSight assessor and<br />

OrCam trainer. For more, see the Low<br />

Vision Services classified on p26.<br />

Tackling trachoma and<br />

other NTDs<br />


In December 2017, Dr Martin Kollmann, a<br />

consultant ophthalmologist and associate<br />

professor at the University of Nairobi, travelled<br />

to New Zealand to address delegates from the<br />

partnerships, humanitarian and multilateral<br />

division of the New Zealand aid programme at the<br />

Ministry of Foreign Affairs and Trade (MFAT). The<br />

main aim of the visit was to build awareness of the<br />

link between neglected tropical diseases (NTDs)<br />

and poverty and demonstrate how tackling NTDs<br />

is key to a region’s socio-economic development.<br />

Dr Kollman, a senior advisor on NTDs for the<br />

international charity CBM (formerly the Christian<br />

Blind Mission), was accompanied by CBM NZ<br />

chief executive, Stephen Hunt, and international<br />

programmes manager, Linabel Hadlee.<br />

NTDs are a diverse group of tropical infections,<br />

especially prevalent in low-income populations in<br />

developing regions. They are caused by a variety<br />

of pathogens such as viruses, bacteria, protozoa<br />

and helminths. The disabling and debilitating<br />

effects of NTDs include blindness, mobility<br />

impairment, preventing children’s growth and<br />

development, malnutrition and extreme pain.<br />

They are labelled ‘neglected’ because they affect<br />

communities in extreme poverty. In some cases,<br />

the uncontrolled spread of NTDs has resulted<br />

in pastoral communities abandoning their land<br />

to escape the transmitting pathogen but, as a<br />

result of NTD control programmes, in more recent<br />

times 25 million hectares of arable land has been<br />

regained, feeding 17 million people annually.<br />

Two of the most common blinding NTDs are<br />

onchocerciasis (river blindness), found in Africa<br />

and some parts of the Americas, and trachoma,<br />

the leading cause of infectious blindness in<br />

humans, caused by infection with the bacterium<br />

Chlamydia trachomatis, which is still found in<br />

Africa, the Americas, Asia, the Middle East and<br />

the Pacific. Ethiopia carries 39% of the global<br />

trachoma burden, with an estimated 74 million<br />

people at risk and 40% of children aged 1-9<br />

infected. Women are highly susceptible due to<br />

greater exposure to young children, who typically<br />

spread the disease. Trachoma is active in the<br />

Pacific, particularly Papua New Guinea and<br />

Australia in remote communities.<br />

A doctor treats a trachoma sufferer in Ethiopia<br />

Blindness from trachoma is irreversible. Infection<br />

is spread through personal contact and by flies<br />

that have been in contact with facial discharges<br />

from an infected person. With repeated episodes of<br />

infection over many years, a sufferer’s eyelashes may<br />

be drawn in so they rub on the surface of the eye,<br />

causing pain and permanent damage to the cornea.<br />

CBM supports NTD control and elimination<br />

programmes in 12 countries promoting the<br />

SAFE (surgery, antibiotics, facial cleanliness<br />

and environmental educational) strategy at<br />

a community level. Over the last 12 years,<br />

CBM has funded nearly 16 million mass drug<br />

administration projects and almost 900,000<br />

trachoma surgeries. CBM has also supported the<br />

training and education of more than 83 million<br />

health and community workers.<br />

At his meeting with MFAT, Dr Kollmann<br />

showcased a CBM-funded programme in<br />

Amhara, Ethiopia which received an award for<br />

its innovative approach embracing community<br />

engagement and ownership. International aid will<br />

not achieve its sustainable development goals<br />

with an economic focus only, he said, but must<br />

also focus on preventing and eliminating NTDs to<br />

be successful.<br />

Although NTD interventions have proved to<br />

be very cost-effective, globally only 0.6% of<br />

health expenditure targets NTDs, hence CBM’s<br />

government awareness programme, which wants<br />

aid givers to target more aid towards health to<br />

support more NTD elimination programmes. This<br />

will represent a tangible benefit for children,<br />

women and adults; solidly contributing to poverty<br />

eradication and sustainable development goals,<br />

explained Dr Kollman.<br />

Dr Martin Kollmann<br />

Dr Martin Kollmann, a consultant ophthalmologist and associate professor at<br />

the University Nairobi, is a senior CBM advisor, coordinating global activities<br />

in the fight against diseases of poverty and inequity. He studied human<br />

medicine in Germany and worked for three years with the German volunteer<br />

service, DED, in rural hospitals in Ethiopia before completing his training in<br />

ophthalmology at Munich University. He holds a degree in tropical medicine<br />

and medical parasitology and an MBA in healthcare management. Today,<br />

at the University of Nairobi Institute of Tropical and Infectious Diseases,<br />

Dr Kollmann trains postgraduates, undergraduates and mid-level eye care<br />

Dr Martin Kollmann, raising<br />

awareness of trachoma and other<br />

NTDs<br />

professionals and is heavily involved in research. He has also developed an innovative sponsorship<br />

programme, which supports training for young Africans at recognised institutions in the region.<br />

8 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

Constant Progress<br />

ZEISS Precision Lenses<br />

1912<br />

Punktal ®<br />

The first axially symmetric spectacle<br />

lenses with point-focal Imagery, a<br />

concept that still plays a significant<br />

role in today’s lens designs. This<br />

invention was enabled by a close<br />

collaboration with Moritz von Rohr<br />

and Alvar Gullstrand.<br />

1935<br />

Patent for AR coatings<br />

ZEISS invents a process to create<br />

durable coatings to reduce reflections<br />

on optical lens surfaces.<br />

1969<br />

The photos of the first moon landing<br />

were taken with ZEISS camera lenses.<br />

1970<br />

First photochromic spectacle lenses<br />

A partnership with SCHOTT helps ZEISS<br />

launch the world’s first brown glass<br />

photochromic spectacle, known as<br />

Umbramatic.<br />

1980<br />

Gradal ® HS<br />

ZEISS unveils the world’s first progressive<br />

lens design based on splines. It is the<br />

predecessor of freeform lenses.<br />

1997<br />

Patent for a new manufacturing process<br />

With the Hof / Hanssen patent ZEISS sets a new<br />

standard in progressive lens production. To date,<br />

this manufacturing process has been licenced to<br />

the entire ophthalmic market by ZEISS.<br />

2000<br />

Gradal Individual ®<br />

Progressive Lenses<br />

For the first time in history,<br />

ZEISS offers personalised<br />

parameters in the computation<br />

of progressive lens surfaces.<br />

2007<br />

i.Scription ®<br />

ZEISS launches the first lens<br />

technology that incorporates<br />

higher-order aberrations and<br />

combines subjective refraction<br />

and wavefront analysis.<br />

2010<br />

MyoVision ®<br />

The world’s first lens that<br />

enables a reduction in myopia<br />

progression by an average of<br />

30% in Asian children.<br />

2014<br />

Digital Lenses<br />

ZEISS introduces a new first-pair lens<br />

product category that is an eye care<br />

solution for mobile devices<br />

1992<br />

Video Infral ®<br />

The world’s first computer-based<br />

centration device is introduced<br />

by ZEISS to set new standards in<br />

individualised lens fitting.<br />

2015<br />

DriveSafe Lenses<br />

ZEISS develops an everyday<br />

lens solution consisting of three<br />

elements to make driving safer<br />

and more comfortable.<br />

<strong>2018</strong><br />

Watch this Space!<br />

Our breakthrough innovations are the result of every decision we have made, every idea<br />

we have had and every contribution that everyone at ZEISS has made. We are proud of<br />

our long history and tradition in shaping the future of optics. We even made it to the<br />

moon, and we are aiming for even greater heights. Be part of this never-ending story.<br />

Find out which ZEISS lens solutions are most suitable for you and your<br />

business at www.zeiss.com.au/vision or 1800 882 041.<br />

<strong>April</strong> <strong>2018</strong><br />



SPECIAL FEATURE: RANZCO <strong>2018</strong><br />

Welcome to the RANZCO<br />

NZ <strong>2018</strong> Conference<br />

The New Zealand Branch<br />

RANZCO committee<br />

welcomes everyone<br />

to Auckland for the <strong>2018</strong><br />

conference.<br />

This year we have decided to<br />

not have a specific educational<br />

theme, but rather to offer a<br />

broad range of subspecialty<br />

topics, useful to both<br />

generalists and subspecialists<br />

in medical, nursing and<br />

orthoptic fields. The meeting<br />

is combined with the NZ<br />

Ophthalmic Nurses and the<br />

NZ Orthoptic Society, offering<br />

plenary sessions targeted to all attendees,<br />

followed by concurrent streams for each group.<br />

Our keynote speakers are Professor David<br />

Mackey (genetic ophthalmologist, Australia),<br />

Dr Brendan Vote (vitreoretinal and cataract<br />

specialist, Australia), Associate Professor<br />

Lyndell Lim (uveitis and retinal disease,<br />

Australia), and Helen Gibbons (Clinical Lead<br />

Nurse, UK). These speakers are internationally<br />

renowned for their clinical and scientific<br />

expertise and their dynamic presentations.<br />

They will be joined by a further 60 speakers<br />

covering a very wide range of topics including<br />

anterior segment, cornea, cataract, uveitis,<br />

glaucoma, retina, paediatrics, oculoplastics,<br />

oncology, infectious disease, trauma, health<br />

care provision, nursing, psychophysics, basic<br />

science and emerging technologies.<br />

The conference will be held at the Hilton<br />

Hotel which sits in a prime waterfront location<br />

in the heart of Auckland, adjacent to all the<br />

central Auckland shopping and entertainment<br />

venues.<br />

We would like the conference to have a<br />

relaxed, collegial, “weekend” feel, and as such,<br />


Auckland ‘city of sails’ and RANZCO NZ <strong>2018</strong> Meeting venue, the Hilton Hotel (centre,<br />

waterfront)<br />

the dress code is casual.<br />

The conference dinner will be held at<br />

The Maritime Museum, an iconic venue in<br />

Auckland, that celebrates New Zealand’s long<br />

and broad association with the sea. In line with<br />

the casual tone of the meeting, the dinner<br />

will offer a wide variety of quality street food,<br />

street entertainers, and a live band.<br />

We are very grateful to the multiple industry<br />

sponsors who are facilitating the meeting<br />

and there will be a large industry exhibition,<br />

covering the latest and greatest ophthalmic<br />

technology available in New Zealand.<br />

The venue has a set capacity and so we<br />

encourage early registration for what<br />

promises to be a broad ranging, contemporary,<br />

educational and fun meeting.<br />

To register, please visit: https://<br />

ranzcomeetingnz.cvent.com/<strong>2018</strong><br />

*Dr Sue Ormonde is a consultant ophthalmologist at Auckland<br />

Eye and Greenlane Clinical Centre, a senior lecturer at the<br />

University of Auckland and a member of the <strong>2018</strong> RANZCO<br />

NZ organising committee together with Professor Trevor<br />

Sherwin and Sue Raynel from the University’s Department of<br />

Ophthalmology.<br />

An enjoyable, educational<br />

affair<br />

The RANZCO New Zealand Annual Scientific<br />

Meeting is one of the most important<br />

meetings in the New Zealand ophthalmic<br />

calendar and is unique in that it incorporates the<br />

New Zealand Ophthalmic Nurses Group Meeting<br />

and the New Zealand Orthoptic Society Meeting.<br />

The programme<br />

This year, the two-day programme from 11 – 12<br />

May at Auckland’s Hilton Hotel, features concurrent<br />

streams, focusing on each speciality, with<br />

presentations ranging from five to 25 minutes from<br />

more than 60 speakers (40 in the Scientific Meeting<br />

alone) followed by question and answer sessions<br />

from the floor.<br />

The programme kicks off with a welcome function,<br />

with canapés and drinks in the exhibitors’ hall of the<br />

Hilton on Thursday 10 May from 5.30-7.30pm. This<br />

year, the popular annual meeting dinner will be held<br />

on Friday 11 May in The Maritime Room, just a short<br />

walk from the Hilton, with views over Auckland’s<br />

famous Viaduct Harbour. As well as the normal good<br />

food, great atmosphere and general bonhomie, this<br />

year’s organisers are also promising a few surprises<br />

at the dinner, so definitely not one to be missed.<br />

The main Scientific Meeting this year welcomes<br />

a number of overseas specialist speakers, as<br />

well as a plethora of local talent, many of whom<br />

will be sharing their own unique experiences<br />

across a number of different, and often unusual,<br />

cases, including, ‘Duped by BDump’; an unusual<br />

presentation of systemic lupus erythematous; and<br />

panuveitis in Sweet’s syndrome.<br />

Other topics include, New Zealand cataract risk<br />

stratification, audit and paediatric surgical outcomes;<br />

psychophysics; the development of a novel webbased<br />

deep learning system, to identify common<br />

retinal pathologies, and an open-source pupilometer;<br />

Vogt-Koyanagi-Harada disease; orbital decompression<br />

surgery in thyroid eye disease; keratoconus in Down<br />

syndrome in New Zealand; corneal cross-linking<br />

outcomes; and, tackling that biggest of questions, oft<br />

lauded by eye health professionals: “are the eyes really<br />

the window to the soul?”<br />

Meet the speakers…<br />

And that’s just some of the smaller sessions. As<br />

a further taster of what’s on offer at this year’s<br />

RANZCO NZ gathering, NZ Optics’ approached the<br />

four keynote speakers from the Scientific Meeting<br />

and the Nurses Meeting and asked them to tell us a<br />

little bit about what they would be presenting, how<br />

they came to be working in ophthalmology and what<br />

they were most looking forward to from this years<br />

meeting.<br />

Professor<br />

David Mackey<br />

Internationally-renowned<br />

genetic ophthalmologist,<br />

Professor David Mackey is<br />

managing director of the<br />

Lions Eye Institute and<br />

professor of ophthalmology<br />

and director of the Centre<br />

for Ophthalmology and<br />

Professor David Mackey<br />

Vision Science at the<br />

University of Western Australia. Having devoted<br />

his career to decreasing blindness from optic nerve<br />

disorders, his work has helped revolutionise the<br />

management of hereditary optic atrophy (Leber and<br />

ADOA) and glaucoma.<br />

In 1993 he initiated the Glaucoma Inheritance Study<br />

in Tasmania, creating one of the largest glaucoma<br />

biobanks in the world that led to the discovery of the<br />

myocilin gene and its association with glaucoma.<br />

His work with the Twins Eye Study in Tasmania and<br />

Brisbane characterised the heritability of many ocular<br />

measurements, while his Genome Wide Association<br />

Studies have identified genes for myopia, corneal<br />

thickness, intra-ocular pressure optic nerve size and<br />

glaucoma. In 2007-8, he led the Norfolk Island Eye<br />

Study, examining 800 mixed-race descendants of<br />

the Bounty mutineers as part of a major genetic eye<br />

study. In Western Australia, he has collected ocular<br />



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10 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

DISCOVER AcrySof ® IQ<br />

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– Delivers on patients’ lifestyle needs<br />

• Exceptionally high light utilisation in a presbyopia-correcting IOL 1,6<br />

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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://<br />

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<br />

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<br />

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.<br />

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<br />

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).<br />

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

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<strong>April</strong> <strong>2018</strong><br />

Advancing<br />




SPECIAL FEATURE: RANZCO <strong>2018</strong><br />

Zeiss<br />

Clarus 500 is the next generation, ultrawidefield<br />

fundus imaging system from Zeiss,<br />

providing true colour and high-resolution<br />

across a 200-degree ultra-wide image.<br />

The true colour images are essential for<br />

differential diagnosis. Each can be split into<br />

red, green and blue channels. In addition,<br />

fundus auto-fluorescence images are<br />

available, displaying important information<br />

about RPE health. Utilising Zeiss optics, the<br />

Clarus 500 achieves seven-micron resolution,<br />

eyelash-free images allowing the user to<br />

zoom in to visualise fine details. Lastly,<br />

being based on a traditional fundus camera<br />

design and utilising an IR preview, the<br />

Clarus provides a more comfortable patient<br />

experience whilst avoiding inconvenient<br />

recaptures.<br />

Device Technologies<br />

Visit our stand at RANZCO NZ and experience<br />

the revolutionary Topcon Triton Swept<br />

Source OCT-A and other exciting innovations<br />

first hand. Learn more about our range<br />

of ergonomic and time-saving devices:<br />

EndoOptik endo-camera and laser system,<br />

Quantel lasers, a full range of chairs and<br />

stands, new polarised Frey VA charts and<br />

perimeters. Also on display will be the<br />

Maestro OCT providing a one-click wide<br />

scan plus all relevant retinal info. in a single<br />

report. It’s an easy to use, reliable, affordable<br />

and space-saving combo-OCT (anterior scan<br />

and networking available). Plus we have the<br />

agnostic Synergy Ophthalmic Data System<br />

which integrates virtually every ophthalmic<br />

device into one intuitive platform and is<br />

compliant with all the major international<br />

medical communication protocols.<br />


and environmental data on 2000 20-year old Raine<br />

Cohort participants. A follow-up study of these<br />

participants at age 27 commenced in 2017, while<br />

a new study he started in 2012 is examining the<br />

positive-negative effects of UV sun exposure.<br />

How did you come to focus on this area of eye<br />

health?<br />

I am an ophthalmic geneticist, which is an<br />

uncommon subspecialty in ophthalmology. I’ve<br />

always been interested in genetics, since school.<br />

During medical school, I was also fascinated<br />

by ophthalmology, so I combined them in my<br />

fellowships at the Royal Children’s Hospital<br />

in Melbourne, the Johns Hopkins Centre for<br />

Hereditary Eye Disease in the USA and Moorfields<br />

Eye Hospital in London.<br />

Genetics are at the cutting edge of science and<br />

we have been part of the major discoveries of<br />

genes associated with many different eye diseases.<br />

We learn new pathways for disease and can predict<br />

those at high risk, and in diseases like glaucoma or<br />

retinoblastoma we can intervene to reduce vision<br />

loss.<br />

Can you tell us about your talks this year?<br />

I am giving four talks. First, an overview of where<br />

genetics is taking us. Gene therapy to treat eye<br />

disease has been in the press a lot of late with a<br />

treatment just licenced in the US being marketed<br />

at $850,000! (Luxturna, NZ Optics Feb <strong>2018</strong>, p21).<br />

However, we need to consider genetic testing to<br />

prevent genetic eye disease, which may be cheaper.<br />

Plus, the new technologies for visually impaired<br />

people like smart phone apps and driverless cars<br />

offer an exciting future of independence. We need<br />

to follow all these paths.<br />

Second, we have been studying families to find<br />

glaucoma genes since the Glaucoma Inheritance<br />

Study in Tasmania began in 1994. In the coming<br />

months, several papers will show a large number<br />

of genes causing adult glaucoma are also the ones<br />

that cause childhood glaucoma.<br />

Third, there is a global epidemic of myopia, where<br />

a lack of time outdoors is a contributing factor.<br />

However, in Australia and New Zealand, where we<br />

already have the highest risk of skin cancer, what<br />

will happen if we send our kids outdoors more to<br />

prevent myopia?<br />

Fourth, a disease I studied for my doctorate thesis<br />

called Leber Hereditary Optic Neuropathy is now<br />

undergoing clinical trials for a new gene therapy.<br />

Dr Brendan Vote<br />

Dr Brendan Vote is<br />

a clinical associate<br />

professor with the<br />

University of Tasmania<br />

and a vitreoretinal and<br />

cataract specialist. He<br />

was a medical officer in<br />

the RAAF for six years<br />

before commencing his<br />

ophthalmology training<br />

in Dunedin and completing retinal fellowships in<br />

Auckland, Brighton and at Moorfields Eye Hospital<br />

in London. He established the Tasmanian Eye<br />

Institute in 2008 to offer research, educational<br />

and ophthalmic service to the Tasmanian<br />

community.<br />

He is currently involved in multicentre trials<br />

assessing intravitreal therapies in diabetic<br />

maculopathy, age-related macular degeneration<br />

(AMD) and vascular occlusion, including evaluating<br />

the long-term effectiveness of Lucentis for the<br />

treatment of MD in a large cohort of patients<br />

treated now for more than 10 years. He has also<br />

been an active researcher of femtosecond laser<br />

in cataract surgery through the first prospective<br />

comparative cohort study, which began in 2012.<br />

Can you tell us about your topics at RANZCO NZ?<br />

My first topic is ‘Lessons from my 10+ year macular<br />

degeneration relationship utilising intravitreal<br />

injections’; the second is, ‘Cataract surgery and a<br />

doctor’s role in emerging technologies’; the third,<br />

‘CRISPR-Cas 9 is the exponential game changer<br />

in gene therapy; and the fourth, ‘Crypto currency,<br />

Blockchain and healthcare – a dystopian future or<br />

necessary evolution?’.<br />

I am always excited by the technological<br />

breakthroughs we are making. But I like to see<br />

how these will apply in the real world beyond the<br />

marketing and hype. I suppose that makes me an<br />

enthusiastic sceptic; keen to try new things but<br />

looking for the evidence it works.<br />

What are you looking forward to at this year’s<br />

meeting?<br />

I think the New Zealand meeting is one of the best,<br />

as it has the perfect mix of science and social, so I<br />

always look forward to attending.<br />

I enjoy hearing from speakers without industry<br />

associations presenting their research and insights.<br />

The New Zealand RANZCO Branch meeting has<br />

always had this balance and I think this is where<br />

more of our international scientific congresses<br />

need to head.<br />

Associate Professor<br />

Lyndell Lim<br />

Associate Professor<br />

Lyndell Lim is principal<br />

research fellow at the<br />

Centre for Eye Research<br />

Australia (CERA) at the<br />

University of Melbourne,<br />

where she also heads the<br />

Clinical Trials Research<br />

Unit. A consultant<br />

ophthalmologist at the Royal Melbourne Hospital<br />

and the Royal Victorian Eye and Ear Hospital<br />

(RVEEH), where she leads the Ocular Immunology<br />

Clinic, her sub-specialities include medical retina<br />

and ocular inflammatory disease. Her current<br />

areas of research include the possible role of<br />

inflammation in the pathogenesis of several<br />

retinal diseases such as AMD, as well as clinical<br />

studies in diabetic retinopathy and uveitis.<br />

At RANZCO NZ, A/Prof Lyndell Lim will be<br />

presenting on cataract surgery in patients with<br />

uveitis and diabetic macular oedema; and ‘the rise<br />

and rise of infectious uveitis’. Other topics to be<br />

confirmed.<br />

Why eye health and research?<br />

I became a doctor because I liked the idea of<br />

helping people; an ophthalmologist, as it’s the<br />

perfect blend of medicine and surgery; a uveitis<br />

specialist, because no one patient with uveitis is<br />

the same and there are so many unknowns; and a<br />

researcher because it presents the chance to make<br />

a real difference to patients’ lives.<br />

As a doctor, you can help hundreds to thousands<br />

in your lifetime of work. But as a researcher, you<br />

have the chance to help millions.<br />

What are you most excited about for this year’s<br />

meeting?<br />

The chance to talk about uveitis and my research<br />

is always fun, especially with such a nice group of<br />

people.<br />

Ophthalmic nurses<br />

keynote: Helen<br />

Gibbons<br />

Heading up the New<br />

Zealand Ophthalmic<br />

Nurses Group Meeting,<br />

Helen Gibbons is currently<br />

the clinical lead nurse<br />

(education and research)<br />

at Moorfields Eye Hospital<br />

in London. She has<br />

extensive clinical ophthalmology experience in<br />

pre- and post-operative care, out-patients and<br />

establishing a nurse-led ophthalmic emergency<br />

clinic within a district general hospital. Gibbons<br />

was the first nurse to be trained to perform<br />

Nd:YAG laser capsulotomy and Nd:Yag laser<br />

iridotomy. She has used her knowledge to help<br />

develop more skilled nursing roles in a new eye<br />

hospital in Accra, Ghana, and visits every 18<br />

months to support the team.<br />

How did you come to your profession?<br />

At 18, I had a place to undertake my Enrolled<br />

Nurse training but there was an 18-month wait,<br />

so I got a job as a nursing auxiliary which was on<br />

an ophthalmic ward. I loved ophthalmology. The<br />

only other speciality I considered was cardiology,<br />

however, on qualifying I was one of two people<br />

from my set to be offered a job, mine was parttime<br />

so I decided to apply back to my old ward and<br />

focus on ophthalmology.<br />

Throughout my career the patients have always<br />

been my main focus. As a nurse practitioner, I<br />

enjoyed treating my patients independently giving<br />

the best care I could and when performing YAG laser<br />

capsulotomies, I never tired of seeing the joy of<br />

patients’ vision improving. Now, as an educator, I get<br />

so much pleasure out of supporting and developing<br />

future ophthalmic nurses, but I still enjoy patient<br />

contact when I support staff in their clinical areas.<br />

What are you focusing on at RANZCO NZ?<br />

I am giving five presentations at the conference:<br />

how we train our staff to understand what it’s like<br />

to have a visual impairment; the research link nurse<br />

programme we have introduced at Moorfields to<br />

encourage nurses to take part in nursing research<br />

and audit; advance practice roles for nurses at<br />

Moorfields; the ‘New to Ophthalmology’ Induction<br />

programme for staff new to ophthalmology; and<br />

my work in Korle Bu, West Africa. All the topics are<br />

relevant to everyday practice and I have learnt from<br />

each experience and subject.<br />

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

Corneal Lens Corporation (CLC)<br />

Corneal Lens is very excited to be showcasing<br />

our new eyecare range at the RANZCO NZ<br />

conference.<br />

Our premium range Evolve highlights four<br />

different formulations which are designed<br />

to target specific areas of dry eye. The<br />

Evolve range is a generation 2 technology,<br />

preservative-free delivery system, which<br />

gives the multi-dose benefits of a single dose<br />

unit with the familiarity of a standard bottle.<br />

It has a soft, squeezable bottle to improve<br />

ease of use offering the blue-tip technology<br />

designed to improve accuracy of dispensing<br />

a drop and maintaining a preservative-free<br />

environment. The Evolve range consists of HA<br />

2, Carmellose 0.5%, Hypromellose 0.3% and<br />

Eyelid Wipes.<br />

Designs for Vision<br />

Designs for Vision is turning 40 and is<br />

thrilled to be associated with RANZCO NZ.<br />

To celebrate, DFV has assembled a number<br />

of state-of-the-art instruments for delegates<br />

to view and to talk to the experts about. The<br />

Oculus Pentacam AXL, the gold-standard<br />

for anterior segment analysis, now comes<br />

with biometry including Barrett in the IOL<br />

calculator. Combine this with the Corvis<br />

ST for true IOP measurement, incredibly<br />

sensitive ectasia detection and cross-linking<br />

visualisation – the complete package for<br />

the glaucoma and refractive surgeon. Also<br />

on show will be the Tomey OA-2000 Optical<br />

Biometer: topography, pachymetry, axial<br />

length, pupil diameter, Barrett, all at a class<br />

leading price.<br />

12 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>




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Other product names/brand names are trademarks of their respective owners. Bausch & Lomb (New Zealand) Ltd<br />

c/- Bell Gully Auckland, Vero Centre, 48 Shortland Street, Auckland 1140, New Zealand. Marketed by Radiant Health Ltd.<br />

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<strong>April</strong> <strong>2018</strong><br />



SPECIAL FEATURE: RANZCO <strong>2018</strong><br />

What’s on in Auckland in May…<br />

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

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

few on offer in May for those attending the <strong>2018</strong> RANZCO NZ conference who want to make a little<br />

more of their stay.<br />

Body Worlds exhibition 23 <strong>April</strong> to 13 July, the<br />

Hilton Hotel<br />

https://www.bodyworldsvital.com<br />

The highly anticipated and internationally<br />

acclaimed original exhibition of real human bodies<br />

is being hosted by the same venue as RANZCO NZ<br />

<strong>2018</strong>, the Hilton Hotel. Visited by more than 45<br />

million people worldwide, the exhibition takes<br />

you on an intricate journey of the workings of the<br />

human body, through an authentic, visual display<br />

of over 150 donated specimens.<br />

The human bodies and body parts, donated for<br />

the benefit of public education, have gone through<br />

a meticulous year-long process of plastination, and<br />

Evolve ® Hypromellose 0.3%<br />

For Moderate<br />

Dry Eye<br />

Evolve ® Carmellose 0.5%<br />

Evolve ® HA - Sodium Hyaluronate 0.2%<br />

Evolve ® Eyelid Wipes<br />

For Mild<br />

Dry Eye<br />

For Severe<br />

Dry Eye<br />

14 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong><br />

For<br />

Daily<br />

Eyelid<br />

Hygiene<br />


Corneal Lens Corporation<br />

sales@corneal-lens.co.nz<br />

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visually demonstrate the complexity, resilience<br />

and vulnerability of the human body in distress,<br />

disease and optimal health.<br />

World of Wine Festival 12-13 May, AUT’s City<br />

Campus, opposite Auckland Art Gallery<br />

https://theworldofwinefestival.nz/<br />

New Zealand’s newest wine festival, is our first to<br />

showcase purely international wines, designed to<br />

open Kiwi sauvignon blanc drinkers’ eyes to new<br />

producers, wineries, grapes, regions and styles.<br />

The Auckland University of Technology’s (AUT’s)<br />

Tasting Hall will play host to more than 130 wines<br />

from 13 countries and a revolving wine bar. The<br />

weekend also includes master classes and<br />

special events, such as the Mas Daumas<br />

Gassac vertical tasting, when the Southern<br />

French winery’s head wine-maker Samuel<br />

Guibert, will host a multi-vintage tasting of<br />

the company’s legendary Grand Vin Blanc<br />

and Rouge wines.<br />

Mrs Warren’s Profession 1 – 16 May, ASB<br />

Waterfront theatre, Wynyard Quarter<br />

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

When Vivie discovers that her expensive<br />

education was funded by her mother’s<br />

earnings from a string of brothels, Vivie’s<br />

thoroughly modern worldview is thrown<br />

into tumult. Written in 1893, George<br />

Bernard Shaw’s play was originally banned<br />

by the censors for its subject matter and<br />

the hypocrisies it exposed. What continues<br />

to shock is how old taboos stay topical and<br />

how little things have changed.<br />

Celebrated New Zealand theatremaker<br />

Eleanor Bishop returns from New<br />

York to direct her own version of this<br />

rarely-performed classic that takes a<br />

Radiant Health &<br />

Bausch+Lomb<br />

Bausch + Lomb (B+L) is excited to<br />

announce the launch of the next<br />

generation Stellaris Elite phaco<br />

system with ‘adaptive fluidics’.<br />

Join us at the Radiant Health and<br />

Bausch+Lomb stand at RANZCO<br />

NZ where we will be showcasing<br />

Stellaris Elite, and find out about<br />

other new products B+L will have for<br />

<strong>2018</strong>, especially in the VR segment.<br />

We will also be demonstrating<br />

Finevision trifocal and enVista IOLs.<br />

Stem cells<br />

restore<br />

sight<br />

Two patients with severe wet<br />

AMD, implanted with a speciallyengineered<br />

retinal pigment<br />

epithelium cells patch, derived from stem<br />

cells, have regained their reading vision<br />

in a ground-breaking clinical study at<br />

Moorfields Eye Hospital in London.<br />

The study investigated whether the<br />

diseased cells at the back of the patients’<br />

affected eye could be replenished using the<br />

stem cell-based patch. The patients were<br />

monitored for 12 months and went from<br />

not being able to read at all to reading with<br />

normal reading glasses.<br />

The study, published in Nature Biotech, is<br />

a major milestone for the London Project<br />

to Cure Blindness, a partnership between<br />

Professor Pete Coffey from University<br />

College London and Professor Lyndon da<br />

Cruz, a Moorfields retinal surgeon.<br />

contemporary lens to centuriesold<br />

questions of sexuality and<br />

empowerment.<br />

‘Let me be myself’ – the story<br />

of Anne Frank 9 Feb to 13 May,<br />

Auckland Museum<br />

http://www.aucklandmuseum.com/<br />

visit/exhibitions/let-me-be-myself<br />

Developed by Anne Frank House<br />

in Amsterdam, this international<br />

exhibition ‘Let Me Be Myself’ explores<br />

what life was like for Anne Frank<br />

and her family, looks at the events<br />

surrounding the Holocaust and the<br />

rise of the Nazi Party in Germany and<br />

explores identity, prejudice, exclusion<br />

and discrimination.<br />

Best Comedy Show on Earth 13 May,<br />

Sky City<br />

https://www.skycityauckland.co.nz/<br />

whats-on/theatre/best-comedyshow-on-earth/<br />

Ten comedians, 100s of jokes and thousands of<br />

laughs, get a sneak peak of the Auckland Comedy<br />

Fest’s brightest stars and freshest talent in this<br />

fast-paced stand-up showcase, billed as having<br />

something to suit everyone.<br />

Dans le Noir? Dining in the dark Thursday, Friday<br />

and Saturday, from 6:30pm to 7:30pm, Rydges<br />

Hotel<br />

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

Presented by Auckland’s Rydges Hotel and the<br />

Blind Foundation, Dans le Noir is a unique, sensory<br />

dining experience where patrons eat in complete<br />

darkness, guided and served by low vision or blind<br />

people. More than 1.3 million people have already<br />

lived this experience worldwide. Organisers say<br />

Swept Source OCT Angiography<br />

RA:28042016/CS<br />

The internationally-acclaimed ‘Body Worlds’ exhibition also at the Hilton<br />

Jennifer Ward-Lealand stars in Mrs Warren’s Profession<br />

DRI OCT Triton Plus<br />

Multi-Modal Imaging<br />

OCT-1Triton<br />

First combined anterior and posterior<br />

swept source Extremely fast scanning speed<br />

DRI<br />

100,000 A/Scans secondSeries<br />

Retinal Journal 1021r1.indd 1<br />

Swept Source OCT now with 1050nm OCT invisible wavelengths Angiography<br />

penetrates<br />

Cataracts and Haemorrhages<br />

See. Discover. Explore.<br />

Feeder vessels in a CNV with GA<br />

OCT Angiography image taken with a Topcon OCT Triton<br />

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

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

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

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

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

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

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Color FA FAF OCT-A<br />

1. Not for sale in the US.<br />

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DRI OCT-1Trito<br />

Swept Source OCT now with OC<br />

See. Discover. Exp<br />

Feeder vessels in a CNV with GA<br />

Auckland plays host to NZ’s first international wine show in May<br />

a full immersion in this sensual dining adventure<br />

will impress you as a once in a lifetime experience.<br />

OCT Ang<br />

Courtesy of Dr. Carl Glittenberg, MD Karl Lans<br />

The Topcon Swept Source DRI OCT-1 Triton Series 1<br />

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

imaging.The DRI OCT-1 Model Triton rapidly penetrates all ocular tiss<br />

media opacity or hemorrhage. See you at AAO Booth 3732.<br />

Color FA FAF OCT-A<br />

1. Not for sale in the US.<br />

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

ONZ: Ophthalmology<br />

with one voice<br />


The board of ONZ is delighted<br />

to announce that we have<br />

welcomed many new members<br />

to the organisation over the last<br />

four months. With 85 members,<br />

ONZ truly represents the majority of<br />

ophthalmologists in New Zealand.<br />

This growth in membership is due to<br />

two factors, a more visible profile and<br />

a wish on behalf of ophthalmology to<br />

speak with one voice on current affairs.<br />

With this voice, ONZ can unite our<br />

ophthalmologists, giving them the<br />

tools and techniques to deal with the<br />

many commercial issues in their field.<br />

This initiative is never more important<br />

than now with ophthalmologists<br />

facing many challenges in funding in<br />

both the private and public sectors. As<br />

their central representative body, we<br />

are forging relationships with providers<br />

and advisors. We are fortunate to have<br />

great resources on the board, but more<br />

importantly amongst our members. Let<br />

us not succumb to the Kiwi “she’ll be<br />

right” attitude, evidenced elsewhere,<br />

such as Auckland traffic and Hawke’s<br />

Bay water, two prime examples of poor<br />

leadership and planning.<br />

ONZ’s role to represent<br />

ophthalmologists and their patients’<br />

interests can already be seen in our<br />

lobbying of insurers for the Xen<br />

implant, MIGs in general and Ozurdex.<br />

We have worked within the board but<br />

also had great engagement from Sonya<br />

Bennett to move a plan and direction<br />

forward, in a coordinated fashion,<br />

for funders to come to the party on<br />

technology for glaucoma care. Another<br />

example, with thanks to Rebecca Stack,<br />

is our support and facilitation of the<br />

Clinical Leaders Forum on 27 March in<br />

Wellington. Plus, there is our Business<br />

Forum, ‘The Other Matters’ (see below),<br />

which will run just after the RANZCO<br />

NZ Branch meeting in May in Auckland.<br />

We will be asking members to help<br />

us coordinate our efforts over the next<br />

few weeks by way of information and<br />

thoughts, but also by directing general,<br />

non-contract insurance queries to<br />

ONZ. This will help ophthalmologists<br />

to speak with one voice on behalf of<br />

all our members, old and new. We<br />

also expect to increase our presence<br />

at meetings and via email to let<br />

you all know we are now working<br />

in a unified fashion to amplify the<br />

voice of concerned New Zealand<br />

ophthalmologists.<br />

ONZ: The Other Matters<br />

This year, in an attempt to ensure more<br />

members can attend, we will hold<br />

our ONZ Business Forum on Saturday<br />

12 May, from 5pm to 7 pm at the<br />

Hilton, directly following the RANZCO<br />

NZ Branch meeting. Please join us<br />

for this event and drinks afterwards.<br />

Invites will be issued shortly or see our<br />

website for information.<br />

Finally, ONZ is helping to find<br />

placements for the RANZCO-sponsored<br />

ophthalmology leadership programme.<br />

If you are interested, or know of<br />

someone who is interested, please<br />

email us at admin@ophthalmologynz.<br />

co.nz.<br />

RANZCO to run Foundation<br />

The Royal Australian and New Zealand College of<br />

Ophthalmologists (RANZCO) has wound up its charitable<br />

arm, the Eye Surgeons’ Foundation (ESF) as a separate legal<br />

entity and will run its own version, together the administration<br />

of its research arm, the Ophthalmic Research Institute of<br />

Australia (ORIA) in-house to save costs.<br />

The ESF had been operating for 15 years to raise money<br />

to support medical research and sustainable development<br />

projects across the Asia-Pacific region. “In recent years the<br />

pressures of an increasingly competitive charity sector<br />

have meant that it has been difficult to build a sustainable<br />

fundraising base to meet the costs of a standalone charitable<br />

organisation,” said Dr David Andrews, RANZCO CEO. “It was<br />

clear, therefore, that changes to the organisational model<br />

were required to ensure that the support provided by ESF<br />

fundraising could be continued.”<br />

The ESF Board decided to wind up ESF on 30 September 2017<br />

and made their final distribution of funds to international<br />

development projects. To ensure the ESF legacy continues,<br />

however, the majority of its functions are being taken in-house<br />

where the running costs can be reduced, said Dr Andrews.<br />

New worm found in eye<br />

A<br />

new<br />

species of parasitic nematode has now been<br />

identified in three previously healthy, relatively young<br />

residents of Saipan, the largest island of the USmanaged<br />

Northern Mariana Islands in the Pacific.<br />

According to a case report published by the Marianas Eye<br />

Institute in the American Journal of Ophthalmology, the three<br />

patients, identified over a 20-year period, all had the same<br />

unidentified worm in their eyes, causing corneal opacification,<br />

conjunctival injection and uveitis.<br />

“This is a fascinating series of cases,” said Dr David Khorram, the<br />

co-founder and prior ophthalmologist at Marianas Eye Institute.<br />

“When the first patient came into us in 1997 with a live worm in<br />

their eye, we knew we were seeing something never seen before.<br />

We weren’t sure what to do. We tried removing the worm which<br />

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

die. Finally, with the help of Dr Stephen Gee in Hawaii, a special<br />

technique was used to successfully extract the worm.”<br />

The first worm was handed to a pathologist for analysis and<br />

identification, but was lost, while the second worm to be found<br />

(some years later) was removed, but was not intact and could<br />

RANZCO is now looking to appoint a new “Foundation<br />

committee”, including representatives from its indigenous and<br />

international development committees, the ORIA Board and Save<br />

Sight Society NZ and RANZCO fellows interested in philanthropy<br />

and education, to run an in-house version, which can continue to<br />

raise funds for education and research. RANZCO will be able to<br />

accept donations from Australian members directly or from New<br />

Zealand members through the NZ Branch, though not from the<br />

public, except as bequests. The donations will be used to fund<br />

early stage research through ORIA, and education programmes.<br />

ORIA<br />

ORIA will also be administered in-house by RANZCO following<br />

the retirement of executive officer Anne Dunn-Snape last year,<br />

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

the situation with ESF, ORIA remains a separate legal entity,<br />

though much of the day-to-day administration will now be<br />

run by RANZCO staff, again providing reduced overheads for<br />

ORIA and maximising the benefit that can be achieved with<br />

the available funds, explained Dr Andrews. The ORIA Board will,<br />

however, continue to manage the research organisation and set<br />

its direction and strategic priorities.<br />

not be successfully analysed<br />

or identified. The third and<br />

final case was identified in<br />

2008. The worm was removed<br />

intact and sent for analysis<br />

Intrastromal haze and poorly visible worm<br />

inferiorly (circled)<br />

and identification to the Armed Forces Institute of Pathology in<br />

Washington, DC, and was found to be a completely new parasite.<br />

The published case report describes the details of each of the<br />

three cases, showing that each worm was an isolated finding,<br />

with no other worms found in other parts of the body. All the<br />

patients were young and healthy. It is not known how the<br />

worm entered the eye, but it is speculated that it was probably<br />

introduced through an insect bite and grew within the body,<br />

migrating to the cornea, said Dr Khorram. “Although these are<br />

the first three reported cases in the world, now that doctors<br />

know that a tiny worm can live in the cornea, we are certain<br />

that more cases will be found.”<br />

Future clinical findings regarding this newly described<br />

nematode are needed to further develop understanding of the<br />

disease, he added.<br />

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<strong>April</strong> <strong>2018</strong><br />



SPECIAL FEATURE: RANZCO <strong>2018</strong><br />

ANZGS <strong>2018</strong><br />

Toomac Ophthalmic<br />

Toomac Ophthalmic is proud to introduce<br />

the latest development in MIGS, the Glaukos<br />

iStent inject, a tiny surgical implant that can<br />

effectively lower IOP in adult patients with<br />

mild to moderate open-angle glaucoma.<br />

Trabecular micro-bypass technology<br />

developed by Glaukos has taken a leap<br />

forward with the new titanium microbypass<br />

stent that’s preloaded in a single-use<br />

sterile inserter. Come and see our stand at<br />

RANZCO NZ, where Ian and Mark together<br />

with the Glaukos representative will be<br />

happy to answer all your questions. Also<br />

new for RANZCO NZ is the MALOSA singleuse<br />

instrument range. See us for a bespoke<br />

surgical pack.<br />

Allergan – Xen<br />

The latest innovation in glaucoma<br />

management, the XEN Gel Implant, is<br />

now available in New Zealand for patients<br />

whose condition is not well managed with<br />

glaucoma drops. The unique technology<br />

is based on the same principle as<br />

trabeculectomy, creating a new outflow<br />

channel bypassing trabecular and scleral<br />

resistance forming a diffuse, low-lying bleb.<br />

As the technique becomes more familiar,<br />

the XEN procedure can offer a less intensive<br />

and less time-consuming alternative to<br />

the mainstay trabeculectomy. In the APEX<br />

clinical study, 70% of patients with XEN<br />

achieved an IOP of ≤ 15mmHg following the<br />

treatment with a significant reduction in<br />

glaucoma drop use. See the Allergan stand<br />

for more.<br />


This was the first gathering of the group<br />

formerly known as ANZGIG, now the<br />

Australian and New Zealand Glaucoma<br />

Society (ANZGS), where glaucoma subspecialists<br />

from the region come together to meet colleagues,<br />

discuss difficult cases and gain insights from both<br />

local and international speakers.<br />

This year’s conference in Sydney from 23 to 24<br />

February commenced with presentations on a<br />

variety of rare conditions and challenging cases<br />

with robust discussion about different approaches.<br />

The second session of paper presentations<br />

included two projects introducing new technology<br />

into patient testing. The first showed that an<br />

iPad-based perimetry programme could deliver<br />

similar results to a Humphrey visual field analyser.<br />

While there are some minor technical issues to<br />

fine tune, this is a promising development. The<br />

second looked at use of home tonometry to detect<br />

significant diurnal IOP variation in patients whose<br />

clinic IOPs had been unremarkable but whose<br />

glaucoma was progressing.<br />

The afternoon started with a fascinating nonophthalmic<br />

lecture by invited speaker Mr Peter<br />

Ellerton from the University of Queenslands’<br />

Critical Thinking Project. He delivered a thoughtprovoking<br />

lecture on the nature of critical thinking<br />

and deliberate practice in gaining and maintaining<br />

skills or expertise. It highlighted the importance<br />

of contact with our peers to challenge biases that<br />

may influence our decision making.<br />

This was followed by Professor John Salmon,<br />

from Oxford University who shared his views on<br />

‘Diagnosing glaucoma. The seven deadly sins’.<br />

These included the mistakes of not taking a good<br />

history, not doing gonioscopy, not using sufficient<br />

magnification to examine the optic disc (leading<br />

to disc haemorrhages being overlooked) and not<br />

correlating disc changes with visual field findings.<br />

These ‘sins’ were illustrated by cases from his<br />

vast clinical experience and even for those seeing<br />

glaucoma patients on a daily basis they were a<br />

timely reminder of possible pitfalls.<br />

Dr Shenton Chew from Auckland outlined the<br />

campaign he was involved in to try and highlight<br />

the burden of overdue follow-up patients and<br />

Drs Nicholas Johnston and Sonya Bennett at ANZGS<br />

showed how well-organised patient advocacy can<br />

achieve tangible results.<br />

A number of new treatment techniques were<br />

showcased at the meeting, including Associate<br />

Professor Paul Chew from the National University<br />

of Singapore who discussed the increasing use<br />

of micropulse diode laser in different clinical<br />

situations. Another promising new technique<br />

was the use of tissue glue in reducing the size of<br />

dysaesthesetic trabeculectomy blebs.<br />

Associate Professor Paul Healey from Sydney gave<br />

the Gillies lecture titled ‘100 years of progress in<br />

glaucoma’. This highlighted three paradigm shifts<br />

that have occurred over this time. The first was the<br />

move from using IOP as a defining feature to a risk<br />

factor in glaucoma. The second was to understand<br />

the chronic nature of glaucoma so that when we<br />

assess patients with glaucoma we are considering<br />

both the current state (determining how it may<br />

be affecting quality of life) and also the rate of<br />

progression (how the patient is likely to be affected<br />

in the future). Lastly, he presented data showing<br />

low rates of glaucoma medication adherence in<br />

Australia. This showed the importance of patient<br />

education and participation in treatment decisions<br />

given that for many patients their only symptoms<br />

are from the treatments we prescribe.<br />

Professor Salmons’ final talk detailed the seven<br />

Drs Jesse Gale and Graham Reeves at ANZGS<br />

types of challenging patients who require glaucoma<br />

surgery. Most in the audience could think of patients<br />

who fell into at least one of these categories.<br />

These included “the patient who has researched<br />

the options on the internet”, “the patient at risk of<br />

visual loss from the surgery” and the “the patient no<br />

one else will do”.<br />

The final session covered minimally-invasive<br />

glaucoma surgery (MIGS) with a collection of<br />

experts sharing their experience with different<br />

devices including the iStent inject and the Cypass<br />

supraciliary stent and offering advice on patient<br />

selection and technical tips. Associate Professor<br />

Michael Coote from Melbourne gave a salient talk<br />

about the costs involved with adding these new<br />

techniques to our armamentarium, both in terms<br />

of the financial costs and the risk of losing skills<br />

needed for traditional glaucoma surgery.<br />

Overall this was a very interesting meeting and<br />

I look forward to next year when it will be timed<br />

to coincide<br />

with the World<br />

Glaucoma<br />

Congress in<br />

Melbourne.<br />

*Dr Graham Reeves is a glaucoma subspecialist practicing at<br />

Manukau Superclinic and the Eye Institute.<br />

Rethink glaucoma management<br />

The power of simplicity 1<br />

Reference: 1. Allergan XEN directions for use.<br />

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

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.<br />

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,<br />

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.<br />

16 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

ANZCS <strong>2018</strong><br />


This year’s annual Australia and New Zealand Cornea Society<br />

(ANZCS) meeting was held in Sydney in February and was<br />

organised by Drs Con Petsoglou, Noni Lewis and Chameen<br />

Samarawickrama and Jane Treloggen from the NSW Tissue Bank.<br />

The well attended meeting, originally developed by Professor<br />

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

year’s gathering was the InterContinental Hotel, set back from the<br />

bustling Circular Quay which had been wonderfully decorated for the<br />

‘Year of the Dog’ Chinese New Year Festival.<br />

In the first session, entitled ’Cutting Edge’, invited guest speaker<br />

Associate Professor Jod Metha of the Singapore National Eye Centre<br />

kicked off proceedings with an interesting talk on developing nonsurgical<br />

therapies for TGFBI (transforming growth factor beta-induced<br />

gene) dystrophies by identifying peptide targets to reduce corneal<br />

opacity formation. Dr Greg Moloney then described his experiences<br />

introducing a successful keratoprosthesis service in Sydney, using the<br />

osteo-odonto keratoprosthesis (OOKP) technique, with his colleague<br />

and friend Dr Shannon Webber who provides maxillofacial expertise.<br />

Professor Gerard Sutton from the Save Sight Institute introduced<br />

the iFix pen and iFix bio-ink, which was the winner of the inaugural<br />

‘Big Idea’ research funding challenge last year. His 3D-printed<br />

technology promises the exciting prospect of a biocompatible<br />

transparent ‘ink’ delivered by a handheld device that actually<br />

facilitates cell proliferation and thus ulcer repair.<br />

Dr Petsoglou and microbiologist Professor Wieland Meyer provided<br />

a detailed account of the recent ‘therapeutic goods recall’ by the<br />

Lions NSW Eye Bank following an apparent cluster of cases of candida<br />

endophthalmitis in DSAEK cases with pre-cut tissue. The honest and<br />

detailed account of the course of events and thorough investigation<br />

provided reassurance to surgeons of the quality and safety of service<br />

strived for.<br />

The annual report from the Australian Corneal Graft Registry was<br />

received with interest, as usual. The number of DMEK cases continues<br />

to rise with good visual outcomes, but reduced survival compared<br />

with penetrating keratoplasty and Descemet’s stripping endothelial<br />

keratoplasty (DSEK) in-keeping with results from around the world.<br />

But the numbers remain small and the follow-up short for now.<br />

Professor Stephanie Watson presented the Keratitis Antimicrobial<br />

Resistance Surveillance Program (KARSP) update. Resistance remains<br />

low and is stable; others were encouraged to join the programme.<br />

The first day concluded with a debate on whether femtosecondassisted<br />

pterygium surgery was a ‘welcome application of new<br />

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

against reflected the scientific but still humorous tone of the<br />

meeting! For now, at least, the audience was not swayed towards the<br />

femtosecond technique.<br />

The relaxed and informal meeting dinner, hosted in The Pavilion in<br />

the Royal Botanical Gardens, was a welcome opportunity to catch up<br />

with colleagues and meet new friends, and was very well attended.<br />

It was a particularly pleasure to chat to invited guest speaker Dr Mike<br />

Straiko, from the Devers Eye Institute in Portland, Oregan, prior to his<br />

informative and instructive talk which began the DMEK session on<br />

Saturday morning. His presentation was full of videos and pearls of<br />

wisdom for those starting out with this often tricky to master technique<br />

for replacing Descemet’s membrane and the corneal endothelium with<br />

a true anatomical likeness. The significantly lower rejection risk of DMEK<br />

versus DSEK and PK and the improved quality of vision remains the<br />

significant attraction for mastering this technique. There were more tips<br />

to come the following day too, for those attending the Sydney DMEK<br />

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

Mehta and Drs John Males and Andrew Apel.<br />

Later on the Saturday, Professor Minas Coroneo presented cases of<br />

ocular surface squamous neoplasia (OSSN) treated medically with<br />

retinoic acid and interferon, and topical cidofovir for refractory cases,<br />

with very promising success.<br />

This year’s Blandford Lecture was given by Professor Gordon Wallace<br />

of the University of Wollongong who provided a fascinating look at<br />

3D bio-printing and its exciting potential applications in medicine<br />

and ophthalmology.<br />

The next session<br />

focused on crosslinking<br />

with talks<br />

covering the use of a<br />

soft contact lens to<br />

allow treatment of thin<br />

corneas; iontophoresis;<br />

combining the treatment<br />

with intra-stromal<br />

corneal ring segments in<br />

anisometropic patients<br />

from asymmetric disease<br />

with clear corneas; and<br />

Professors Gordon Wallace and Charles McGhee<br />

the effective treatment of<br />

children. Attention was<br />

drawn to the potential for rapid progression in children with need for<br />

close monitoring. The Doug Coster lecture titled ‘Corneal endothelial<br />

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

The afternoon then split into concurrent sessions on eye banking<br />

and ‘News from the lab’ focusing on dry eye, which included<br />

Auckland’s own Associate Professor Jennifer Craig as one of the<br />

speakers. Topics discussed in this session included how a poor blink<br />

can lead to ‘drop-out’ and atrophy of the meibomian glands and<br />

how blink exercises can be helpful; how intense pulsed light (IPL)<br />

can restore meibomian gland function with an accumulative effect;<br />

and how the cholesterol-lowering agent, atorvastatin, is being<br />

investigated as a novel treatment for evaporative dry eye.<br />

Dr Tom Cuneen then shared how patients with Stevens Johnson<br />

Syndrome, the rare blistering skin reaction that can devastate the<br />



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

femtosecond laser-assisted pterygium debate<br />

ocular surface, can benefit from early amniotic membrane transplant.<br />

He described his effective surgical technique that can be performed<br />

outside the operating theatre, if necessary.<br />

The conference then ended with an interesting interactive complex<br />

case presentation and video session.<br />

Overall the meeting provided open, in-depth discussion with<br />

informative and entertaining speakers in a friendly and informal<br />

manner. There is a lot of exciting research in the field of cornea and<br />

I, for one, am looking forward to seeing where bio-printing, corneal<br />

endothelial regeneration and novel treatments for previous ‘surgical’<br />

diseases will take us next.<br />

*Dr Jennifer Court is a senior corneal fellow at the Department of Ophthalmology at<br />

the University of Auckland<br />

OptiMed<br />

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at RANZCO NZ <strong>2018</strong>. Come and visit the OptiMed NZ booth<br />

to view our latest technology. Be sure to check out the<br />

Eidon Ultra-Wide Field Confocal Scanner for high-resolution<br />

fundus imaging as well as other innovations and diagnostic<br />

equipment. OptiMed NZ will have product specialists available<br />

to answer all your queries. Robert, Craig and Richard invite you<br />

to come and discuss your interests, have a chat or just “hang<br />

out”.<br />

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pathology sooner. Optomap images are a proven tool for<br />

effective clinical decision making with over 400 peer-reviewed<br />

studies showing the importance of Optomap imaging in<br />

diagnosis and treatment planning. Visit us at this year’s<br />

RANZCO NZ branch meeting to find out more about the latest<br />

technology from Optos. See ad on p10 for more details.<br />

TECNIS is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. All other trademarks are the intellectual property of their respective owners.<br />

AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW 2113. AMO Australia Pty. Limited (Incorporated in Australia) PO Box 401, Shortland Street, Auckland, 1140.<br />

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<strong>April</strong> <strong>2018</strong><br />


14/3/17 10:00 am<br />


SPECIAL FEATURE: RANZCO <strong>2018</strong><br />

Calling all Kiwi doctors to AUSCRS <strong>2018</strong><br />


This year’s annual meeting of the Australasian Society of Cataract<br />

and Refractive Surgeons (AUSCRS) will be held at Macquarie<br />

Conference Centre, Peppers (previously known as the Outrigger),<br />

Noosa from Wednesday 17 October to Saturday 20 October.<br />

Since its beginnings in 1996, AUSCRS has been the only local<br />

Australian and New Zealand annual meeting devoted to cataract and<br />

refractive surgery. Despite this, it remains poorly attended by New<br />

Zealand ophthalmologists many of whom are refractive surgeons<br />

and almost all of us are cataract surgeons. I’d like to encourage<br />

more attendance at our local meeting by New Zealand-based<br />

ophthalmologists many of whom would find this a useful and very<br />

enjoyable meeting to attend.<br />

AUSCRS is a much less formal meeting than either the American or<br />

European cataract and refractive surgery meetings. Dress has always<br />

been casual with no jackets, suits or ties and the meeting has always<br />

intentionally been held at “resort” destinations in Australia and New<br />

Zealand, making it very “family friendly” to attend. The relaxed and<br />

friendly atmosphere, is also more than complemented by the high<br />

calibre of speakers drawn from across the world and locally.<br />

There’s lots of discussion and debate, and plenty of opportunity to<br />

freely discuss topics with both internationally-renowned and local<br />

experts, truly unrivalled by similar meetings. Another annual AUSCRS<br />

highlight and tradition is the imaginative themes and formats of<br />

the sessions, with local and international speakers often dressing<br />

up in entertaining costumes, sometimes bordering on the bizarre.<br />

It has been very entertaining over the years to see world-renowned<br />

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The Barrett formulas are now integrated<br />

in the IOL Calculator of the Pentacam ®<br />

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Barrett Universal II, Barrett Toric and<br />

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Drs Dean Corbett, Peter Ring, Michael Merrimen and David Kent demonstrating the more relaxed<br />

attire favoured at AUSCRS at the 2015 conference in Noosa<br />

ophthalmologists dressed up in amusing costumes debating often<br />

quite controversial topics.<br />

Some New Zealand ophthalmologists appear to be put off<br />

attending AUSCRS because of a perception the meeting is largely for<br />

refractive surgeons. This has never been the case and most of the<br />

meeting remains primarily concentrated on advances in cataract<br />

surgery. So any New Zealand ophthalmologist who performs cataract<br />

surgery would also find AUSCRS a very useful meeting to attend.<br />

Another unique part of AUSCRS is the advanced trainee session on the<br />

Wednesday morning where some of the leading Australasian cataract<br />

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and refractive surgeons present a series of educational lectures and<br />

interactive sessions for senior registrars and fellows. Feedback from<br />

registrars has always been very positive for this programme.<br />

The conference-proper starts with an opening street party on<br />

Wednesday evening, then there are three days of academic sessions on<br />

Thursday, Friday and Saturday with the Gold Medal Lecture on Thursday<br />

morning. The meeting finishes with the AUSCRS Gala Event on Saturday<br />

night, leaving Sunday for delegates to sight-see and travel home.<br />

The overseas speakers are yet to be announced for this year’s<br />

AUSCRS, but usually include some of the world’s leading cataract and<br />

refractive surgeons. Professor Graham Barrett continues to preside<br />

over AUSCRS and there really isn’t anyone better in Australasia with<br />

the experience and academic mana to be the leader of our local<br />

cataract and refractive surgery meeting.<br />

I believe most New Zealand ophthalmologists should consider<br />

attending AUSCRS as they will truly enjoy it and find the calibre of<br />

education second-to-none. We should also all be supporting this<br />

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

you’ll join me at AUSCRS <strong>2018</strong> in Noosa this October.<br />

For more: please visit http://www.auscrs<strong>2018</strong>.org.au/<br />

*Dr David Kent is a consultant ophthalmologist with Fendalton Eye Clinic and<br />

Christchurch Eye Hospital. He has co-authored many papers and presented at many<br />

international meetings on laser refractive surgery. He is a member of both the<br />

American and Australasian Societies of Cataract and Refractive Surgery, and the New<br />

Zealand AUSCRS council representative.<br />

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Dr Jacqui Beltz overseeing new VR training at RVEEH<br />

The Royal Victorian Eye and Ear Hospital (RVEEH) has introduced<br />

state-of-the-art virtual reality simulators to train the next<br />

generation of eye surgeons.<br />

The RVEEH’s new Eyesi Surgical simulators allow ophthalmology<br />

trainees to learn highly specialised micro-surgery skills in a safe<br />

and controlled environment, and the trainer to objectively monitor<br />

and track an individual’s progress, said Dr Jacqueline Beltz, RVEEH<br />

ophthalmologist and training director for the Victorian Branch of<br />

RANZCO. “Practice is vital to learn any skill and microsurgery is no<br />

exception. Virtual reality simulation provides a setting that forgives<br />

failure, and allows trainees to develop fine motor skills as well as<br />

learn from their errors without causing harm.”<br />

Studies have shown that patient outcomes are improved when<br />

trainees have undertaken virtual reality training. Virtual reality<br />

simulation training will be used alongside traditional training<br />

methods, including wet and dry labs, to increase the breadth of<br />

surgical training for young ophthalmologists, said Dr Beltz. “With the<br />

data that is collected, we can track each individual trainee’s progress,<br />

identifying and addressing any gaps that may require extra practice<br />

or additional teaching. We can also compare trainees’ progress both<br />

locally and globally, so we can evaluate and improve our training<br />

programme.”<br />

The first stage of RVEEH’s virtual reality training programme will<br />

focus on preparing first year trainees for cataract surgery. Future<br />

programmes will include training for vitreoretinal surgery and<br />

complication management. ▀<br />

18 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

Case study: Mycobacterium chelonae keratitis<br />

following cataract surgery<br />



Here we present a rare case of postcataract<br />

surgery and corneal wound<br />

infection caused by the non-tuberculous<br />

mycobacterium species Mycobacterium chelonae.<br />

This case illustrates the difficulties in diagnosis and<br />

treatment of this uncommon condition to increase<br />

awareness of this potentially devastating infection<br />

among optometrists and ophthalmologists.<br />

Case history<br />

A usually fit and well, 85-year-old, New Zealand<br />

European female presented with redness, pain and<br />

reduced vision in her left eye, eight weeks after<br />

routine, uncomplicated, cataract phacoemulsification<br />

with intraocular lens implantation.<br />

Visual acuity OS at presentation was reduced<br />

to 6/30 unaided, 6/15 with pinhole (previously<br />

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

1.0 x 2.8mm stromal infiltrate in the temporal<br />

clear corneal wound site, without an overlying<br />

epithelial defect. The anterior chamber exhibited<br />

2+ cells but no hypopyon. The vitreous was quiet<br />

and the fundus examination was normal. She was<br />

admitted to hospital and treated with intensive<br />

topical antibiotic drops (hourly cefuroxime 5%<br />

and tobramycin 1.36%). However, the intraocular<br />

inflammation worsened so she underwent anterior<br />

chamber washout, vitrectomy and administration<br />

of intravitreal antibiotics (ceftazidime and<br />

vancomycin). Oral doxycycline, ciprofloxacin and<br />

prednisone were added. Surprisingly, aqueous<br />

and vitreous samples were entirely negative for<br />

bacterial and fungal culture as well as for viral PCR.<br />

After slow improvement, she was discharged on<br />

day 16 on topical ciprofloxacin and prednisolone 1%.<br />

She was monitored closely as an outpatient and the<br />

infection waxed and waned over the subsequent<br />

two months (Figs 1 and 2). A large corneal biopsy<br />

also failed to identify any causative organism.<br />

Therefore, after 13 weeks of treatment, ciprofloxacin<br />

was cautiously tapered and stopped, however, the<br />

infection recurred with greater severity with an<br />

overlying corneal melt and the prospect of corneal<br />

perforation. Subsequently, a superficial keratectomy,<br />

accompanied by a focal, partial-thickness, tectonic<br />

corneal graft (5mm), was performed to excise the<br />

majority of the lesion, approximately four months<br />

after initial presentation.<br />

Two weeks later, white flecks were noted in the<br />

graft-host-interface (Fig 3) and a rapidly growing<br />

mycobacterium species, Mycobacterium chelonae<br />

was also isolated from the superficial keratectomy.<br />

This isolate was notably resistant to ciprofloxacin<br />

and doxycycline, but sensitive to clarithromycin,<br />

tobramycin and linezolid on standard MIC (mean<br />

inhibitory concentration) testing. Therefore,<br />

intensive topical tobramycin and linezolid were<br />

started, and topical prednisolone withheld.<br />

Despite intensive, appropriate, dual-antibiotic<br />

topical treatment the inflammation increased and<br />

the overlying graft became oedematous and opaque<br />

(Figs 4a and 4b). Consequently, the lamellar graft<br />

was removed to reduce the infective load and allow<br />

better drug penetration to the underlying host<br />

cornea. After an extended two-month course of<br />

treatment, the infection gradually settled, almost 10<br />

months after her initial cataract surgery (Fig 5). Her<br />

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

and her eye was comfortable. She is expected to<br />

continue on low dose topical antibiotics, under close<br />

monitoring, for up to a year.<br />

Discussion<br />

Non-tuberculous mycobacteria (NTM) refers to a<br />

group of Mycobacterium species other than the<br />

Mycobacterium tuberculosis complex. NTM exist<br />

ubiquitously in the environment including in soil<br />

and drinking water. They are rare causes of systemic<br />

and ocular infections, particularly related to trauma<br />

and surgery 1 . The Mycobacterium chelonae species is<br />

an insidious yet aggressive pathogen that has been<br />

reported as a devastating cause of post-LASIK and<br />

post-cataract surgery keratitis and endophthalmitis 2-6 .<br />

There are several cases of Mycobacterium chelonae<br />

keratitis after clear cornea cataract surgery reported<br />

in the literature, many requiring significant<br />

intervention such as corneal transplant, but typically<br />

with poor visual outcomes 4-6 .<br />

Known risk factors for developing mycobacterial<br />

keratitis include trauma, ocular surgery, poor tear film<br />

integrity, inappropriate use of topical corticosteroids<br />

and contact lens use 4 . Systemic conditions such as<br />

diabetes mellitus or immunosuppression increase the<br />

susceptibility to infection. Our patient did not have<br />

any of these risk factors, other than routine postoperative<br />

steroid drops.<br />

Fig 1. Recurrence of dense stromal infiltrate at the temporal clear<br />

corneal wound with keratic precipitates, two weeks after discharge from<br />

hospital, while on treatment with topical ciprofloxacin<br />

Fig 4a. Progessive infection with development of interface fluid affecting the<br />

temporal, lamellar tectonic corneal graft with loosening of sutures (6 weeks<br />

post-op)<br />

Fig 5. After two months of continuous topical Linezolid and Tobramycin,<br />

the base of the previous patch graft site had epithelialised and was<br />

clinically free of infection<br />

Post-operative Mycobacterium chelonae keratitis<br />

has an insidious onset, with variable time between<br />

surgery and onset of symptoms, from days to<br />

months. The affected cornea may exhibit a “cracked<br />

windshield” appearance around the edges of a<br />

stromal infiltrate, often without an overlying<br />

epithelial defect. Infiltrates may have irregular<br />

margins or stellate lesions, mimicking a fungal<br />

keratitis 1 .<br />

NTM infections are particularly dangerous<br />

because most routinely used topical antibiotics<br />

are ineffective against them, and antibiotic<br />

resistance is a significant issue 7 . A review of<br />

in vitro microbiological susceptibilities of<br />

NTM showed the following susceptibilities:<br />

clarithromycin (93%), amikacin (81%), linezolid<br />

(36%), moxifloxacin (21%), and ciprofloxacin<br />

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

only 1% were susceptible to ciprofloxacin 8 . In<br />

addition, Mycobacterium chelonae can be difficult<br />

to culture, with fastidious growth requirements,<br />

which increases the risk of false negative reports<br />

and delayed diagnosis as in this case 7 .<br />

Mycobacteria keratitis requires aggressive<br />

treatment, ideally with multiple fortified topical<br />

antibiotics with consideration of systemic cover<br />

(such as oral clarithromycin) if severe 7, 8 . An<br />

extended treatment course is required.<br />

As illustrated in the presented case,<br />

Mycobacterium chelonae keratitis can take a<br />

prolonged, waxing and waning course that<br />

may falsely reassure the clinician of impending<br />

resolution. Negative corneal scrapes in a nonresponding<br />

infection warrants surgical biopsy to<br />

enable correct diagnosis and prevent complications,<br />

such as infective scleritis or endophthalmitis.<br />

Surgical debridement of infected tissue may reduce<br />

the bacterial load and also improve antibiotic<br />

penetration into deep stroma, where organisms<br />

may have been seeded into a surgical wound.<br />

While mycobacterial ocular infection is rare, it<br />

must be kept in mind by all ophthalmic health<br />

providers when evaluating any atypical post-laser<br />

or post-surgical infection. NTM are a particular<br />

diagnostic and treatment challenge compared<br />

to other microbes due to delays in pathogen<br />

identification, multiple antibiotic resistances and<br />

a higher likelihood to require surgical intervention.<br />

Therefore, maintaining a high level of suspicion<br />

in unusual cases, obtaining early, accurate<br />

microbial diagnosis, with aggressive and extended<br />

antimicrobial treatment and early surgical<br />

intervention are key to minimising morbidity and<br />

maximizing visual outcome. ▀<br />

Fig 2. Apparent early control of keratitis after three months of treatment.<br />

Note the quiescent eye but suspicious white deposits in stroma.<br />

Ciprofloxacin was stopped at this stage<br />

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

References<br />

1. Kheir WJ, Sheheitli H, Abdul Fattah M, Hamam RN.<br />

Nontuberculous mycobacterial ocular infections: A Systematic<br />

Review of the Literature. Biomed Res Int. 2015;2015:164989.<br />

2. Freitas D, Alvarenga L, Sampaio J, Mannis M, Sato E, Sousa L, et<br />

al. An outbreak of Mycobacterium chelonae infection after LASIK.<br />

Ophthalmology. 2003 Feb;110(2):276-85.<br />

3. John T1, Velotta E. Nontuberculous (atypical) mycobacterial<br />

keratitis after LASIK: current status and clinical implications.<br />

Cornea. 2005 Apr;24(3):245-55.<br />

4. Martinez JD, Amescua G, Lozano-Cárdenas J, Suh LH. Bilateral<br />

Mycobacterium chelonae keratitis after phacoemulsification<br />

cataract surgery. Case Rep Ophthalmol Med. 2017;2017:6413160.<br />

5. Servat JJ, Ramos-Esteban JC, Tauber S, Bia FJ. Mycobacterium<br />

chelonae-Mycobacterium abscessus complex clear corneal<br />

wound infection with recurrent hypopyon and perforation after<br />

phacoemulsification and intraocular lens implantation. J Cataract<br />

Refract Surg. 2005 Jul;31(7):1448-51.<br />

6. Ramaswamy AA, Biswas J, Bhaskar V, Gopal L, Rajagopal<br />

Coming<br />

soon<br />

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

post-op, day 19, demonstrating white interface specks on retro-illumination,<br />

heralding the return of infection<br />

R, Madhavan HN. Postoperative Mycobacterium chelonae<br />

endophthalmitis after extracapsular cataract extraction and<br />

posterior chamber intraocular lens implantation. Ophthalmology.<br />

2000 Jul;107(7):1283-6.<br />

7. De la Cruz J, Behlau I, Pineda R. Atypical mycobacteria keratitis<br />

after laser in situ keratomileusis unresponsive to fourthgeneration<br />

fluoroquinolone therapy. J Cataract Refract Surg. 2007<br />

Jul;33(7):1318-21.<br />

8. Girgis DO, Karp CL, Miller D. Ocular infections caused by<br />

non-tuberculous mycobacteria: update on epidemiology and<br />

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

*Dr Lucy Lu (pictured) is a clinical research<br />

fellow and Dr Jennifer Court is a senior<br />

corneal fellow with the Department of<br />

Ophthalmology at Auckland University.<br />

Professor Charles McGhee is department<br />

head, a consultant ophthalmologist and<br />

chair of RANZCO’s Cornea Society<br />

iStent inject is intended to provide safe and effective<br />

IOP reduction by addressing OAG at the primary<br />

site of resistance to outflow<br />

iStent inject:<br />

• Re-establishes physiological outflow to significantly decrease IOP<br />

• Reduces or eliminates drug burden<br />

• Indicated with and without cataract surgery<br />

• Developed by Glaukos Corporation, the corporate founder<br />

of Micro-Invasive Glaucoma Surgery (MIGS)<br />

Toomac<br />

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GL33071 Glaukos iStent Inject QtrPage Adv.indd 1<br />

March <strong>2018</strong><br />

16/3/18 10:28 am<br />



Summer Students Symposium <strong>2018</strong><br />

The ninth joint Auckland University Department of<br />

Ophthalmology and School of Optometry and Vision<br />

Science Summer Student Symposium in March<br />

was an upbeat affair. Amusingly chaired by Professor<br />

Trevor Sherwin, 17 students from across the departments<br />

presented projects and findings from their 10-week<br />

studies in rapid, strictly-timed, four-minute sessions.<br />

The presentations crossed the gamut of eye disorders<br />

and concerns from glaucoma and aging to dry eye and<br />

drug delivery mechanisms, each attracting a number<br />

of questions and sparking discussion among the<br />

70-strong audience.<br />

School of Medicine head, Professor Alan Merry, and<br />

Associate Dean (research) Professor Andrew Shelling<br />

from the University’s Faculty of Medical and Health<br />

Sciences had the tough job of selecting the best<br />

presentations on the night. “It’s a challenge to present<br />

in four minutes and the standard this evening was<br />

uniformly very high,” said Prof Merry.<br />

The following is summary of the presentations:<br />

• Spheres of Influence, Catherine Tian (Tom Cat Trust)<br />

– 1st prize<br />

• Influence of high glucose and inflammation on<br />

barrier properties of retinal pigment epithelial (ARPE)<br />

cells, Charisse Kuo – 2nd prize<br />

• Differentiation of transition zone stem cells into<br />

corneal endothelial cells, Hannah Ng (Eye Institute) –<br />

3rd prize<br />

• Comparison and review of visual field referrals to<br />

ADHB glaucoma clinic, Catherine Kwak<br />

• Crystallin protein modification and spatial mapping<br />

in an aging lens model, Jerry Shen<br />

• Evaluating the long-term usability of ex-vivo<br />

bovine corneas for drug delivery applications, Darshan<br />

Shrestha (Buchanan Charitable Foundation)<br />

• The effect of erythropoietin on the vasculature of<br />

the premature sheep retina: a cellular and molecular<br />

characterisation, Muthana Noori<br />

• Nailfold capillary abnormalities in glaucoma, Hilary<br />

Goh (Gordon Sanderson Scholarship from Glaucoma<br />

New Zealand, see full story p3)<br />

• Review of glaucoma referrals to ADHB glaucoma<br />

clinic, Tess McCaffrey<br />

• Confirmation of UV filter distribution in the<br />

aging human lens, Arwa Ibrahim (Molecular Vision<br />

Laboratory)<br />

• To give or not to give? Should I provide feedback<br />

during acuity measurement, Maggie Xu<br />

• Monitoring age-related changes of the vitreous of<br />

the eye using MRI, Louisa Howse<br />

• Evaluating the utility of an eyelid massage device<br />

for the management of meibomian gland dysfunction,<br />

Jasmine Feng (NZAO Education and Research Fund)<br />

• Effect of temperature on the thickness of the<br />

human ocular choroid measured with optical coherence<br />

tomography, Sungyeon Kim<br />

• The effect of virtual reality on the tear film and<br />

ocular surface, Joyce Wong<br />

• Adaptation of jumping spider behaviour to a<br />

modified focal environment, Aimee Aitken (Paul Dunlop<br />

Memorial Research Scholarship, NZAO)<br />

• Visual impairment in stroke in a New Zealand<br />

context: patient characteristics in the CBR Stroke<br />

Recovery Clinic, Carla Fasher ▀<br />

The 2017-<strong>2018</strong> Summer students<br />

Sam Simkin, Chelsea Wood and Dr Hannah Kersten<br />

Safal Khanal, Soheil Mohammadpour and Lily Chang<br />


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<br />


The Neuro-Ophthalmology Survival Guide,<br />

second edition<br />

By Anthony Pane, Neil R. Miller and Mike Burdon<br />


I was delighted to be invited by the NZ Optics’<br />

editorial team to review this book as I had not<br />

taken the opportunity to read the previous<br />

edition, although I had heard many references<br />

to it from colleagues both here, in New Zealand,<br />

and in Australia, where the principle author, Dr<br />

Anthony Pane is based.<br />

I have listened to Anthony’s presentations over<br />

the years and appreciate his directness about<br />

the potential pitfalls (sometimes known as<br />

medico-legal watch cases) of neuro-ophthalmic<br />

conditions that might have irreversible sightthreatening<br />

sequelae or be life-threatening<br />

emergencies seen in routine ophthalmic clinics,<br />

but potentially under-diagnosed! Additionally,<br />

I have spent time with, and greatly respect, Drs<br />

Neil Miller and Michael Burdon, so anticipated<br />

this small text book would be a good read and<br />

live up to expectations!<br />

I was not disappointed; especially after reading<br />

the first chapter ‘Staying out of trouble’ which<br />

lists 20 neuro “rules” to keep you out of strife.<br />

Each rule is illustrated with a case example and<br />

cross-referenced to the expanded discussion<br />

on that topic in subsequent chapters. This<br />

chapter alone should pique interest about<br />

common neuro-ophthalmic conditions and,<br />

as stated in the introduction, you can’t avoid<br />

neuro-ophthalmology – neuro-ophthalmology is<br />

special, you want your patients to see well, you<br />

want your patients to stay healthy, you want to<br />

stay out of trouble, you want to pass your exam<br />

(if you still have it ahead of you).<br />

This is a short text book designed to be of<br />

everyday practical use for ophthalmologists,<br />

trainees, optometrists and neurologists, based<br />

on clinical symptoms, examination checklists,<br />

management flowcharts and referral guidelines.<br />

There are 12 chapters (340 pages) that cover<br />

blurred vision or field loss, swollen disc(s), double<br />

vision, unequal pupils and unexplained eye pain,<br />

orbital pain or headaches.<br />

The final chapter outlines<br />

neurophthalmic history<br />

and examination, with<br />

particular reference to giant<br />

cell arteritis and an excellent table 13.1 titled<br />

‘Localizing value of visual field defects’. This last<br />

chapter, in my opinion, should be a must read<br />

for all ophthalmic trainees not only to reinforce<br />

sound clinical practice but also to help with<br />

challenging formal examinations.<br />

The chapter on ‘Double vision’ is a wonderful<br />

synthesis of an extremely complex topic, but<br />

presented in an easily understandable and<br />

clinically significant format. While the discussion<br />

on cranial mono-neuropathies and localising<br />

value flowcharts should guide clinicians to<br />

appropriate investigations in particular third<br />

nerve disease processes that might have very<br />

serious consequences!<br />

One of my favourite chapters, however, dealt<br />

with ‘Seeing things’. Patients may see things<br />

because of eye, optic nerve or brain disease and<br />

unusual visual symptoms need to be explained.<br />

Visual illusions and hallucinations are explained<br />

with excellent cartoons and flow charts, and<br />

Anthony reminds the reader that if the patient<br />

presents with visual phenomena that are not<br />

consistent with visible intraocular disease<br />

processes then referral to a neuro-ophthalmologist<br />

or a neurologist is appropriate with neuro-imaging<br />

to check for serious brain disease.<br />

This is a great book to have close to your<br />

consulting room and, as with many modern texts,<br />

when you purchase the second edition it comes<br />

with an eBook version which is downloadable to<br />

your electronic screen ensuring great portability<br />

and a fantastic set of clinical videos.<br />

*Dr Stephen Best is a consultant ophthalmologist, with<br />

sub-specialities in glaucoma and neuro-ophthalmology, with<br />

Auckland Eye and the Greenlane Clinical Centre.<br />

20 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

NZ hosts the world of retina<br />


The biennial Retina International World Congress was held<br />

for the first time in Auckland on the 10 and 11 February.<br />

With recent host cities including Taipei and Paris, Auckland<br />

had a lot to live up to!<br />

The Retina International Congress is a unique meeting,<br />

bringing together the world’s foremost retinal scientists and<br />

clinicians, patients and their families, health professionals and<br />

patient advocates. The scientific programme, organised by local<br />

retina specialist Associate Professor Andrea Vincent, boasted an<br />

incredible line-up of 11 international speakers as well as many<br />

local and national presenters. The speakers and delegates were<br />

joined by a large group of volunteers, from the Blind Foundation<br />

and the University of Auckland, to assist the many low-vision or<br />

blind delegates.<br />

Speaking to such a diverse audience was always going to be a<br />

difficult task, but the speakers more than rose to the challenge.<br />

The scientific programme was opened by Professor Elise Héon,<br />

from the University and Hospital for Sick Kids in Toronto, who<br />

gave a brilliant clinical overview of inherited retinal disease,<br />

putting into context much of what was going to be discussed at<br />

the meeting. This was followed by a presentation by Professor<br />

Eric Pierce, from Harvard Medical School, summarising the<br />

genetic causality of inherited retinal diseases and current<br />

therapeutic approaches for treating these conditions. Both<br />

opening speakers spoke of the difficulties associated with the<br />

current inherited retinal disease nomenclature; many disease<br />

names (for example, retinitis pigmentosa) cover a range of<br />

genetic mutations and phenotypes.<br />

The second session of the day covered the somewhat daunting<br />

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

outlined the clinical findings that can provide clues to the genetic<br />

diagnosis in inherited retinal disease, while Associate Professor<br />

Alex Hewitt (Tasmania) provided an overview of the advances<br />

in genetic testing for retinal disease. He included a memorable<br />

analogy, where each DNA nucleotide was a matchstick,<br />

explaining how changes in the ‘matchstick’ configuration<br />

can lead to genetic disease. Professor Jean Bennett, from the<br />

University of Pennsylvania, then took to the stage to discuss the<br />

enormous amount of work that goes into conducting a clinical<br />

trial, and the phenomenal costs involved (up to US$1.8 billion if<br />

conducted by a pharmaceutical company!).<br />

In the afternoon, the meeting broke off into two parallel<br />

sessions, ‘Retinal degenerations’ and ‘AMD and other<br />

maculopathies’. I attended the AMD session and one of the<br />

highlights was Professor Mark Gillies from Sydney discussing<br />

the Australian Fight Retinal Blindness project and the role of big<br />

data. He emphasised the importance of natural history disease<br />

studies – by understanding the course of disease in individuals,<br />

we are able to gather information that cannot be acquired<br />

through clinical trials alone.<br />

In this session, we also heard from a number of local speakers;<br />

Drs Narme Deva, Rachel Barnes, David Squirell and Dianne<br />

Sharp covered a range of topics including advances in treating<br />

age-related macular degeneration (AMD) and diabetic eye<br />

disease, and the latest in retinal imaging for AMD.<br />

Claire Fitzgerald, Gary Williamson and Margaret McLeod from the Blind Foundation with<br />

volunteer Nancy and Martine Able-Willamson<br />

Diego Sonderegger, Drs David Squirrell, Graham Wilson and Angus Hatfield-Smith<br />

Part III Optom students and volunteers Linda Zhou, Lusi Yu, Joyce Wong and Kate Lee<br />

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

Edwards<br />

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

The final session of the day included presentations by Associate<br />

Professors Alice Pébay, from Melbourne, and Alex Hewitt on using<br />

stem cells to model eye disease, and CRISPR gene editing in retinal<br />

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

CRISPR gene editing in humans are vast and exciting, it could be<br />

many years before they are used in patients with retinal diseases.<br />

Dr Kent Small then spoke about his work in North Carolina Macular<br />

Dystrophy with patients from across the world.<br />

The interesting topics continued on day two of the<br />

programme, with ‘Scientific Breaking News’. Professor Bennett,<br />

who conducted the first gene therapy treatment trial for<br />

patients with inherited retinal disease, spoke about the recent<br />

FDA approval of Luxturna (or voretigene neparvovec-rzyl to use<br />

its proper name) for the treatment of patients with mutations<br />

in the RPE65 gene. Professor Pierce gave an update on the<br />

ReNeuron clinical trial of human retinal progenitor cells for<br />

patients with advanced retinitis pigmentosa. Dr Sharp discussed<br />

treatment difficulties in patients with polypoidal choroidopathy<br />

and retinal angiomatous proliferation. Professor Gillies gave an<br />

overview of AMD clinical trial results, including brolucizumab<br />

as a potentially longer-lasting treatment for neovascular AMD<br />

and lampalizumab, trialled for the treatment of geographic<br />

atrophy. Finally, Dr Tom Edwards from Melbourne, gave an<br />

overview of the safety and efficacy of a robot-assisted retinal<br />

surgery system. The robot is able to make very fine movements,<br />

particularly important in patients with fragile retinas (including<br />

patients with inherited retinal disease). In the video, ‘Robot<br />

vs. Surgeon’, the robot was much steadier, with slower, more<br />

deliberate movements.<br />

The futuristic theme continued, with a session on artificial<br />

vision. Dr Edwards discussed the first attempt at artificial vision<br />

(back in 1968!) and the considerable progress that has been<br />

made since then. Artificial vision requires an intact inner retina,<br />

so retinitis pigmentosa is often a good target. Dr Penny Allen<br />

from the Royal Victorian Eye and Ear Hospital, talked about<br />

Bionic Vision Australia’s suprachoroidal retinal prosthesis, and<br />

presented the results of a prototype clinical trial, where all<br />

three patients showed improvement in navigational ability<br />

following the surgery. Dr Thiran Jayasundera, a New Zealandtrained<br />

retinal specialist now working in the USA, was the first<br />

to implant the Argus II over a decade ago. Today, there have<br />

now been over 350 Argus II implant surgeries. He discussed the<br />

Argus II’s surgical procedure and clinical journey. Because the<br />

implant only provides very basic vision, pre-operative vision<br />

needs to be light perception or worse, he said.<br />

The afternoon was again split into parallel sessions, with<br />

separate sessions for patients and professionals. I chaired one of<br />

the patient sessions, which included an illuminating presentation<br />

by ophthalmic nurses Sandy Grant and Olga Brocher on the<br />

services offered by the Auckland District Health Board’s low<br />

vision clinics. Blindness consultant Jonathan Mosen, blind since<br />

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

person. Technology was also the focus of the Blind Foundation’s<br />

adaptive technology trainer Matthew Rudland, who turned our<br />

attention to the Seeing AI app for those with visual impairment,<br />

while the Blind Foundation’s Sandra Budd detailed some of the<br />

Foundation’s services.<br />

Following the parallel sessions, Professor Gerald Chader from<br />

the Doheny Institute in the USA, gave the closing keynote<br />

presentation, summarising the decades of laboratory and<br />

clinical work that have led to clinical trials and better outcomes<br />

for patients with retinal disease.<br />

Feedback about the conference was positive, with attendees<br />

commenting on the high quality of the speakers and the fantastic<br />

networking opportunities available. The next Retina International<br />

World Congress will be held in Reykjavik, Iceland, in 2020; the<br />

perfect excuse to organise a trip to the Northern Hemisphere. ▀<br />

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

the University of Auckland and a member of the local organising committee for the<br />

<strong>2018</strong> Retina International World Congress.<br />

Focus on<br />

Eye Research<br />

Retinal detachment,<br />

epiretinal membranes<br />

and anti-VEGF for DMO<br />




BETTER?<br />

Frings A, Markau N, Katz T et al<br />

British Journal of Ophthalmology.<br />

2016;100:1466 -1469<br />

Unlike macula-on retinal detachment,<br />

which is often treated as an<br />

“ophthalmic emergency” and repaired<br />

swiftly before the macula detaches,<br />

macula-off retinal detachment<br />

is usually considered less of an<br />

emergency. However, determining<br />

the ideal time for repair of maculaoff<br />

retinal detachment before<br />

compromising the visual prognosis<br />

can be difficult. The purpose of this<br />

study was to evaluate the influence<br />

of lag-time between the onset of<br />

central visual acuity loss and surgical<br />

intervention of macula-off retinal<br />

detachment.<br />

A retrospective review of 1727 patients<br />

was undertaken, with 89 patients<br />

meeting the inclusion criteria. The<br />

main outcome measure was final<br />

visual acuity as a function of symptom<br />

duration of macula-off detachment.<br />

Symptom duration was defined as the<br />

time from the onset of loss of central<br />

vision (macula detachment) to surgical<br />

intervention.<br />

The results showed there was no<br />

clinically significant difference in<br />

final visual acuity in those operated<br />

within 10 to 30 days of macula-off<br />

retinal detachment. But patients with<br />

symptom duration of three days or<br />

less achieved best final visual acuity<br />


for optometrists and eye care professionals<br />

with<br />

Professors Charles<br />

McGhee & Dipika Patel<br />

Series Editors<br />

Should glaucoma patients avoid caffeine?<br />



Caffeine is a popular psychostimulant that<br />

acts as an adenosine receptor antagonist at<br />

physiological concentrations. It is the most<br />

widely used drug in history, consumed daily by<br />

more than 70% of New Zealanders in the form of<br />

coffee, tea, chocolate and caffeinated soft drinks. It<br />

has been estimated that adults aged between 20<br />

and 64 years are exposed to an average of 3.5mg<br />

of caffeine/kg body weight/day 1 .<br />

Historical studies suggest some<br />

ophthalmologists have long expressed concerns<br />

about the effect of caffeine on intraocular pressure<br />

(IOP) in glaucoma patients 2,3 . To date, IOP remains<br />

the only treatable risk factor in primary open<br />

angle glaucoma (POAG), the most common type<br />

of glaucoma. Thus, establishing the link between<br />

caffeine and IOP is of great importance for<br />

improving the management of POAG.<br />

Effect of caffeine on IOP<br />

A number of clinical trials have investigated the<br />

immediate effect of caffeine on IOP. The effect<br />

of caffeine has been regarded as controversial<br />

due to inconsistencies amongst study findings.<br />

These inconsistencies can be attributed to variable<br />

study protocols, such as sources and doses of<br />

caffeine, methods of tonometry and time points<br />

of IOP measurement. Additionally, participant<br />

characteristics and severity of glaucoma were<br />

often not clearly documented in some studies.<br />

Nonetheless, a careful review of the literature<br />

reveals a common trend.<br />

In young and healthy volunteers without history<br />

of ocular diseases, no significant changes in IOP<br />

were detected up to four hours following ingestion<br />

of caffeine capsules 4,5 . One study, however,<br />

demonstrated a post-caffeine increase in IOP of<br />

2-3 mmHg in healthy volunteers aged between<br />

20 and 29 and this increase was maintained for<br />

three hours 6 . However, the volunteers drank a litre<br />

of coffee in this study and the authors did not<br />

delineate the effects of volume overload and high<br />

dose caffeine.<br />

Several randomised controlled trials and<br />

subsequent meta-analysis of those studies<br />

reported IOP changes in patients with POAG or<br />

ocular hypertension following caffeine ingestion.<br />

There was a statistically significant increase in<br />

IOP when the patients were exposed to 180mg of<br />

caffeine in coffee, equivalent to approximately one<br />

double-shot espresso 7,9 (see Table 1). The metaanalysis<br />

showed the weighted mean IOP differences<br />

before and after coffee consumption in patients<br />

with glaucoma or ocular hypertension: 0.347 at<br />

30 minutes, 2.395 at 60 minutes and 1.998 at 90<br />

minutes (95% confidence interval 0.078-0.616,<br />

1.741-3.049, 1.522-2.474, respectively) 7 .<br />

A major shortcoming of this meta-analysis is the<br />

lack of age-matched controls, leaving the effect of<br />

aging unknown. The healthy controls were mostly<br />

in their 20s. The age range of glaucoma patients<br />

were not stated in the papers but were expected<br />

to be in a much older age group. Furthermore,<br />

the authors did not differentiate high tension<br />

POAG from ocular hypertension, or normo-tension<br />

POAG, when they could represent distinct disease<br />

entities. Despite these weaknesses, the consensus<br />

is that caffeine, at least transiently, induces a small<br />

increase in IOP in glaucomatous eyes, but not in<br />

young healthy eyes.<br />

What is the pathophysiological significance<br />

of the IOP change?<br />

Two large-scale epidemiologic studies addressed<br />

the question whether caffeine consumption is<br />

associated with the development or progression<br />

22 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong><br />

of glaucoma. The Blue Mountains<br />

Eye Study, a cross-sectional<br />

study conducted in Australia,<br />

investigated correlation between<br />

IOP and regular daily caffeine<br />

intake in POAG patients 10 .<br />

The participants completed<br />

questionnaires on their pattern<br />

of coffee consumption and<br />

underwent comprehensive<br />

glaucoma assessment. The<br />

study demonstrated a positive<br />

association between daily coffee<br />

drinking and high IOP, only in<br />

people with POAG. POAG patients<br />

who drank coffee daily had higher<br />

mean IOP (19.6mmHg) than<br />

those who did not (16.8mmHg).<br />

This result reached statistical<br />

significance after adjusting for<br />

age, sex, systolic blood pressure,<br />

myopia, current smoking and<br />

diabetes.<br />

A large-scale prospective study<br />

of health professionals in the<br />

USA showed an association<br />

between coffee consumption<br />

and development of POAG in<br />

people with a family history of<br />

glaucoma¹¹. A large number of<br />

health professionals over 40 years of age and<br />

without a history of POAG were followed up for<br />

18 years in this study. Daily caffeine intake of up<br />

to 600mg per day (approximately four doubleshot<br />

espresso coffees or five cups of brewed<br />

coffee) was not associated with increased risk<br />

of developing POAG as shown by relative risks<br />

of around 1. With over 600mg of daily caffeine<br />

intake, the relative risk increased slightly to<br />

1.61. Notably, in people with a family history<br />

of glaucoma, high caffeine intake of more than<br />

600mg per day increased the relative risk from<br />

0.94 to 2.01. In other words, people with a family<br />

history were twice as likely to develop POAG as<br />

those without, if they were heavy coffee drinkers<br />

(>600mg per day).<br />

Taken together, there is still insufficient evidence<br />

to support caffeine as an independent risk factor<br />

for the development of POAG, but people with<br />

POAG or with a family history of glaucoma (ie.<br />

genetic susceptibility) may be more vulnerable to<br />

the effects of caffeine.<br />

Mechanism of caffeine-induced IOP<br />

elevation<br />

The main mechanism of caffeine’s effect is via<br />

adenosine receptor antagonism and subsequent<br />

increase in sympathetic tone and a slight<br />

elevation of blood pressure¹². In young and<br />

healthy volunteers, 200mg of oral caffeine led<br />

to significant retinal vasoconstriction one hour<br />

post-ingestion 4 . This was negatively correlated<br />

with mean arterial pressure, suggesting an<br />

auto-regulatory response to increased blood<br />

pressure. Another study demonstrated that<br />

ingestion of 300mg of caffeine caused an increase<br />

in the resistive index of retrobulbar arteries in<br />

young and healthy volunteers¹³. Hypothetically,<br />

the increase in systemic blood pressure will<br />

increase pressure within the ciliary arteries,<br />

which in turn will increase ultrafiltration and<br />

aqueous production, thereby elevating IOP.<br />

Increased arterial pressure can also increase<br />

venous pressure and reduce aqueous clearance,<br />

thereby contributing to elevated IOP. Caffeineinduced<br />

vasoconstriction was however not<br />

associated with high IOP in the young and<br />

healthy, suggesting the presence of an unknown<br />

homeostatic mechanism to maintain the IOP.<br />

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

Coffee and glaucoma?<br />

Consequently, more questions arise as to<br />

why caffeine elevates IOP in only glaucoma<br />

patients. Several researchers postulate there<br />

may be an inherent susceptibility to the effect<br />

of caffeine in glaucomatous eyes. There is<br />

mounting evidence that vascular and autonomic<br />

dysfunction is a key pathologic process in<br />

glaucoma (for a comprehensive review, see<br />

reference 14). Doppler ultrasound imaging<br />

studies demonstrated that POAG patients failed<br />

to auto-regulate central retinal artery blood<br />

flow during postural change. Gene expression<br />

studies identified impairment of nitric oxidemediated<br />

smooth muscle cell relaxation and<br />

excessive plasma levels of endothelin, a potent<br />

vasoconstrictor, in response to physiological<br />

perturbations in POAG patients. Polymorphisms<br />

of nitric oxide synthase and caveolin, which lead<br />

to impaired vasodilation, have been associated<br />

with POAG. Genetic dysautonomic conditions<br />

such as familial dysautonomia and nail-patella<br />

syndrome are associated with subtypes of<br />

POAG. Moreover, examination of the nail bed<br />

capillary network revealed abnormal peripheral<br />

microvascular circulation in glaucoma patients.<br />

It is possible that caffeine produces a pathologic<br />

haemodynamic response and consequent IOP<br />

change in glaucoma patients with structurally<br />

and functionally impaired microvasculature.<br />

The debate continues…<br />

Based on the evidence accumulated to date,<br />

glaucoma patients may be advised to avoid<br />

caffeine intake for 90 minutes before IOP<br />

measurement, in order to obtain a more accurate<br />

IOP reading. However, there is no known clinical<br />

benefit of avoiding caffeine in the long-term<br />

management of POAG and without clear<br />

evidence we are more likely to cause unnecessary<br />

anxiety associated with caffeine consumption.<br />

A few crucial questions remain to be answered<br />

before clinicians can make evidence-based<br />

recommendations on caffeine consumption.<br />

l If caffeine transiently elevates IOP, does<br />

frequent coffee drinking lead to sustained<br />

elevation in IOP? What is the effect of repetitive<br />

caffeine intake?<br />

l Vasoconstriction was observed in healthy<br />

eyes following caffeine administration, but the<br />

haemodynamic response to caffeine is yet to be<br />

explored in glaucoma patients.<br />

l The link between chronic caffeine exposure<br />

and the severity of glaucoma has not been<br />

established. Is chronic caffeine exposure<br />

associated with more advanced POAG? Does<br />

withholding caffeine provide any long-term<br />

benefit in terms of POAG progression?<br />

These questions need to be addressed in<br />

future studies to establish evidence-based<br />

recommendations. In the meantime, it would be<br />

reasonable to advise patients to avoid excessive<br />

caffeine intake if IOP control is critical since<br />

even a small reduction in IOP has been shown to<br />

reduce the risk of glaucoma progression 15 . ▀<br />

References<br />

1. Ministry for Primary Industries. Caffeine. New Zealand:<br />

2012 November.<br />

2. Leydhecker W. Influence of coffee upon ocular tension in<br />

normal and in glaucomatous eyes. Am J Ophthalmol. 1955<br />

May;39(5):700-5.<br />

3. Davis RH. Does caffeine ingestion affect intraocular<br />

pressure?. Ophthalmology. 1989 Nov;96(11):1680-1.<br />

4. Terai N, Spoerl E, Pillunat LE, Stodtmeister R. The effect<br />

of caffeine on retinal vessel diameter in young healthy<br />

subjects. Acta Ophthalmol (Oxf). 2012 Nov;90(7):524.<br />

5. Adams BA, Brubaker RF. Caffeine has no clinically<br />

significant effect on aqueous humor flow in the normal<br />

human eye. Ophthalmology. 1990 Aug;97(8):1030-1.<br />

6. Okimi PH, Sportsman S, Pickard MR, Fritsche MB. Effects of<br />

caffeinated coffee on intraocular pressure. Appl Nurs Res.<br />

1991 May;4(2):72-6.<br />

7. Li M, Wang M, Guo W, Wang J, Sun X. The effect of<br />

caffeine on intraocular pressure: a systematic review and<br />

meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2011<br />

Mar;249(3):435-42.<br />

8. Higginbotham EJ, Kilimanjaro HA, Wilensky JT, Batenhorst<br />

RL, Hermann D. The effect of caffeine on intraocular<br />

pressure in glaucoma patients. Ophthalmology. 1989<br />

May;96(5):624-6.<br />

9. Avisar R, Avisar E, Weinberger D. Effect of coffee<br />

consumption on intraocular pressure. Ann Pharmacother.<br />

2002 Jun;36(6):992-5.<br />

10. Chandrasekaran S, Rochtchina E, Mitchell P. Effects of<br />

caffeine on intraocular pressure: the Blue Mountains Eye<br />

Study. J Glaucoma. 2005 Dec;14(6):504-7.<br />

11. Kang JH, Willett WC, Rosner BA, Hankinson SE, Pasquale<br />

LR. Caffeine consumption and the risk of primary<br />

open-angle glaucoma: a prospective cohort study. Invest<br />

Ophthalmol Vis Sci. 2008 May;49(5):1924-31.<br />

12. James JE. Critical review of dietary caffeine and blood<br />

pressure: a relationship that should be taken more<br />

seriously. Psychosom Med. 2004;66(1):63-71.<br />

13. Ozkan B, Yuksel N, Anik Y, Altintas O, Demirci A, Caglar Y.<br />

The effect of caffeine on retrobulbar hemodynamics. Curr<br />

Eye Res. 2008 Sep;33(9):804-9.<br />

14. Pasquale LR. Vascular and autonomic dysregulation in<br />

primary open-angle glaucoma. Curr Opin Ophthalmol.<br />

2016 Mar;27(2):94-101.<br />

15. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L,<br />

Komaroff E, et al. Factors for glaucoma progression and<br />

the effect of treatment: the early manifest glaucoma trial.<br />

Arch Ophthalmol. 2003 Jan;121(1):48-56.<br />

Dr Jinni Yoon<br />

Prof Helen Danesh-Meyer<br />

About the authors<br />

*Dr Jinny Yoon is a neuroophthalmology<br />

research fellow.<br />

She studied neuroscience at<br />

the University of Auckland<br />

and graduated with a PhD.<br />

After completing basic medical<br />

training in Auckland, she<br />

followed her passion for<br />

eye health and joined the<br />

Department of Ophthalmology.<br />

Professor Helen Danesh-Meyer<br />

is an international authority<br />

on glaucoma and neuroophthalmology<br />

and chair of<br />

Glaucoma NZ. She is a sought<br />

after international speaker, has<br />

published more than 150 articles<br />

and is a respected international<br />

journal editor.

MyHealth1st now in NZ<br />


Klaus Bartosch knows more than most the<br />

importance of being able to act on a whim and<br />

book a health appointment quickly and easily,<br />

out of hours.<br />

The co-founder of patient booking and engagement<br />

software MyHealth1st, and managing director of<br />

the platform’s parent company 1stGroup, had just<br />

finalised plans for his Vision Crusaders cycling team<br />

to complete the Australian Ride to Conquer Cancer<br />

fundraising races when his family urged him to get<br />

the swelling of his right knee looked at. Bartosch<br />

thought it was just a symptom of his recently<br />

diagnosed arthritis, but given his family’s concerns he<br />

somewhat begrudgingly went online, using his own<br />

platform, at 9pm to book an appointment the next<br />

day with a local doctor.<br />

He had no white blood cells left in his body. The<br />

doctor packed him off to a specialist pronto and he<br />

was diagnosed with advanced-stage leukaemia and<br />

committed to hospital for emergency treatment.<br />

If he’d gone cycling; if it had not been so simple to<br />

book the appointment, he could easily have died, he<br />

says. The memory is a powerful one, and few at the<br />

Auckland launch of MyHealth1st didn’t tear up when<br />

Bartosch went on to share how his daughter took<br />

his place in the endurance race, raising the promised<br />

funds for much-needed cancer research.<br />

That was 2013 and neatly illustrates why Bartosch,<br />

together with an experienced team of online and<br />

health practice veterans, had joined forces to shake up<br />

the age-old way of booking healthcare appointments<br />

and engaging with patients.<br />

Background<br />

Since launching in Australia in 2012, first in dentistry<br />

before moving into other health areas, MyHealth1st<br />

has netted more than 6,000 customers and booked<br />

more than 6.5 million online appointments. It<br />

began selling the platform to Australian optometry<br />

practices just over a year ago and today books online<br />

appointments for more than 1,200 Australian practice<br />

owners; over 60% of the country’s independent<br />

optometry market.<br />

Of the optometry bookings made online in Australia<br />

today, 43% are new customers and 57% are existing.<br />

But perhaps the most interesting statistic of all, says<br />

Bartosch, is that 70% of all online bookings are made<br />

during business hours, demonstrating that the vast<br />

majority of patients, if given the choice, would rather<br />

book online than have to call a practice.<br />

A Kiwi case study<br />

Sharing the Auckland launch platform in March for<br />

MyHealth1st in New Zealand, was Whangarei-based<br />

practice Visualeyez director Craig Robertson.<br />

Frustrated by his own business’ inability to allow<br />

new and existing customers to book online, last year<br />

Robertson asked his practice management software<br />

provider, Optomate, for help and was referred<br />

to 1stGroup. After just two months of using the<br />

MyHealth1st booking system, Robertson was hooked.<br />

It helped drive bookings to his practice, was simple<br />

to use and integrated seamlessly with Optomate,<br />

his website and his Facebook page, he says. He also<br />

can’t wait to add 1stGroup’s patient recall service,<br />

EasyRecall, to his online marketing toolbox, despite<br />

the extra cost, he says, as soon as it becomes available<br />

in New Zealand.<br />

“As a consumer I want to be part of the digital<br />

revolution. I want to contact people with emails<br />

and book online and I found it very frustrating that I<br />

couldn’t do that with my own practice, so that’s why<br />

I tried it. It’s a cost effective, very simple platform. It’s<br />

easy,” Robertson told the Auckland launch audience.<br />

More compelling numbers<br />

Of the 30-plus practice owners and managers at the<br />

Auckland launch, all the ones NZ Optics’ spoke too<br />

were having the same frustrations and were keen to<br />

provide an easy and effective online booking service<br />

to their current practice management systems. Many<br />

Klaus Bartosch presenting at the Auckland launch<br />

Klaus Bartosch, MD of MyHealth1st platform, and Visualeyez director Craig<br />

Robertson at the Auckland launch<br />

signed up on the night.<br />

Bartosch, quoting from an international survey, says<br />

these frustrations are common among consumers,<br />

with 90% saying they wanted to use digital channels<br />

to manage their healthcare, 88% preferring digital<br />

reminders and a worrying 37% who switched<br />

providers to ones who offered online appointments.<br />

Using an online booking and engagement platform<br />

like MyHealth1st allows you to convert your website<br />

and social media traffic into booked appointments,<br />

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

on investment for practices which have joined<br />

MyHealth1st’s booking and patient recall service<br />

is A$5,000 to A$20,000 a month per practice, with<br />

an average 41% of bookings being new patients,<br />

according to the ASX-listed company’s own data.<br />

Other services<br />

As well as its patient online booking and EasyRecall<br />

services, 1stGroup will also be rolling out its<br />

EasyFeedback service, allowing patients to engage<br />

more easily with the practice and let it know how it’s<br />

performed and what it can do better. The company<br />

also runs a free, optional contact lens service,<br />

designed to encourage more patients to consider<br />

contact lenses as an option. On average, those<br />

practices which have opted in to the contact lens addon<br />

are having 20% more discussions about contact<br />

lenses, says Bartosch, 62% of which are converted<br />

into contact lens sales.<br />

As in Australia, 1stGroup also intends to launch<br />

a MyHealth1st portal in New Zealand in June or<br />

July, which acts as an independent online directory<br />

to drive consumers to your practice, says Bartosch.<br />

Once a consumer selects and books with a practice,<br />

however, those consumers won’t see any competitor<br />

practices when they decide to sort out their next<br />

booking, just the first practice they booked with, and<br />

complimentary local healthcare service providers,<br />

such as dentists or GPs, until they’ve built up a group<br />

of their preferred suppliers and can then use the<br />

portal to book all their health requirements online,<br />

whatever the time of day or night, he explains.<br />

The pitch<br />

Given the way the internet is changing the way we<br />

do business, you can’t just sit idly by, Bartosch tells<br />

his audience. “Here we are, in the age of the internet<br />

and yet nearly all of us still require patients to pick<br />

up a telephone in business hours to do something as<br />

simple as book an appointment… Can you imagine<br />

booking hotels like we used to… looking for a job,<br />

browsing for a home?<br />

“The way we do business is changing, whether we<br />

like it or not. We can’t stop it. The question is how are<br />

you going to engage<br />

with it, leverage<br />

it, get ahead of<br />

the curve and do<br />

it, before others<br />

do!” ▀<br />

Focus on Business<br />

sponsored by<br />

Independent spirit, collective strength<br />

FOCUS Too small ON BUSINESS for<br />

How<br />

independent<br />

to become<br />

advice?<br />

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independent<br />

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

and service or neil.human@iogroup.co.nz<br />

independents need to thrive<br />

To find out more contact Neil Human On 0210 292 8683<br />

To find out more contact Neil or neil.human@iogroup.co.nz<br />

Human on 0210 292 8683 or neil.human@iogroup.co.nz<br />

<strong>April</strong> <strong>2018</strong> NEW ZEALAND OPTICS<br />

14 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong><br />

that is the case, it is still worthwhile having<br />

an external advisor. That person will be an<br />

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Style-Eyes<br />

A unique way to sell more<br />

Tapping into the ‘pop-up’ phenomena<br />


Commerce has rapidly changed over the past<br />

decade and the optometry game is not<br />

immune. Today, many customers begin their<br />

eyewear search online rather than in traditional<br />

storefronts, especially when it comes to the<br />

younger generation. Social media plays a huge part<br />

in their buying decisions too.<br />

To ensure you’re adequately tapping into this<br />

burgeoning market, here’s an interesting and yet<br />

innovative way you may not have considered to<br />

help you increase your revenue.<br />

Why try a pop-up?<br />

hold too much merchandise. People understand<br />

the exclusivity of a pop-up so don’t expect you to<br />

have more than one of anything!<br />

Fashion update<br />

Jono Hennessey<br />

The latest releases from Jono Limited Edition includes the <strong>2018</strong><br />

Liberty of London fabric collection, transformed using Hennessy’s<br />

unique technique of fabric lamination to create these beautiful<br />

new models. Both are available in three different colours<br />

featuring Liberty’s classic paisleys and garden-inspired designs,<br />

including gold detailing. Distributed by Phoenix Eyewear.<br />

Ogi Eyewear<br />

Neubau<br />

Ogi’s latest releases are a continuation of the brand’s statementmaking<br />

styles and bold colour options. The masculine, larger<br />

frame is designed with marbled acetate and accented with<br />

subtle stainless-steel temple detailing, and is “ultra-wearable,”<br />

said the company. While the delicate, cat-eye silhouette of the<br />

other model, pictured here, is available in subdued pastels, with<br />

transparent touches of acetate in a primarily translucent frame,<br />

making it beautifully balanced. Distributed by BTP DesigNZ.<br />

A glimpse of the future was on display this year at Neubau’s MIDO<br />

stand, where the company launched its new 3D-printed frames.<br />

The 3D printing process allows for exceptionally precise detailing,<br />

environmentally sustainable production and the highest standards of<br />

quality, said the company, for example, fine details and textures appear<br />

like engravings, all of which would be hard to achieve in conventional<br />

manufacturing. Neubau’s 3D models will be available from <strong>April</strong> in<br />

seven striking colour finishes combined with stainless steel in gold,<br />

silver, rose, black ink and black ink matte. Distributed by Euro-Optics.<br />

Carter Bond<br />

Also by Jono Hennessy, Carter Bond’s new luxury vintage collections include<br />

this lightweight stainless-steel<br />

frame; classic and stylish, it’s<br />

available in matt and shiny<br />

finishes. Distributed by<br />

Phoenix Eyewear.<br />

At its most basic level, a pop-up is a small, physical<br />

store with an expiry date – think temporary, not<br />

permanent. There are many options when it comes<br />

to running one, but the most common is a standalone<br />

pop-up at an event such as a farmers’ or crafts’<br />

market, or perhaps it’s a way of using a vacant<br />

tenancy space within a shopping centre to attract<br />

new customers.<br />

There are many varieties on the pop-up theme,<br />

such as a collaboration with another store (where<br />

you take over a small space within their store and<br />

you both benefit from increased traffic); a kiosk<br />

or booth at a shopping centre or along a busy<br />

shopping strip; or align yourself with a specific space<br />

or event such as an art gallery or trade show. The<br />

possibilities are only limited by your imagination<br />

and resourcefulness. For example, an interesting<br />

collaboration might be with a local bookstore. After<br />

all, bookworms often wear glasses!<br />

Each space<br />

has its own<br />

pros and<br />

cons but<br />

the good<br />

usually<br />

outweighs<br />

the bad.<br />

The major<br />

benefit of<br />

a pop-up<br />

means you<br />

get to target a whole new selection of customers,<br />

many of whom may not even know you exist!<br />

Depending on the pop-up location, the foot traffic<br />

can be considerable and you may also be a novelty<br />

attraction (an optometrist selling their wares at a say,<br />

craft market) and pull a bigger crowd.<br />

One further tip, is to try to pick a location close to<br />

your physical store, or within reasonable traveling<br />

distance, should customers need an eye test and<br />

updated prescription for their new glasses. Or<br />

perhaps consider taking the whole kit and caboodle<br />

to them, like US-based Warby+Parker has done<br />

with its mobile optometry store bus or, closer to<br />

home, Auckland-based EyeLove EyeCare’s mobile<br />

optometrist service for rest homes.<br />

A great way to test the waters<br />

A pop-up can help you move old stock, but it may<br />

be an even better way to test out a new brand or<br />

concept. Perhaps you’ve always had a penchant for<br />

funky eyewear or custom work, but never taken the<br />

plunge because it’s too risky for your bricks-andmortar<br />

store. A pop-up gives you the chance to try<br />

it out.<br />

You can do small orders of new stock – be it<br />

outrageous, one-offs or bespoke – and also keep<br />

up to date with what’s on trend without having to<br />

Be brave with your pop-up merchandise (Face à Face and Silhouette)<br />

Furthermore, by its very nature, a pop-up is not<br />

forever. Some are just for one day, at an event of<br />

you choosing, so the cost outlay can be kept to a<br />

minimum. Others may require more investment<br />

with a 30 or 60-day lease for retail space, for<br />

example.<br />

Whatever avenue you pick, at the end of the<br />

exercise, it makes business sense to review success<br />

based on foot traffic, how long customers spent<br />

looking at particular products, sales conversion<br />

rates and general feedback and follow-up from<br />

clients. Compare this to your traditional storefront<br />

and online sales too (if you have them) to<br />

determine viability.<br />

Support pop-ups with social media<br />

If you like<br />

the sound of<br />

a pop-up, it’s<br />

important<br />

to realise<br />

its success<br />

relies on a<br />

thorough<br />

social media<br />

campaign<br />

launched Support your pop-up venture with social media<br />

before it,<br />

run alongside it and maintained after it. While this<br />

may sound a little daunting or labour-intensive,<br />

pop-ups really are a fantastic way to generate<br />

social buzz, increase your brand awareness and<br />

bring more traffic to your website and physical<br />

store (especially if there’s a competition or discount<br />

voucher attached to them!).<br />

Like many of us, you may find yourself completely<br />

stuck when it comes to social media. To combat<br />

this, considering hiring a student – with or without<br />

optometry experience – for a few hours a week<br />

to run the campaign for you. A further option<br />

is to do some research online about how to run<br />

a successful social media campaign. There’s a<br />

plethora of blog posts and articles on this verypopular<br />

topic. Another great recourse is to get your<br />

kids to do it (or a well-loved niece or nephew)!<br />

Should you decide to go ahead with a pop-up,<br />

start your social media campaign early to build<br />

up anticipation. Flog the pop-up on all your social<br />

media channels (Facebook, Snapchat, Instagram<br />

and Twitter). Don’t have those? You should get<br />

them set up as they are important, especially if you<br />

want to capture the youth market.<br />

Lastly, it doesn’t hurt to advertise your pop-up<br />

using more traditional methods such as direct<br />

flyers, local papers and word-of-mouth in your<br />

store too.<br />

So go on, give it a pop-up!<br />

*Renee Lunder is an Australian freelance journalist and proud<br />

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

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

without them!”<br />

Vanni<br />

Pantone’s annual celebration of colour, nominated ‘ultraviolet’ as<br />

the colour of the year, something Italian frame maker Vanni picked<br />

up as a challenge. The ultraviolet that rages on the catwalks and<br />

among the <strong>2018</strong> accessory collections is a colour that is both for<br />

the strong and more peaceful hearted, said the company. “We think<br />

that violet is an unconventional colour that gives a vibrant and<br />

interesting look.” The Vanni violet is streaked into the acetates of its<br />

Monochromo collection and used as “assertive” block colour in its<br />

Colours range. Distributed by Little Peach.<br />

Coco Song<br />

Coco Song’s new collection introduced at Mido is a tribute to<br />

faraway cultures with beautiful colours and dreamy detailing.<br />

The Sunset Horizon model featured here has a delicate<br />

feather on silk between the acetate layers of the<br />

frame front and temples, creating incredible colour<br />

contrasts, with semi-precious stones inserted in the<br />

enamelled metal profiles. Available direct.<br />

Stars and their Eyes…<br />

Ella Fitzgerald<br />

The first lady of song, Ella Fitzgerald was<br />

one of the most prolific jazz recording<br />

artists of all time. She began her sixdecade<br />

career when she was just 16 years<br />

of age. Fitzgerald was famous for her scat<br />

improvisation and her almost three-octave<br />

range. Throughout her career she<br />

won 13 Grammy awards (more<br />

than any other jazz musician) and<br />

was awarded honorary doctorates,<br />

from Yale and Dartmouth, and the<br />

National Medal of Arts.<br />

Fitzgerald, however, had type<br />

II diabetes which had a massive<br />

impact on her life, causing vascular<br />

problems, congestive heart failure<br />

and eventually leg amputation. From<br />

the early 1970s, when Fitzgerald was<br />

in her 50s, she began to have vision<br />

problems from advanced diabetic<br />

retinopathy, leading to severe vision<br />

problems from her late 60s.<br />

AC/DC<br />

AC/DC and Vinylize launched the<br />

loudest eyewear collection ever at<br />

Vision Expo East, New York in March, presenting three<br />

different optical frames in three sizes and three sunglass<br />

models made from the vinyl of the multi-platinum album<br />

‘Back in Black’ records themselves. Model Hell, featured<br />

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

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

A shy woman, who was very sensitive to<br />

criticism, she spent her last years in the garden<br />

of her Beverly Hills mansion in a wheelchair with<br />

her son and granddaughter. “I just want to smell<br />

the air, listen to the birds and hear Alice laugh,”<br />

she said. She died, aged 79 in 1996.<br />

24 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

Bellinger returns to NZ<br />

New Zealand frame distributor Euro Optics has<br />

added Danish brand Bellinger to its portfolio.<br />

Carl Doherty, Euro Optics’ managing director,<br />

says Bellinger is already a familiar brand among<br />

high-end independent eyecare professionals and is<br />

well-established in Europe and North America.<br />

Some New Zealand practices used to stock<br />

Bellinger in the past when a previous distributor<br />

was selling it, explains Doherty. “We liked the new<br />

Bellinger collections and saw an opportunity to<br />

re-launch this well-respected brand back into the<br />

New Zealand market.”<br />

Feedback received from customers so far has<br />

been extremely positive, he says. “Bellinger is a<br />

top-quality product that prides itself on being<br />

different and special. The acetate mixes that<br />

Bellinger uses are unique. They add extra textures<br />

to the acetate.”<br />

For example, some frames have a small amount<br />

of glitter mixed into the acetate, says Doherty,<br />

through a production technique not that dissimilar<br />

to making candy. “The acetate is made of cotton<br />

mixed with acetone and alcohol forming a<br />

homogeneous dough. It’s filtered, kneaded, heated<br />

and finally pushed into large blocks; only then, the<br />

creative work with Bellinger techniques begins.”<br />

The most amazing effects are obtained by<br />

mixing, heating and twisting up to five different<br />

types of acetate together until the desired effect is<br />

achieved, he adds.<br />

Innovative Mido trends<br />

Mido is to eyewear,<br />

what Oscar night is to<br />

cinema,” said Giovanni<br />

Vitaloni, Mido president at this<br />

year’s event in Milan.<br />

Organisers said the 48th<br />

Mido event this year welcomed<br />

more than 58,000 eyewear<br />

professionals and 1,305 exhibitors<br />

across three days to seven<br />

pavilions, showcasing eyewear,<br />

technology and new innovations,<br />

the latter being the theme of<br />

this year’s event. Mido organisers<br />

noted a strong increase in foreign<br />

attendees, resulting in a 4.9%<br />

increase in overall attendance and<br />

5% in the exhibitor space.<br />

Phoenix Eyewear’s Mark<br />

Collman, a veteran of 21 Midos,<br />

said this year’s fair certainly delivered. “In typical<br />

Italian style, especially during Milan fashion<br />

Bellinger back in New Zealand<br />

Bellinger’s latest range is now available from Euro<br />

Optics. ▀<br />

Mark Collman and Phillip Wilson with Robert Morris of William Morris (centre) at Mido<br />

week, the event was full of immaculately dressed<br />

locals, oceans of espresso and prosecco, gorgeous<br />

promo girls, lavish stands plus the<br />

occasional sneaky pick pocket.”<br />

When queried about the latest<br />

trends, both Collman and his<br />

colleague Phillip Wilson agreed<br />

it’s clear the double bridge metal<br />

aviator is back with a vengeance<br />

both for men and women. Metal<br />

frames were also once again<br />

at the forefront of many of the<br />

new optical collections, which<br />

the Phoenix team thought was<br />

interesting as metal frames have<br />

long been a great seller in New<br />

Zealand and growing still. For<br />

all lovers of colourful acetates,<br />

however, it’s not all gloom as<br />

Collman and Wilson said plastic still<br />

pretty much dominates the fashion<br />

scene, many in large 70s and 80s<br />

inspired oversized looks.<br />

“I honestly feel that after a couple<br />

of flat years this year’s vibe was the<br />

most optimistic and positive I have<br />

experienced in recent times,” said<br />

Collman. “Everyone we came across<br />

supplying the independent eyewear<br />

sector were really busy and in great<br />

shape which has to be good for the<br />

future!” ▀<br />

CPD for NZ DOs at AVC<br />

A<br />

comprehensive<br />

dispensers’<br />

education programme, with<br />

CPD points for accredited Kiwi<br />

dispensing opticians, will run alongside the<br />

optometrists’ programme for the first time<br />

at the Australian Vision Convention (AVC) in<br />

Brisbane, Queensland from 7–8 <strong>April</strong>, <strong>2018</strong>.<br />

Supported by AVC sponsor Rodenstock,<br />

the inaugural Dispenser Programme features five<br />

sessions on the latest lens technologies, patient<br />

communication strategies and advantages of<br />

premium lenses:<br />

• Resolving non-tolerance issues with digital<br />

lenses – Nicola Peaper, sales and professional<br />

services manager, Rodenstock<br />

• The digital world needs digital lenses, not<br />

progressives – Steven Daras, course coordinator,<br />

optical dispensing, TAFE<br />

• Wham, Bam, Pow. How position<br />

of wear measurements will knock your<br />

patients out – Leigh Robinson, Consultant<br />

and Training Facilitator, Spectrum Optical<br />

• Dispensing to enhance sports<br />

performance – Helen Venturato,<br />

optometrist and principal consultant at<br />

Helen Venturato Consulting<br />

• Complex cases and compensated<br />

values – Grant Hannaford, adjunct senior lecturer at<br />

School of Optometry and Vision Science, UNSW and<br />

director, Academy of Advanced Ophthalmic Optics<br />

The programme runs from 10.45am to 3.15pm<br />

on Sunday 8 <strong>April</strong> and has been accredited for<br />

Kiwi dispensing optician attendees with 2.5 CPD<br />

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

oa.optometry.org.au. ▀<br />

Essilor Transitions’ prize<br />

draw<br />

A<br />

patient<br />

from Noel Templeton’s<br />

Marlborough Optical practice is the first<br />

to win one of three patient prize trips to<br />

Fiji, courtesy of Essilor New Zealand’s Transitions<br />

promotion.<br />

All patients from Essilor-partner independent<br />

optometrists who purchase Transition lenses<br />

from 1 February until 30 <strong>April</strong> are eligible to enter<br />

one of three-monthly draws to win a three-night<br />

package at the Sofitel Fiji Resort on Denarau<br />

Island. The draws take place on the 9th of March,<br />

<strong>April</strong> and May, with an independent guest asked<br />

to make the draw on Essilor’s behalf. This month,<br />

the drawee was none other than NZ Optics’ own<br />

editor Lesley Springall. There’s also an additional<br />

draw in <strong>April</strong> for practice eye care professionals,<br />

linked to their Transition lens sales.<br />

Each prize package includes economy return<br />

flights for two people to Nadi from Auckland,<br />

Wellington or Christchurch, and shared<br />

accommodation at the Sofitel Fiji Resort. Draw<br />

Essilor’s Chris Aldous with NZ Optics’ Lesley Springall who was invited<br />

to draw the first prize winner in the Transitions Fiji promotion<br />

One closed on 28 February; draw two closes on<br />

31 March; and draw three closes on 30 <strong>April</strong><br />

<strong>2018</strong>. Entry is open to all New Zealand residents<br />

purchasing Transitions Lenses from selected<br />

independent optometrists in New Zealand<br />

and limited to one entry per person per pair of<br />

Transitions lenses sold.<br />

0800 573 224<br />

<strong>April</strong> <strong>2018</strong><br />



The power at our finger tips…<br />

by<br />

Chalkeyes<br />

“Red sky in the morning, shepherds warning.<br />

Red sky at night, shepherds delight.”<br />

The Mavis Beacon Teaches Typing software had me type this over<br />

and over. We had just decided that we were going to ditch paper and<br />

use our practice management system for clinical records too.<br />

Until now we had only used our system for recording dispensing<br />

details, generating lens orders and doing the billing, so this was a<br />

big move for us. Our major concern was losing the data when the<br />

system went down. Should we do an interim period of recording<br />

everything twice? One hard copy and one soft copy? Do automatic<br />

backups really work?<br />

Paper records were real! Even if they were lost to misfiling at least<br />

one patient a day; and how the hell did you figure a system for<br />

filing Scottish surnames? Then there was handwriting, of course. I<br />

couldn’t really blame my colleagues because I couldn’t even read my<br />

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

fully appreciated digital records. They could be re-birthed; emerging<br />

from the panic like nothing had ever happened.<br />

THE<br />

EVENT<br />

SEPT. 28 TH<br />

OCT. 1 ST<br />

<strong>2018</strong><br />

Digital record cards are normal now, as are<br />

those awkward silences when the healthcare<br />

practitioner turns their attention, and usually<br />

their backs, away from us to write something up.<br />

A mutually disagreeable experience! Both the<br />

record and the personal interaction suffer. There<br />

are not too many practitioners of my generation<br />

(and this Chalkeyes has been around for a while)<br />

or older, that have ever really adapted. The records<br />

show this very clearly.<br />

Compare, if you will, the oldest optometrist in<br />

your practice’s notes with the youngest. Many<br />

records are not to standard with the notes very<br />

brief and incomplete – not really an accurate or<br />

complete record of what was examined and how<br />

the patient responded. At the end of the day, how<br />

can you do both in such a limited time?<br />

A complex case was referred to me recently<br />

and the accompanying information was a fax of<br />

a handwritten card. It was almost completely<br />

indecipherable. Once my recoil wore off and I was<br />

able to work it out I was immediately struck by<br />

how much information had been recorded on that messy page, in<br />

abbreviations, ticks, scribbles and sketches. I’ll bet it was all done<br />

while chatting to the patient too. We have definitely lost something<br />

going digital!<br />

But there is also lots to be gained if we could just have better<br />

systems that work for us and our patients, and if they were<br />

compatible with each other.<br />

I have, at one time or another, had the opportunity to look at all<br />

the available digital record systems used in New Zealand. Some<br />

practitioners are definitely better at recording than others, maybe<br />

it’s Mavis Beacon, but then maybe it’s talking to the patient instead<br />

of pecking at their keyboard with their backs turned.<br />

The last decade has been transformative in eyecare. The<br />

technology that is now found in most practices is mind boggling<br />

compared with when I started out! Automated perimetry and<br />

digital fundus imaging is an expectation. Even OCT today is almost<br />

normal. Widefield confocal images are also becoming standard<br />

as are topography, digital eye charts and many other things.<br />

Modern optometrists are able to get a very good idea of what is<br />

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

technology runs on its own separate databases – I use seven – on<br />

different platforms and all of it poorly integrates with the practice<br />

management system, digital or written.<br />

I am sure this is not just a Kiwi thing. American practice<br />

management advice recommends having a “scribe” in your<br />

consulting room to record your results. I suppose you would mumble<br />

your findings as you go along for them to record on a laptop.<br />

Personally, I don’t think I’d like doing that very much!<br />

All the practice management systems on the market today have<br />

strengths and weaknesses, but are all ultimately similar. Our<br />

practice uses the Sunix Vision system, written in Foxpro. A Microsoft<br />

product that has been unsupported by them since 2007, written for<br />

the IT environment of the 1980s and ‘90s. A heritage application<br />

that surely can’t have much more to offer for the future. Although<br />

it is totally inadequate, it is familiar and no worse than the other<br />

systems when you look at the big picture.<br />

We use many hacks to get it to work better for us. We import<br />

clinical images, once they’ve been zoomed and manipulated to<br />

highlight the detail we try to record, via the windows clipboard<br />

into Microsoft Paint, to attach them to patient’s files. We have to<br />

remember to record pinhole acuities on referral letters because<br />

that field can’t be transferred and contact lens orders are treated as<br />

consultations, which is just downright obstructive. And that’s just a<br />

few of the things I find frustrating about just our system!<br />

It’s hard not to get a little sad about all this. It’s a major<br />

opportunity that is being missed. We all use databases that record<br />

findings from a diversity of people of different ages and stages, from<br />

all walks of life and in all sorts of states of health. We record notes<br />

on the same findings, using the same techniques in very much the<br />

same way, albeit that the specifics are a little loose. Imagine if this<br />

data could be anonymised and pooled. What learnings are hidden in<br />

those little boxes on our screens; across all our patients from across<br />

the country, or even the world!<br />

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

be better that this! The current providers seem complacent and are<br />

unlikely to cannibalize their own market share to disrupt things. The<br />

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

better, surely! Is our industry too small? Are we too difficult?<br />

This Chalkeyes would like to challenge someone from all those<br />

competing software providers to do better, to share better, to really<br />

make a difference for individual practices and, in-turn, the wider eye<br />

health world to better record and share our data. Now wouldn’t that<br />

be a technological advance worth talking about!<br />

In the meantime, I better keep practicing my typing…<br />

“Red sky in the morning, shepherds warning.<br />

Red sky at night, shepherds delight.”<br />


For all your optical and ophthalmic needs<br />

nzowa.org.nz<br />

Refer your low vision patients to Naomi Meltzer,<br />

optometrist specialising in low vision rehabilitation.<br />

For appointments and information<br />

low vision<br />

services<br />

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

www.lowvisionservices.nz<br />

Oasis spa open for business<br />

Auckland Eye’s new Oasis Spa, premium<br />

dry eye treatment facility, has opened for<br />

business.<br />

Patients referred to the new Oasis Spa or those<br />

simply seeking help for dry and itchy eyes, will<br />

be given a full clinical evaluation of the likely<br />

causes of their eye irritation and a tailored<br />

treatment plan, in what Auckland Eye says is “a<br />

luxurious, relaxing environment.”<br />

Traditional approaches to dry eye, such as<br />

lid margin hygiene, topical lubricants and<br />

antibiotics or steroids, for example, only help<br />

a percentage of patients, whereas a tailoredtreatment<br />

approach, undertaken at the spa,<br />

should help far more patients, both with efficacy<br />

and compliance, explained Auckland Eye’s Dr<br />

Dean Corbett. “The Spa is a means to provide a<br />

more complete service to our eye patients.”<br />

The quality of a patient’s tears and tear film<br />

and the health of their meibomian glands will<br />

all be assessed. Treatments include Lipiflow<br />

and Lumenis’ Optima intense pulsed light (IPL)<br />

technology, often in the comfort of the spa’s<br />

massage chairs.<br />

Though the Oasis Spa has only been open for a few weeks, and<br />

Auckland Eye isn’t going to begin marketing it more widely until it<br />

has had an opportunity to assess what works best, the team have<br />

already received positive feedback about the equipment, treatments<br />

and staff skills, said Dr Corbett.<br />

There are also plans to expand the spa’s offerings to treat rosacea<br />

and possibly some other cosmetic conditions, he added. ▀<br />

Auckland Eye’s Oasis Spa, a<br />

luxurious take on eye care<br />

26 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>




Multiple opportunities available across both the North and South Islands to suit your career aspirations<br />

Specsavers’ growing New Zealand store network offers a variety of roles catering<br />

to different development needs and are available for optometrists at all stages of<br />

their career.<br />

Joining one of our regional New Zealand stores provides an ideal opportunity to<br />

firmly establish yourself within a community while progressing your clinical skills.<br />

You will be equipped with the latest ophthalmic equipment and presented with<br />

a range of interesting conditions across a high-volume patient base – all with the<br />

support of an experienced dispensing and pre-testing team, the mentorship of the<br />

store partners, and access to an exemplary professional development program.<br />

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

present an attractive business venture. With average annual sales running at $2.4<br />

million per store, and Support Office training and assistance available every step of<br />

the way, there’s no better time to uncover the leader within you.<br />

Ask us about the opportunities we have waiting for you – contact Chris Rickard<br />

on 027 579 5499 or via chris.rickard@specsavers.com<br />


Voted by New Zealanders<br />

Reader’s Digest<br />

Quality Service<br />

Award<br />

2017<br />

Best Talent<br />

Development<br />

Program<br />

2017<br />

Best Customer<br />

Service in NZ<br />

Optometry<br />

2017<br />

Millward Brown<br />

Research<br />

No.1 for eye tests<br />

2016<br />

Excellence in<br />

Marketing<br />

Award<br />

2016<br />

Retail<br />

Store Design<br />

Award<br />

2016<br />

Retail<br />

Employer<br />

of the Year<br />

2015<br />

Overall<br />

National<br />

Supreme Winner<br />

2015<br />

Franchise<br />

Innovation<br />

Award<br />

2015<br />

NZ Franchise<br />

System of<br />

the Year<br />

2014<br />

Retail<br />

Innovator<br />

of the Year<br />

2014<br />

<strong>April</strong> <strong>2018</strong><br />



To advertise in NZ Optics’ classified pages<br />

contact: Susanne Bradley at susanne@nzoptics.co.nz<br />


Our client provides leading edge eyecare services seven days per<br />

week and is seeking to employ an additional full-time Optometrist<br />

from June <strong>2018</strong> or sooner.<br />

The successful candidate will be sharing a monthly roster with<br />

three other full-time Optometrists. The equipment is superb, the<br />

wider team are all highly experienced.<br />

Salary level is $125k for the right candidate, subject to experience.<br />

There is also an opportunity (long term) to purchase a shareholding<br />

in the business.<br />

If this sparks your interest, please contact Stu Allan at OpticsNZ<br />

(confidentiality assured). Applications for this position close at<br />

5pm, Wednesday 18 <strong>April</strong> <strong>2018</strong>.<br />

OpticsNZ, PO Box 1300, Nelson or<br />

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


Spectacle frame inventory for sale. Designer frames offered at<br />

below wholesale prices. Prefer to sell entire lot to single buyer.<br />

Fendi, Marchon, Flexon, Coach, Calvin Klein etc. About 350 in total.<br />

Please contact seller at tyghbn73@gmail.com or 0210483139<br />


If you are looking for your first practice or wish to add scale to<br />

existing operations, this long-standing and very well-run practice,<br />

which is showing impressive performance, could be the answer.<br />

Enquiries welcome to Stuart Allan at OpticsNZ, Tel (03) 5466 996,<br />

027 436 9091 or stu@opticsnz.co.nz<br />



1-2 week-days per week plus 2-3 Saturdays<br />

per month.<br />

Hours: 10 -5.30pm week days, 10 -5pm Saturdays<br />

Hourly rate $25-40 depending on experience<br />

Become part of the team at Parker & Co, Newmarket, Auckland, selling<br />

fabulous eyewear. You will be working with a small team of experienced<br />

consultants/Dispensers and Optometrist who love eyewear and<br />

helping people to find the perfect fit of eyewear and lenses.<br />

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

we need someone to join the team. If you have two or more years<br />

experience in the industry and this sounds like you please email<br />

lynne@parkerandco.nz<br />



Our client provides leading edge eye care services seven days per<br />

week and is seeking to employ an additional full-time Optometrist<br />

from May <strong>2018</strong> or sooner.<br />

The successful candidate will be sharing a monthly roster with two<br />

other highly experienced full-time Optometrists. The equipment is<br />

superb and the wider team are all highly experienced as well.<br />

Salary level is $125k for the right candidate, subject to experience.<br />

There is also an opportunity (long term) to purchase a shareholding<br />

in the business.<br />

If this sparks your interest, please contact Stu Allan at OpticsNZ<br />

(confidentiality assured). Applications for this position close at 5pm,<br />

Wednesday 18 <strong>April</strong> <strong>2018</strong>.<br />

OpticsNZ, PO Box 1300, Nelson or<br />

Tel (03) 5466 996 or 027 436 9091 or email<br />

stu@opticsnz.co.nz<br />



Paterson Burn Optometrists<br />

are currently looking for a passionate TPA endorsed Optometrist to<br />

join our team.<br />

Working with Paterson Burn Optometrists will offer you the ability<br />

to develop your clinical skills to full potential and the opportunity<br />

to specialise in your desired field. You will have the ability to work<br />

independently and, with fourteen other optometrists in the group,<br />

you will be part of a larger group of highly qualified, experienced<br />

and dedicated optometrists.<br />

Our Optometrists have special interests in Low Vision, Children’s<br />

Vision, Ortho K, Specialised contact lens fits, Dry eye and Irlen<br />

lenses. You will also have the opportunity to meet regularly for<br />

peer review sessions while gaining CE points within our practice.<br />

As an Optometrist with Paterson Burn Optometrists you will be<br />

able to provide exceptional patient care with access to the most up<br />

to date technology and state of the art equipment (OCT, Corneal<br />

Topographer, Medmont VFA’s, IPL etc).<br />

This position is for 4-5 days per week, including some Saturdays.<br />

If this sounds like you, please send your CV with a covering letter to<br />

sandri@patersonburn.co.nz<br />



We are looking for an experience TPA qualified, full-time<br />

Optometrist to join our team at Browning & (Matthews), New<br />

Plymouth. This is a busy, well equipped practice with a great<br />

support team.<br />

Please contact Michelle Diez on 027 246 7499 or email<br />

michelle.diez@matthews.co.nz<br />

DREAM OF<br />


Have you ever wanted to travel NZ? Do you like<br />

flexibility and crave variety? OPSM New Zealand is<br />

looking to expand its relief team with a combination<br />

of area and regional floats. As a float you will be<br />

exposed to lots of different patients and locations<br />

across New Zealand. We are looking for Optometrists<br />

who share our passion, and want to join our customer<br />

focussed teams in making a difference to how people<br />

see the world.<br />

We are looking for optometry floats in these<br />

key locations:<br />




Alternatively OPSM NZ is also on the lookout for locums<br />

willing to service the Wellington, Bay of Plenty and<br />

Waikato regions.<br />


If interested in joining our fun loving team, please contact<br />

Jonathan Payne<br />

Jonathan.Payne@opsm.co.nz or call 021 195 3549<br />



A CHANGE?<br />

When you join OPSM, you work within a team who are<br />

committed to providing the best possible eyecare solution<br />

with exceptional customer service. You will work with world<br />

class technology and have many opportunities for professional<br />

development. You can also make a real difference in the<br />

way people see the world by participating in our OneSight<br />

outreach program. OPSM New Zealand is looking for<br />

passionate Optometrists to join the team in these locations:<br />

THAMES<br />

Located on the doorstep of the Coromandel, Thames is<br />

a gateway to outdoor adventures and fantastic beaches.<br />

An opportunity has arisen for a full time optometrist to<br />

join an amazing team in our community based store with<br />

interesting and appreciative clientele. Only 1 hour outside<br />

of South Auckland, Thames is close enough to enjoy the<br />

big city, without the traffic or house prices!<br />


Why visit this holiday hot spot when you can live there!<br />

Our brand new Mt Maunganui store is looking for a fresh<br />

optometrist eager to grow with the store. Located only 800<br />

meters from the beach, with relaxed easy going clientele.<br />

If you are seeking for a great mix of work and play,<br />

whether its surfing or just relaxing at the beach –<br />

“The Mount” is the ultimate summer destination.<br />


A rare vacancy has arisen in our much sort after Lower<br />

Hutt practice. We are currently looking to expand our<br />

energetic and vibrant team. Only 15 minutes from the<br />

capital, Lower Hutt is close enough to enjoy the sport,<br />

culture and cuisine that central Wellington has to offer.<br />


If you are interested to find out more about joining the<br />

team, contact Jonathan Payne for a confidential chat.<br />

jonathan.payne@opsm.co.nz or call 021 195 3549<br />


28 NEW ZEALAND OPTICS <strong>April</strong> <strong>2018</strong>

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